Incident To Service

sjenrette

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Hello,

I work in private practice with two locations and 11 providers. I wanted to clarify the guidelines for incident to service with MDs and NPs. My understanding is that a NP can see an established patient and the MD does not have to be in the room supervising the NP. The supervising MD must sign the NP charts for the day and then those charts can be billed under that MD name for reimbursement. Does anyone agree or disagree about this?

Shakeda Jenrette, CPEDC, RMA
 

thomas7331

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This isn't quite right, at least under CMS rules. You're correct that the MD does not have to be in the room to bill the NP services as 'incident to', but there's more to it than the patient just being established. 'Incident to' means that the NP is executing the MD's plan of care, so in order to bill under the MD, the NP can only be evaluating and treating an established problem. If the patient presents with a new issue or requires a change to the plan of care for an existing problem, then the MD would need to see the patient again. As I understand it, if the NP chooses to treat a new problem or to implement their own changes to the plan of care for an existing problem, the visit would no longer qualify for 'incident to' billing and would need to be billed under the NP's own credentials.
 

sjenrette

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More Clarification on Incident to Billing

So if the patient comes in for a well check and the patient has seen the MD for a well check previously, does that qualify for incident to billing under the MD's NPI?

Also, if the patient comes in with a new problem then we have to bill under the Nurse Practitioner's NPI?

If they are established with an existing problem that they have already seen their MD for, what if the NP changes their care of plan and informs their MD of the changes, can that be billed under the MD's NPI number?








This isn't quite right, at least under CMS rules. You're correct that the MD does not have to be in the room to bill the NP services as 'incident to', but there's more to it than the patient just being established. 'Incident to' means that the NP is executing the MD's plan of care, so in order to bill under the MD, the NP can only be evaluating and treating an established problem. If the patient presents with a new issue or requires a change to the plan of care for an existing problem, then the MD would need to see the patient again. As I understand it, if the NP chooses to treat a new problem or to implement their own changes to the plan of care for an existing problem, the visit would no longer qualify for 'incident to' billing and would need to be billed under the NP's own credentials.
 
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