Wiki Billing for NP's incident to

[Rgreen0118]

Hi everyone,

Does anyone know the guidelines for billing incident to for "commercial" payers? Is it different for each payer? Our biggest problem is UHC. The office is located in a rural area and we are the only one's to see patients in this area. UHC is telling us that we can bill the claim under the physician. The problem is that the physician is hardly ever in one of the locations. I am uncomfortable with billing under the physician and the physician is not reviewing the charts or signing off on them. ( and probably has never seen the patient himself)

They suggested billing under the physician and using the SA modifier. I am not sure if this is correct either.

Can anyone help me with this situation. Without something in writing I hesitate to bill out those charges.

Thanks,

Rhonda

 

[cyndeew]

I think the SA modifier is NOT the right one - that is NP rendering service in collaboration with a physician. You don't say if we're talking about an NP or PA or other NPP. Not knowing what state you're in is a disadvantage in trying to help as every state is different in licensing and every payer has their own rules. There is some updated info on another site you can review at http://ht.ly/jFMyD. Hope this helps you.

 

[mitchellde]

If the physician is not physically in the office at the time the patient is being evaluated, then you cannot bill using that physician NPI, no matter which payer it is, unless that payer has provided a written policy indicating they allow using the physician NPI knowing the physician may have never evaluated this patient for the same problem , and the physician may not be in the office at the time of the encounter. Otherwise you must always use the NPI of the NP/PA