Urgent Care/Walk-In Clinic Incident-to Billing?

EmpathicBlue

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Question: For a walk-in/urgent care clinic, the rendering provider is a PA and there is a physician on site that is the supervising physician. The claim is billed out under PA rendering and Doc supervising. The supervising doc does electronically sign the note, but the supervising doc is not involved with the care and the supervising doc does not see the patient face to face. Is this non-incident to, or incident to? What about if the supervising doc does go into the room to evaluate the patient further upon the PA's request? Thank you! (How it is currently being billed, is under the supervising physician, but if I'm understanding it correctly, when the supervising doctor is not involved with the care, it should be the PA independently?)
 

mitchellde

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A physician in that same practice and specialty must have, in a previous encounter, examined the patient for the same diagnosis and must have written a plan of care that includes this encounter as a follow up. If the patient then on presentation for the next visit, has no additional issues and the PA does not change the existing plan of care, this can be billed under the supervising provider, as long as the supervising provider is in the same specialty.
You cannot bill new patients as incident to since they have not been previously examined in that practice.
Urgent care encounters can rarely if ever be considered incident to, since the patient is usually presenting with a new urgent complaint.
So if you meet the incident to requirements the NPI in field 24J as the rendering provider must be the PA's.
As far as the provider stepping in to see the patient during the encounter:
This is called a shared encounter, and again is rare in urgent care as the patient must be an established patient of that provider and that provider must write an independent note of his/her part of the encounter indicating that the PA note has been read and then agree or disagree.
 
Last edited:

Noey

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OMG thank you so much Debra Mitchell :)

I have been looking for someone to explain this to me like I'm a three year old. I just got it! thanks again
 
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