Wiki Incident to questions

[PennyG]

My provider just asked me a couple questions that I could not answer.

NP seeing patient incident to a physicians plan of care. Is there a requirement that the physician needs to see the patient after a certain period of time and if so, how often?

Dr. A has established a plan of care, but is out of the office for the day. NP is seeing Dr. A's established patient in followup to his plan of care. Dr. B is supervising the NP on this date. Can this visit be billed as incident to under Dr. B since they are in the same group practice?

 

[RebeccaWoodward*]

My provider just asked me a couple questions that I could not answer.

NP seeing patient incident to a physicians plan of care. Is there a requirement that the physician needs to see the patient after a certain period of time and if so, how often?

Dr. A has established a plan of care, but is out of the office for the day. NP is seeing Dr. A's established patient in followup to his plan of care. Dr. B is supervising the NP on this date. Can this visit be billed as incident to under Dr. B since they are in the same group practice?

1st question: My carrier has a policy that the physician should see the patient at a frequency of every 3rd visit.

2nd question: As long as your following physician's A plan of care, you can bill incident to with physician B in the office. I have asked this very question in a Medicare conference and was assured it is allowed as long as you don't deviate from physician's A plan of care.

Link below pertains to question #1-

http://www.cignagovernmentservices.com/partb/pubs/mb/2006/2001/01_3/id/b0103id01c.html

 

[PennyG]

incident to questions

Rebecca,

thank you for the response to my incident to questions. I just wish to clarify the Dr. A-Dr. B question. We would submit the claim with Dr. B's info, since he is the one in the office supervising, correct? Even though the plan of care being followed is Dr. A's.

 

[RebeccaWoodward*]

That is correct. Although Physician A established the treatment plan, you would report the services under Provider B since he is supervising on-site.

In highly organized clinics, particularly those that are departmentalized, direct physician supervision may be the responsibility of several physicians as opposed to an individual attending physician. In this situation, medical management of all services provided in the clinic is assured. The physician ordering a particular service need not be the physician who is supervising the service. Therefore, services performed by auxiliary personnel and other aides are covered even though they are performed in another department of the clinic.

Supplies provided by the clinic during the course of treatment are also covered. When the auxiliary personnel perform services outside the clinic premises, the services are covered only if performed under the direct supervision of a clinic physician. If the clinic
refers a patient for auxiliary services performed by personnel who are not supervised by clinic physicians, such services are not incident to a physician’s service.

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https://www.cms.gov/manuals/Downloads/bp102c15.pdf