Quote Originally Posted by sparkles1077 View Post
Our hospital makes nurse practitioners dependent in the inpatient setting. So the bill automatically goes out under the doctor (the organization does not credential the NPs for inpatient). We as auditors have a problem with this because the npp does most of the documentation and the physician adds a supervisory note. There is poor communication in the organization and management has not dealt with the issue correctly. We have recommended the minimal documentation by the physician to bill as a shared visit since incident to is not allowed in the hospital, but management believes this is a violation of the facility's policy because the midlevels are dependent. They are suggesting use of a scribe note in this situation, but I feel this does not accurately portray the relationship between the NP and physician. In my mind, it is a shared visit and should be documented appropriately. I guess the bottom line question is, if the NP has a dependent relationship to the physician, can a shared service be billed?

Any thoughts?

Thank you
Sparkles1077, CPC, at Private
To be a shared service the physician must document their own face to face encounter with the patient not just signing off on the NPPs note. Go to CR1776 from 2002 this covers shared encounters. You cannot share a new patient. It states that if no face to face encounter between the physician and the patient is documented, even if the physician signs off on the documentation provided by the NPP, then the visit must be billed using the NPPs NPI.