Wiki "Incident To" Florida (NEED ADVICE ASAP)

I just started a job and i have came to realize that some of these claims do not follow the incident to Rules!!!My Manager is telling me that in the state of florida a NPP (ARNP/PA) can see new patients and bill under the Doctors Number! When i read these Guidelines time after time it states that the Doctor must see a new pt and make a treatment plan, then the PA/ARNP can render services (incident to) as long as its for the same problem. Can someone show me something that says PA/ARNP can bill for new patients in the office setting and use the Doctors number? This person has not shown me where she got her Information from


This is From our FCSO Contractor in Florida

: If a new patient comes into the office and sees our physician assistant (PA), can our PA bill this as "incident to" the doctor, who is also in the office seeing patients?

A: No. In order for the service to qualify as "incident to," an initial encounter must have occurred between the doctor and the patient, and a course of treatment established by the doctor. In this situation, services performed by the PA do not meet the “incident to'” requirement and would not qualify.

Source: CMS Internet-only Manual (IOM) Pub. 100-02 Medicare Benefit Policy Manual, Chapter 15 Covered Medical and otherHealth Services, Section 60 Services and Supplies Furnished Incident to a Physician's/NPP's Professional Service


It looks like you have found the info you needed, and CMS/your MAC is definitely your best resource. My MAC (Novitas) follows these same guidelines. A PA/NP can see a new patient, but it must be billed under their own NPI, not under the doctor's. A visit cannot be billed incident-to until a physician has seen and evalutated the patient first, and established a treatment plan. Have you shown your manager or compliance officer these guidelines?
 
Medicaid?

When the physician says that "In the state of Florida..." could it mean that MEDICAID in Florida would allow this? Maybe check those rules or those of certain payers that may not recognize mid-levels. It could be that one of these payers allow that, but it was taken to mean that it could be done for every claim.
 
You are correct . I had a consultant present on incident too at our May Mania event. My practice has two ARNP's so it was a topic near and dear to me as well.
After our seminar, I had to sit with the MD's and explain to them that changes needed to be made. Although they weren't happy, they understand that we must remain compliant.
I have the presentation available if you would like a copy.
 
I would appreciate the presentation also as I think it would help to support my findings as well. Please email me at tania@turnkeymd.com if you have the opportunity.

Thanks in advance.
 
You are correct . I had a consultant present on incident too at our May Mania event. My practice has two ARNP's so it was a topic near and dear to me as well.
After our seminar, I had to sit with the MD's and explain to them that changes needed to be made. Although they weren't happy, they understand that we must remain compliant.
I have the presentation available if you would like a copy.

Hi Candice,

Could you please send me a copy of that presentation as well? This would be a great resource.

hbrown01@live.com

Thank you !!!

Holly :)
 
Incident To

Hi I know this is an older post, but can you also send me the presentation? This is a topic that I am currently working on and it would helpful to show our providers that we are not in compliance. @vostrum1206@yahoo.com

Thanks,
Vanda
 
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