NPP visits

AmandaW

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I know the very initial visit, the MD needs to see the new patient to establish the 'plan of care' then as long as incident to guidelines are met, etc. then the PA or APN can see the patient.
BUT, if that patient really needs to get in and be seen or just for whatever reason and the Dr is not in the office and the NPP sees the patient, I know it has to be billed under their NPI, but
my question is if the Dr is available to see the patient on the next visit or three visits later.....can we bill under the MD that day and also the subsequent visits after? Or will it forever have to billed
under the NPP?
 

Mo Crowder

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Local Chapter Officer
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Hi Amanda,

If I understand your question, the answer is NO to billing for the MD for the day the NPP rendered services and direct supervision was not met. YES for subsequent visits when the MD provides medically necessary services and when the NPP provides medically necessary services that meet incident to requirements. Services will never have to forever be billed under any provider (physician or NPP).

I hope that this answers your question.

Mozella Crowder
 

AmandaW

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Thank you for that! Ok, I was concerned that since the MD was not the first one to see the patient that subsequent visits would need to be billed under the NPP since it seems as though they're the ones that established care.
But it would be ok if the MD saw the patient a couple visits down the line....could bill under MD as incident to as long as those guidelines are met?
 

trarut

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Subsequent visits are not restricted to the NPP (just as they would not be if the patient saw an MD first and then transferred care to another MD in the same practice).
If the patient sees the MD for visit #2, the MD would be listed as rendering on the claim for the visit.
If the NPP sees the patient at a later time with the MD present as supervising and assuming all incident-to criteria are met, the NPP follow-up visit could be billed as incident to assuming the payer allows incident-to billing.

Hope this helps.
Tracy
 

Pathos

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I agree with trarut, that in order to bill incident to the patient has to see the physician first for the new patient visit/new problem, and can then subsequently see the patient for any follow ups.
If the NPP wants to bill under their own NPI, then they can also do so but I believe there is a slight payment reduction for most insurances (85%?). Note that each insurance carrier tends to have their own rules about Incident to, so it would be a good idea to familiarize yourself with them as well.

Here are some good guidelines on Incident to billing from my local MAC.

Noridian - Incident to
 

AmandaW

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I don't think I'm being quite clear, so sorry!
Basically, whether it's the first, second, third, fifth time the patient is seen in the clinic; it's only once the MD has seen the patient and established the plan of care that THEN we can bill under him, correct?
I was concerned that if the NPP initially saw the patient on that very first initial visit, that we will only be able to bill under that NPP b/c they are the ones that 'established the plan of care'.

So to try to take confusion out of this, say the NPP saw the patient the very first initial visit and say, second. Of course, only NPP can be billed under.
But the third time, the MD sees the patient - we can now bill under that MD on that third visit and say he sees the patient for the rest of the visits, we can bill under the MD all the rest of those visits also. Correct?

Just b/c the NPP saw the patient initially, doesn't mean that care can't be 'transferred' say the third visit. Correct?
 
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