Wiki Documentation requirements for Incident to billing?

[Kenjohn1]

In order to successfully document for a incident to billing. what is the criteria? The patient was seen in hospital by our group. the follow up was done in the office and seen by the NP. The patient was never seen in our office before. The patient is being seen by our NP as a hospital follow up. Is this patient a new patient for our office? Or an established patient as they were seen in the hospital? if they are considered an established patient does the supervising doctor need to cosign and add documentation to the note explaining that they were present during the visit. Does the hospital visit count as the established care requirements for the incident to billing? In additional what if Dr.A . saw the patient in the hospital but only Dr. B is in the office that day and did not see the patient in the hospital? However Dr. A and Dr. B are in the same group billing for the same TIN. Can Dr. B. fulfill the role of the supervising doctor?

 

[thomas7331]

I’d suggest you should read up a bit on the rules for determining new vs established patient and also ‘incident to’ guidelines. There are lots of good articles about these on this site, and there are just too many questions here to be able to answer succinctly in a forum response.

I’d just mention here to keep in mind that the basic meaning of ‘incident to’ is that the NP is just carrying out their physician’s care plan and not making any independent decisions. So in a case such as a hospital follow-up visit, that would mean that the NP is only reviewing their physician’s care plan from the hospital discharge and evaluating the patient, with no changes to that plan. In the event that the NP needs to change something in the plan, then it’s no longer ‘incident to’ unless the provider also sees the patient and approves those changes at the same encounter.

 

[lgardner]

Thomas' response is spot on.