Wiki Bill under MD or NP?

[hshcoder]

Just as background, this is a clinic that has two NPs that see 99.9% of the patients. Dr. P is one of the NP's husband and he comes in from time to time and sees a patient but this happens very rarely and he is not on site except on the rare occasions when he sees a patient. He has what they call a collaborative agreement with the practice. This practice is in Indiana.

I was given this instruction:
"Aetna will not contract with NP's therefor only Dr. P is contracted. Due to this, we can bill with the NP as a "rendering physician" but Dr. P has to be the "supervising physician". Please change the supervising physician on the superbill whenever the patient has Aetna. Is there anything Dr. P has to do with the chart for compliance?"

I told her that I thought that Dr. P needed to review and sign the chart.

They have called Aetna with this reply: "They wouldn't send me anything in writing but I called 888.632.3862 and spoke to Allison who stated that there is no limitations on how involved the MD needs to be in the care of a patient when treated by an NP (rendering) and billed by the MD (billing), meaning they have no guidelines." I said that I still thought he would need to sign the chart and they replied "He does not need to under his collaborative agreement with the practice. Since Aetna has no guidelines, I would assume following his collaborative agreement would be sufficient...".

Putting him as the billing provider just on claims going to an insurer that requires it for reimbursement, without any documentation indicating he had anything at all to do with the patient in general or with the visit in particular, seems very close to fraud. It makes me very uncomfortable since I would be the one clicking that box and making that determination on the claim. What are your thoughts?

 

[thomas7331]

If I were in your place, I would insist that Aetna give you something in writing and if they refused, I would recommend that the NP providers either stop seeing Aetna patients or drop out of the network. If that is not an option, then perhaps an alternative would be to write to Aetna stating that you have received these verbal instructions and are informing them that is what you are doing and that they should respond in writing if that is not correct. Send it to them certified with a return receipt and keep it on file. I would not put incorrect information on a claim just based on conversations with representatives.

 

[hshcoder]

I have told my supervisor that written notification from Aetna is what I need to code these charts. We will see what happens! I agree with you that a conversation with an Aetna employee is not sufficient. Especially when they decline to provide written guidelines on their policy or written confirmation of the conversation.

Thanks for your thoughts!! Suzi

 

[Newbiller]

Hi, I have the same situation on my office, but it is a group of 3 PCP, some of them dont have contract with some of the insurances , and my supervisor ask me to bill under the Dr who has contract, even if any of the non-contracted Dr saw the patient and signed the soap note. Do you think I need to do the same with each insurances?

 

[pamsbill]

Hi, I have the same situation on my office, but it is a group of 3 PCP, some of them dont have contract with some of the insurances , and my supervisor ask me to bill under the Dr who has contract, even if any of the non-contracted Dr saw the patient and signed the soap note. Do you think I need to do the same with each insurances?

If you are saying you are supposed to bill a physician's visit under a different physician, then NO, you cannot do that, ever. The original question was about mid-level providers, which is a different ballgame.

The only situation I can think of where you can ever bill one physician under another is in a locum tenens circumstance, and that requires specific criteria be met and a modifier be used.

 

[CodingKing]

Hi, I have the same situation on my office, but it is a group of 3 PCP, some of them dont have contract with some of the insurances , and my supervisor ask me to bill under the Dr who has contract, even if any of the non-contracted Dr saw the patient and signed the soap note. Do you think I need to do the same with each insurances?

The payer may have a policy regarding covering physicians that you will want to read. Although those cases you would NOT bill a different provider than the one actually providing the services.

 

[mitchellde]

Look at the claim, box 17 is where you indicate the supervising provider with the qualifier for supervising provider (DQ), box 24J is for the rendering provider, this is where the NP NPI must go.