Wiki Incident to

[KaylaRieken]

Do both providers need to provide a signature when using incident to? or just the pa or np who sees the patient?

 

[csperoni]

The clinician providing the service must sign the note. I have not seen CMS or payor guidance where it is required of the onsite supervising physician to additionally sign the note, but there is at least one MAC that provides that advice. Even if not required, having the physician co-sign only when onsite does make it clearer (if all other incident-to rules are met) whose name goes on the claim.
For example, I have a group of 4 physicians and 6 ACPs that practice out of several different locations. If the onsite physician (when applicable) does not co-sign the note, it becomes a 15 minute process for each visit to determine if a physician was onsite at that particular location at that day & time, and who that physician was. And even then, the biller has to assume that the physician didn't step out for lunch or was otherwise unavailable.
I would strongly recommend to be co-signed, regardless of your MAC.

From Noridian: https://med.noridianmedicare.com/web/jfb/cert-reviews/signature-requirement-q-a
Q18. When a Physician's Assistant (PA) is billing under his/her own number, should he/she sign the chart notes or should the supervising physician sign them?
A18. The documentation should be signed by the provider providing the service and billing for it. In an" incident to" scenario, the documentation should be signed by the supervising provider with a reference in the notes as to who performed the service or co-signed.

 

[KaylaRieken]

Thank you!!!