Wiki When can I bill for the NP

Create Wiki
S

scrawford1690@gmail.com

Contributor
Messages
20
Best answers
0
Hi!!

I was wondering if anyone can tell me what the rules are for billing for the NP.

Management states that when an MD signs under an NP, we need to bill for the MD. Is this correct? Or does there need to be some kind of statement/documentation that the MD actually saw the patients, and or agrees with the plan of care?

Thanks!
 
Hi there, could you provide more detail? Where are the visits taking place? (Office, hospital, ER?)
 
yes, they take place in the office. So an NP is doing the visit, documents everything, then the MD just puts their signature under the NP's signature. We're told to then bill the MD, not the NP
 
scrawford1690@gmail.com said:
Hi!!

I was wondering if anyone can tell me what the rules are for billing for the NP.

Management states that when an MD signs under an NP, we need to bill for the MD. Is this correct? Or does there need to be some kind of statement/documentation that the MD actually saw the patients, and or agrees with the plan of care?

Thanks!
Click to expand...
Your management is mistaken - a signature alone is not sufficient to meet the requirements for billing an NP's services under the MD. In order to do this, the services provided during the encounter must meet the definition of 'incident to' a physician's plan of care.

There are many articles available on this site and others that explain 'incident to' billing in detail, so I won't try to explain it all here. If you do a search for this term, you'll find plenty of guidance on what is required. Here is one good example you can start with: https://www.aapc.com/blog/44912-seven-incident-to-billing-requirements/
 
thank y'all!! I read the article, but it confused me more haha. reading it makes it seem like as long as the MD is in the building and part of the plan of care, he can put his signature under the note and we can bill it under the MD. Am I understanding this incorrectly?
 
He's my summary of incident-to billing.
1) It is carrier dependent. MOST carriers follow Medicare's incident-to guidelines, but some do not. If the carrier does not, you must follow whatever their guideline is. Some say bill under the supervising physician, regardless of whether it meets incident-to. Some say bill under the provider who rendered the care (NP), again regardless of whether it meets incident-to.
2) Must be an established patient, established problem, with a plan of care that your NPP is following. Now the patient also complains of pain in their left foot and not just the right knee? Not incident-to.
3) The physician you bill under must be physically onsite in the same suite and immediately available.
I am not aware of any carrier that specifies the MD to actually sign the note. I do know some practices have some type of statement the physician adds and signs so that it's clear this specific visit meets item 2 & 3 from above.
For our practice, we decided trying to keep track of the requirements (particularly plan of care), and which MD may or may not have been onsite was too cumbersome. We very rarely bill incident-to.
 
csperoni said:
He's my summary of incident-to billing.
1) It is carrier dependent. MOST carriers follow Medicare's incident-to guidelines, but some do not. If the carrier does not, you must follow whatever their guideline is. Some say bill under the supervising physician, regardless of whether it meets incident-to. Some say bill under the provider who rendered the care (NP), again regardless of whether it meets incident-to.
2) Must be an established patient, established problem, with a plan of care that your NPP is following. Now the patient also complains of pain in their left foot and not just the right knee? Not incident-to.
3) The physician you bill under must be physically onsite in the same suite and immediately available.
I am not aware of any carrier that specifies the MD to actually sign the note. I do know some practices have some type of statement the physician adds and signs so that it's clear this specific visit meets item 2 & 3 from above.
For our practice, we decided trying to keep track of the requirements (particularly plan of care), and which MD may or may not have been onsite was too cumbersome. We very rarely bill incident-to.
Click to expand...
👆Yeah, what she said.

We do still allow incident-to billing but we require our APPs to input a statement in those visit notes stating that Dr. So & So was the supervising physician on site and available during the visit. We are branching out into more direct billing for our APPs and we've discussed allowing them to see new patients but there is the problem of keeping track of what the APP has established a plan of care for, what the MD established a plan of care for and where there is overlap. I'm all for doing away with incident-to billing all together but haven't convinced everyone involved at this point.
 
You must log in or register to reply here.
Top