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Billable nurses visits without Doctor present?

penny48

Networker
Messages
53
Location
Albuquerque, NM
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0
:eek: We are having an arguement at our 6 offices, as to whether we can bill out services rendered by a registered nurse without the physician being in the office.
 

Walker22

True Blue
Messages
695
Location
Atlanta, Ga.
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0
Absolutely not.... you can't send a claim with the nurse as a billing provider, and in order for this to qualify as "incident-to", the doctor must be present in the office suite.
 

Walker22

True Blue
Messages
695
Location
Atlanta, Ga.
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0
Technically, it's "insurance fraud". I wish you luck in convincing them to change this practice. Hang in there!
 

penny48

Networker
Messages
53
Location
Albuquerque, NM
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0
Thanks I have been trying to tell them that, if all else fails I am going to go to the compliance officer. That will stop it, mention the word "fraud" the officer panics.....:eek:
 

mitchellde

True Blue
Messages
13,303
Location
Columbia, MO
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0
I agree with Walker, this is a bad practice. Think of your physician's malpractice carrier, how would they feel because if anything goes wrong it will come back on the physician's malpractice because according to the claim, the physician was there!
 
Messages
4,466
Location
Milwaukee WI
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0
RN is not the same as NP

An RN is not the same as an NP. The most that an RN can bill would be 99211 - if the doctor was present in the office suite. Per CPT this type of presenting problem "may not require the presence of a physician."

Incident to billing requires that an qualified Allied Health Professional (such as an NP or PA) perform the service as a follow-up to an already established treatment plan. That's a different thing and the level of service may be higher than 99211.

F Tessa Bartels, CPC, CEMC
 
Messages
4,466
Location
Milwaukee WI
Best answers
0
Who employs the nurses?

Does the ruling for nurses also apply to an outpatient hospital clinic setting?
Depends on who employs the nurses. If it's the doctor (professional practice), yes. If it's the hospital, the facility fee covers the nurse's work.

F Tessa Bartels, CPC, CEMC
 

mbell411

Guest
Messages
6
Best answers
0
Outpatient billing for nurses

In the case of an RN in the outpatient facility, does the existing criteria for E&M's still apply..
 
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