Wiki New Patient

[KaylaRieken]

Does a Doctor need to see every new patient for it to be billed under the doctor for commercial insurance?

 

[Pathos]

I am assuming you are talking about Incident to rules?

Unless there is a special rule for Incident to with that particular insurance, then yes the doctor should see the patient for their first visit or for their new problem. Later, a PA/NP can then see the established patient for their established problem.
The PA/NP can still see the new patient/new problem, but would then have to bill under their own NPI.

 

[jkyles]

I would also add that incident-to is a Medicare concept, so you'll need to check each payer's policy. To keep everyone on their toes private payers will have an "incident-to" policy that bears little resemblance to Medicare's policy.

 

[KaylaRieken]

Does anyone know what commercial payers are like Medicare for incident to?

 

[Pathos]

Each commercial payer usually have their own policies on how to tackle "Incident to" billing, if at all. Best to check their policies and see what they have.

Some commercial payers are very similar to Medicare's Incident to rules, and some commercial payers have their own rules, as jkyles mentioned. Because the range on payer policies is so broad, it would be best to contact the payer directly and find out. Your Provider Rep should be helpful in this situation.