Our hospital makes nurse practitioners dependent in the inpatient setting. So the bill automatically goes out under the doctor (the organization does not credential the NPs for inpatient). We as auditors have a problem with this because the npp does most of the documentation and the physician adds a supervisory note. There is poor communication in the organization and management has not dealt with the issue correctly. We have recommended the minimal documentation by the physician to bill as a shared visit since incident to is not allowed in the hospital, but management believes this is a violation of the facility's policy because the midlevels are dependent. They are suggesting use of a scribe note in this situation, but I feel this does not accurately portray the relationship between the NP and physician. In my mind, it is a shared visit and should be documented appropriately. I guess the bottom line question is, if the NP has a dependent relationship to the physician, can a shared service be billed?
Any thoughts?
Thank you
Sparkles1077, CPC, at Private