Wiki Incident to for New Patients

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tscobee

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I am hearing so many different things about billing new patients under the doctor if the NP sees the patient. Our doctor is on site, goes to the room to introduce himself, and goes over the plan with the NP. The only thing he does not do is the actual physical exam. Can we bill it under the physician or since it's a new patient we bill it under the NP?
 
There can be no such concept as incident-to for a new patient. The terms split/shared and incident to are being confused here it seems. Split/shared only applies in facility settings though. See info in the links below. Now, other than Medicare, there could be some health plans or state Medicaid plans where the NP/PA *might* bill under the physician's because the plan doesn't credential the APPs and/or the contract tells you to do it that way. This must be confirmed before doing it. In most cases, the APPs bill under themselves. Also, in some cases, incident-to is not recognized by a health plan.

Incident to services: "Are an integral part of the patient’s normal treatment when the physician or other listed practitioner personally performed an initial service and remains actively involved in the course of treatment."
 
Agree with Amy - if it's a new patient, it is not incident to. She posted all the links so I won't add more.

Remember that "incident to" is short for "incidental to": the NP is seeing the patient incidental to the physician's established treatment plan.

If the patient is new, there isn't an established treatment plan.
 
Thank y'all! I keep telling the doctor that you can't with new patients and he's not understanding why. I'll show him the links. Thanks again!
 
From an RVU production and time management perspective: If he is taking the time to go in and meet the patient, what else is he doing actually in the room with the patient? Does he go over the plan in the room w/ the NP & patient present or is it a "hallway" talk? It seems it defeats the purpose of utilizing APPs in office if both the MD and APP are duplicating work. Might be best from a scheduling perspective if the MD sees all new patients and the NP sees established patients. Unless it is an urgent matter, the APP requests the supervisor sees the patient or the MD is not present. If the APP sees the new patient and makes a plan, there could not be any incident-to later either because they would be following their own treatment plan. Unless the doctor actually sees the patient at some point and establishes the POC. I don't know what type of practice this is, group size, or what your patient load looks like.
Does the MD think just because he pops in and says hello he can take credit for the APP work and bill it under himself? Is that the only reason he is "saying hello"? Is he confusing split/shared in a facility with incident-to in office?
Just some thoughts.
 
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