If RNP did a physical for a child but did not give parent a sedation clearance to due several psych meds and advice to see psych for letter of clearance or make appt with PCP, but completed the physical. Doesn't the RNP get credit for the physical regardless if she didn't give sedation clearance? Parent did not understand and left upset after exam was completed.
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Wiki Physical Credit
- Thread starter KoBee
- Start date
SharonCollachi
Guest
Unclear what you mean by "get credit for."
Are you asking if the physical can be billed? Yes.
If the parent scheduled an appointment to get a clearance for sedation, and the FNP knew or should have known they weren't going to give clearance because of current meds, I would think a better way to handle it would have been to tell the parent on the phone to get the clearance from psych. I would probably be upset if it were me as the parent.
Are you asking if the physical can be billed? Yes.
If the parent scheduled an appointment to get a clearance for sedation, and the FNP knew or should have known they weren't going to give clearance because of current meds, I would think a better way to handle it would have been to tell the parent on the phone to get the clearance from psych. I would probably be upset if it were me as the parent.
Sorry, yes that is what I mean, bill for the physical. I totally agree how the situation should have been handled if that was case. Parent did schedule child for a physical. thank you for the prompt response
Looks like parent didn't like what happened and decided to see another of our providers and did a whole physical and did the meds clearance. Shouldn't this provider only get billed for E/M and not physical , since child had a physical done by RNP on same day?
So NP provided services but did not clear patient. Patient then saw physician of the same group who repeated the physical exam service and then also cleared the patient.
If the NP works under the same specialty and same group, you would combine their services and bill for 1 visit only. You cannot bill for multiple visits in this situation.
If the NP works under a different specialty/different group, each service could be billed out. But there would be no exclusion that each provider wouldn't bill for the services they individually provided.
Now - regarding "specialty". I understand of course that inherently an NP gets credentialed as an NP, regardless of the exact specialty they work in. But similarly when considering new patient vs established patient, in this scenario, specialty is not how they are credentialed, but rather how they practice.
PS. In this rare situation, even if the NP/MD are different specialties, I would consider not billing for the NP as a matter of customer service. I think what you are saying is that the NP was not comfortable clearing this complex patient and instead wanted the PCP pediatrician (who does have more training than an NP) to make this call.
If the NP works under the same specialty and same group, you would combine their services and bill for 1 visit only. You cannot bill for multiple visits in this situation.
If the NP works under a different specialty/different group, each service could be billed out. But there would be no exclusion that each provider wouldn't bill for the services they individually provided.
Now - regarding "specialty". I understand of course that inherently an NP gets credentialed as an NP, regardless of the exact specialty they work in. But similarly when considering new patient vs established patient, in this scenario, specialty is not how they are credentialed, but rather how they practice.
PS. In this rare situation, even if the NP/MD are different specialties, I would consider not billing for the NP as a matter of customer service. I think what you are saying is that the NP was not comfortable clearing this complex patient and instead wanted the PCP pediatrician (who does have more training than an NP) to make this call.
Or maybe you are saying patient was scheduled for a well-exam and then asked for the medical clearance when arrived for the well-exam? And if you had known when scheduling that the patient needed medical clearance, you would have scheduled patient with MD.
If that's the scenario, and the insurance permits both a well-visit and E/M on same day, and the patient was due for a well-visit anyway, then I would bill well-visit with NP and E/M with MD.
If that's the scenario, and the insurance permits both a well-visit and E/M on same day, and the patient was due for a well-visit anyway, then I would bill well-visit with NP and E/M with MD.
Thank you so much, you got it right on the dot! all this really helps.