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Incident To Billing in Nursing Homes

  1. #1
    Location
    Richardson, TX
    Posts
    34
    Exclamation Incident To Billing in Nursing Homes
    Medical Coding Books
    Hello all,
    I have found out a ton of information concerning incident to billing within the Dr office, however I cannot find anything stating what the rule is in a nursing home or assisted living facility. Does anyone know if the rule is the same and the Dr has to be physically available? Either way can someone send me a resource that I can show the Dr when explaining the situation? Thank you!!

  2. #2
    Location
    Columbia, MO
    Posts
    12,910
    Default
    Quote Originally Posted by KDMarshall View Post
    Hello all,
    I have found out a ton of information concerning incident to billing within the Dr office, however I cannot find anything stating what the rule is in a nursing home or assisted living facility. Does anyone know if the rule is the same and the Dr has to be physically available? Either way can someone send me a resource that I can show the Dr when explaining the situation? Thank you!!
    The reason all the info pertains to physician office is because incident to is only applicable in the physician office setting. In the Medicare manual where you find the incident to rule, there is a portion that does state the provider must be within the office suite area while the patient is being seen. An inpatient , nursing home setting is not under the definition of office suite.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Richardson, TX
    Posts
    34
    Default
    So when they go to the nursing home I just apply the AS modifier to show it was a NP?

  4. #4
    Location
    Columbia, MO
    Posts
    12,910
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    And you must use the NP's NPI number in box 24J as the rendering provider. So the NP must be credentialed.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Location
    Richardson, TX
    Posts
    34
    Default
    What if they are not credentialed?

  6. #6
    Location
    Columbia, MO
    Posts
    12,910
    Default
    Quote Originally Posted by KDMarshall View Post
    What if they are not credentialed?
    Then they are either out of network or it is denied for invalid provider. An NP must be credentialed to see patients in a non incident to scenario

    Debra A. Mitchell, MSPH, CPC-H

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