Wiki Physician Supervising Physicians

Chelle-Lynn

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We are having a discussion at our office regarding the following scenario:

We have a new physician who is starting with our practice who is going through the credentialing process with our carriers. In the meantime while the physician is not credentialed he is seeing patients and another credentialed provider is serving as a "supervising provider" and signing the medical records. The claim is to be billed under the supervising provider since he is credentialed with the insurance carrier.


I believe that this scenario is incorrect, but I cannot find any written guidelines that discuss this scenario. Does anyone know of any documentation that I can use to dissuade our facility from implementing this option?
 
This has been addressed in this forum numerous times, there is official documentation that this practice is not allowed and it has been posted, you should try searching the forums for this. I know it is in the federal register as well as the Medicare manual. Perhaps a google search will produce this as well. The end result is you cannot have a non credentialed physician billed under a credentialed physician, this is misrepresenting the rendering provider and creates a false claim.
 
Here is the latest on incident to that I can come up with

ELECTRONIC CODE OF FEDERAL REGULATIONS
e-CFR Data is current as of August 12, 2014

Title 42 → Chapter IV → Subchapter B → Part 410 → Subpart B → ?410.26

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Title 42: Public Health
PART 410—SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS
Subpart B—Medical and Other Health Services

?410.26 Services and supplies incident to a physician's professional services: Conditions.
(a) Definitions. For purposes of this section, the following definitions apply:

(1) Auxiliary personnel means any individual who is acting under the supervision of a physician (or other practitioner), regardless of whether the individual is an employee, leased employee, or independent contractor of the physician (or other practitioner) or of the same entity that employs or contracts with the physician (or other practitioner) and meets any applicable requirements to provide the services, including licensure, imposed by the State in which the services are being furnished.

(2) Direct supervision means the level of supervision by the physician (or other practitioner) of auxiliary personnel as defined in ?410.32(b)(3)(ii).

(3) Independent contractor means an individual (or an entity that has hired such an individual) who performs part-time or full-time work for which the individual (or the entity that has hired such an individual) receives an IRS-1099 form.

(4) Leased employment means an employment relationship that is recognized by applicable State law and that is established by two employers by a contract such that one employer hires the services of an employee of the other employer.

(5) Noninstitutional setting means all settings other than a hospital or skilled nursing facility.

(6) Practitioner means a non-physician practitioner who is authorized by the Act to receive payment for services incident to his or her own services.

(7) Services and supplies means any services or supplies (including drugs or biologicals that are not usually self-administered) that are included in section 1861(s)(2)(A) of the Act and are not specifically listed in the Act as a separate benefit included in the Medicare program.

(b) Medicare Part B pays for services and supplies incident to the service of a physician (or other practitioner).

(1) Services and supplies must be furnished in a noninstitutional setting to noninstitutional patients.

(2) Services and supplies must be an integral, though incidental, part of the service of a physician (or other practitioner) in the course of diagnosis or treatment of an injury or illness.

(3) Services and supplies must be commonly furnished without charge or included in the bill of a physician (or other practitioner).

(4) Services and supplies must be of a type that are commonly furnished in the office or clinic of a physician (or other practitioner).

(5) Services and supplies must be furnished under the direct supervision of the physician (or other practitioner). The physician (or other practitioner) directly supervising the auxiliary personnel need not be the same physician (or other practitioner) upon whose professional service the incident to service is based.

(6) Services and supplies must be furnished by the physician, practitioner with an incident to benefit, or auxiliary personnel.

(7) Services and supplies must be furnished in accordance with applicable State law.

(8) A physician (or other practitioner) may be an employee or an independent contractor.

(9) Claims for drugs payable administered by a physician as defined in section 1861(r) of the Social Security Act to refill an implanted item of DME may only be paid under Part B to the physician as a drug incident to a physician's service under section 1861(s)(2)(A). These drugs are not payable to a pharmacy/supplier as DME under section 1861(s)(6) of the Act.

(c) Limitations. (1) Drugs and biologicals are also subject to the limitations specified in ?410.29.

(2) Physical therapy, occupational therapy and speech-language pathology services provided incident to a physician's professional services are subject to the provisions established in ??410.59(a)(3)(iii), 410.60(a)(3)(iii), and 410.62(a)(3)(ii).

[51 FR 41339, Nov. 14, 1986, as amended at 66 FR 55328, Nov. 1, 2001; 67 FR 20684, Apr. 26, 2002; 69 FR 66421, Nov. 15, 2004; 77 FR 69361, Nov. 16, 2012; 78 FR 74811, Dec. 10, 2013]


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Thank you Debra. I have been able to locate the information on Incident To, however, the division I am reviewing this with, feels that there is no direct indication that physician cannot supervise another physician. The Incident To only references non-physician practitioners.

Do you know of any specific wording that references the physician to physician issue?
 
The only thing I found is a no substantiated writing that stated as long as all incident to parameters were met and the credential in process had begun that it could be done in some states with some carriers, but it would clearly be follow up care to an established documented plan in the chart for a previous encounter. I can find no CMS substantiation for this. The incident to provision as updated August 2014 in the previous post is clearly for NPP or ancillary personnel only. I would think if physicians were a part of this it would be so stated.
 
Federal Register states:

Knowing misuse of provider identification numbers, which results in improper billing; 16

An example of this is when the practice bills for a service performed by Dr. B, who has not yet been issued a Medicare provider number, using Dr. A's Medicare provider number. Physician practices need to bill using the correct Medicare provider number, even if that means delaying billing until the physician receives his/her provider number

Page 6

http://oig.hhs.gov/authorities/docs/physician.pdf
 
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