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SueLis

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We are an OB/Gyn practice and are bringing on 2 NP providers from another OB/Gyn practice that has closed. They will be bringing some of their pt's over to our practice for care. The NP's will be overseen by the physician on the floor with them and the physician will review and sign off on there visits and billing will go out under the Physician that signs off. The NP is going to see her established pt but billing is going out under our physician, would this be considered a New pt or Est pt?
 
Hi there, could you clarify where these visits are taking place?
 
I am actually seeing a larger issue than new vs established.
You are stating the NP will see the patient, but billing is going under the MD (incident to). However, the scenario described does not meet incident-to guidelines.
Incident-to (which is a Medicare guideline followed by some, but not all, commercial carriers) has several requirements including (THIS IS NOT ALL THE REQUIREMENTS):
1) An established patient with an established problem
2) The ACP following a plan of care already created by the physician
3) Physician must be physically on-site in the suite
In your situation, you cannot meet the requirement for the ACP following a plan of care already created by the physician. The physician in your practice has not seen this patient, therefore no plan of care created.
The scenario described would need to be billed under the NP. If that patient has already seen the NP prior, it would be established.

Here are some new/established references:

And some Incident-to references:
 
csperoni said:
I am actually seeing a larger issue than new vs established.
You are stating the NP will see the patient, but billing is going under the MD (incident to). However, the scenario described does not meet incident-to guidelines.
Incident-to (which is a Medicare guideline followed by some, but not all, commercial carriers) has several requirements including (THIS IS NOT ALL THE REQUIREMENTS):
1) An established patient with an established problem
2) The ACP following a plan of care already created by the physician
3) Physician must be physically on-site in the suite
In your situation, you cannot meet the requirement for the ACP following a plan of care already created by the physician. The physician in your practice has not seen this patient, therefore no plan of care created.
The scenario described would need to be billed under the NP. If that patient has already seen the NP prior, it would be established.

Here are some new/established references:

And some Incident-to references:
Click to expand...
Agree with and would give the same advice.
 
SueLis said:
in the office setting pos 11
Click to expand...
Thanks. I was confused by mention of the visits taking place on the floor.

If these are Medicare patients or patients of a private payer that have an identical incident-to policy, the previous answers cover why you wouldn't report these under the physician's name (and the patients are established). You'll need to check other private payers to see what they allow.
 
We are OB/GYN office. Most of the patients will be pregnant following them for continuation of care for their pregnancy. The pt is est. to the NP and will always have direct supervision by a physician. Any Medicare pt's are always seen by Physician for a new problem.
 
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