I have a couples questions,
incident to guidelines -
1. if PA/NP see's patient office setting-(NOT new, no new problem)- and MD/DO is available @tos- we can bill under the supervising provider(MD/DO), and receive 100% reimbursement?- this is an example of incident to guidelines
1. If the NPP is enrolled with Medicare and a physician is in the office suite and immediately available during the visit - Yes.
I would clarify, that just because it is an established dx, does not, necessarily, make it incident-to.
if the PA/NP is creating a new treatment plan OR changing the previous plan, it is NOT incident-to.
if the PA/NP is following a treatment plan that was created by the MD/DO, that would
be incident-to the provider's plan.
per CMS MLN Matters - Incident to Services
(emphasis NOT added by me):
To qualify as “incident to,” services must be part of your patient’s normal course of treatment, during which a physician personally performed an initial service
and remains actively involved
in the course of treatment. You do not have to be physically present in the patient’s treatment room while these services are provided, but you must provide direct supervision
, that is, you must be present in the office suite to render assistance, if necessary. The patient record should document the essential requirements for incident to service.
More specifically, these services must be all of the following:
• An integral part of the patient’s treatment course;
• Commonly rendered without charge (included in your physician’s bills
• Of a type commonly furnished in a physician’s office or clinic (not in an institutional setting); and
• An expense to you.