HELP....Confused about NP billing

g.fairchild

Networker
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57
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Hi All.....

I have read many posts in here regarding NP billing, and have ended up confused as ever.

We had one of our BCBS Provider Reps tell us that if the NP sees a patient we can bill under the supervising physician's number even though he is not physcially present in the facility, but is accessible via phone. This does not sound right to me and I can find nothing on Medicare's website to back this up. (We are asking her to give us something in writing)

I do not beleive this falls under "Incident To" guidelines, as my understanding is that the Physician must be present within the facility.

Has anyone out there any information on billing under a supervising physician's number if accessible by electronic means....if you could direct me to written words, this would be wonderful.

Thanks everyone....
 

mitchellde

True Blue
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13,418
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Columbia, MO
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You cannot bill under a physician number as the rendering provider if they are not physically present. Some Commercial payers want you to use the NPs number in 24J as the rendering and put the practice owner in 32A and this is OK to do. You may need to clarify what they are asking for.
 

tlc45801

Contributor
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Lima, OH
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Medicare & commercial payers have different rules for "incident to" services provided by NP's. From what we have reviewed Medicare requires the supervising physician to be in the office immediately available. However, some commercial payers have stated the supervising physician must be available by phone or nearby (i.e. within same facility but not necessarily same floor).
 

mitchellde

True Blue
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Columbia, MO
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I know what you are saying .. However when you use your physician NPI as the rendering provider then it is HIS malpractice insurance that is at stake, since you are representing that he either personaly visited with the patient or was on site to directly supervise. You might check with your malpractice carrier about this. Also for an NP to see patients the physican does not have to be onsite but must be reachable by phone and within a certain distance, but would need to bill under the NPs own NPI, it is possible the rep at the carrier is thinking of two different things at the same time. AND Medicare is viewed as the gold standard in this business, just because a carrier says you can bill under the physician does not mean that you can, you must obtain this policy in writing from the carrier.
 
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