Physician bill for procedure performed by an employed RN in an inpatient setting?

[kiwi21mango]

Can a physician bill for a procedure (line placement) performed by an RN, when the RN is an employee of the physician and performs the procedure in an inpatient setting? If our case the APP is performing the procedure (line placement). They want to transfer this service to the RN under an inpatient/hospitalist physician.

 

[SharonCollachi]

I would think the answer is no. First, there is no incident-to in the inpatient setting. Second, the RN cannot bill for services on their own (so no considering a split/shared type of situation). Third, services of an RN are part of the hospital's responsibility to provide.

Oh, and lastly... an RN is not an APP (at least not in my state/area). The RN would have to be an NP, a Nurse Practitioner, to be an Advanced Practice Provider.

Having said all of that, I could be wrong and welcome others to chime in with more knowledge in this area.

 

[thomas7331]

I agree, a physician may never bill a service performed 'incident to' that was done in a facility - all services must be billed by the individual who performed them. If done by an AP nurse, then it has to be billed under that practitioner's credentials. The exception is for an E&M 'split/shared' service where both providers perform a portion of the E&M, and in which case the E&M can be billed under the physician. But a procedure cannot be split or shared.

Agree also that an RN is a different situation. If in fact it was an RN employee, that would be a highly unusual situation as a physician does not typically bring their own staff into a hospital and have them perform services for a patient. I am guessing that this would be against hospital policy and possibly an infraction of regulations, and if in your place I would probably escalate or report it to the hospital's compliance department for investigation. Anyone who treats a patient in a hospital must either be an employee or contractor of the hospital or have been given hospital privileges to do so. Physicians cannot independently bring another person into a hospital and allow them to treat a patient on their behalf. If the patient suffered a complication or injury during the course of this procedure, it could present a very serious and complicated liability issue for the provider or the hospital, or both.

 

[SharonCollachi]

I am guessing that this would be against hospital policy and possibly an infraction of regulations, and if in your place I would probably escalate or report it to the hospital's compliance department for investigation.

I originally thought the RN had already done the procedure, but after re-reading the OP a few times, I was thinking they were saying that some other APP is doing it now, and they want the RN to start doing it.

 

[Pam Warren]

Physicians may not bill for professional services performed by employees of the hospital. Incident-to only applies in the office setting. The nurse can start a line if it's in the scope of her practice, and be supervised by a physician with hospital privileges, but the procedure is going to be bundled into the DRG or APC.