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Billing Services under NP

C

cmasters

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Thompsons Station, TN
Hi,

I have a question about a company that has a chiropractor and NP in the office. The therapies are billed out under the NP due to global cap on certain insurance companies.
 
Last edited:
You cannot use the NP NPI number in field 24J unless they are within the office suite area at the time of service. Also the NP must see the patient first and order the service provided, also the chiropractor must be an employee of the NP. If all the requirements for the incident to provision are met then you are fine. If not then you cannot use the NP number for those services.
 
mitchellde said:
You cannot use the NP NPI number in field 24J unless they are within the office suite area at the time of service. Also the NP must see the patient first and order the service provided, also the chiropractor must be an employee of the NP. If all the requirements for the incident to provision are met then you are fine. If not then you cannot use the NP number for those services.
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Did you mean the other way around? I didnt think a NP could supervise a Chiropractor.
 
I think that part varies from state to state. However I suspect you may be correct, but I have not done the research to know 100%. however it does not sound like incident to rules are being met even so.
 
I am not sure why you are doing that but no. There will be no provision where that would be allowable.
First the NP is not in the office
Second the NP did not see and evaluate the patient.
There is no reason to be billing these services using the NP as the rendering provider.
If you are doing that because the payer will not pay for the manipulation by chiropractors then that is just ...... wrong.
 
Reply

Thank you, I am not doing that, it is a situation for someone I know where this is happening and wanted some clarification. I know it is not right and just needed input from other coders.
 
cmasters said:
Thank you, I am not doing that, it is a situation for someone I know where this is happening and wanted some clarification. I know it is not right and just needed input from other coders.
Click to expand...


Yep, it would be a fraudulent billing to bill for a provider that is not in the office.
 
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