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E/M Levels & Attending

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Best answers
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When you have an infusion center (hospital based) and patients are seen by a nurse practitioner for adverse reactions, does the attending physician assigned to that nurse practitioner have to be on site in order for them to bill under them?
 

airart

Guru
Messages
124
Location
UT Dallas, TX Chapter
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NPPs and Attendings onsite or off?

To bill Medicare for services performed by a NP under a physician's name, the physician must not only be in the building, but in the office suite at the time the service is rendered.

In addition, the physician must see the patient regularly (every 3rd to 5th visit) and the physician must see the patient initially and for each new problem.

If the physician is participating at this level of care for all the patients you see, then the physician should bill for the service under "incident to" provisions using the YR modifier and get 100% reimbursement. (Note that provisions for “incident to” billing only apply to outpatient situations. If you see inpatients, you must bill under your own number for those visits.)
 

mitchellde

True Blue
Messages
13,303
Location
Columbia, MO
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to bill under the physician for any payer, the physician must provider direct supervision, which in the physician office setting is within the office suite, in the facility setting it means "over the shoulder" (touching distance).
 
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