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NPs and Supervising Physicians - Virginia

  1. Question NPs and Supervising Physicians - Virginia
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    We have two insurance carriers that do not allow us to bill under the Nurse Practitioner's NPI (Anthem and United - although, they are credentialed with United). What are the requirements/definition for the "supervising physician"? Do they have to be onsite in order to be considered the "supervising physician"? Do they have to sign off on these charts? If the physician has to sign off on the NPs' charts, do they have to be present in the office during the visit?

    Please advise! Thanks!

  2. #2
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    My local MAC (Noridian) explains this billing method pretty good:

    "1) The services are rendered under the direct supervision of the physician, CP, NP CNM, CNS, or in the case of a physician directed clinic, the Physician Assistant (PA).
    2) The services are furnished as an integral, although incidental, part of the physician's, CP's, NP's, CNM's or CNS's professional services in the course of the diagnosis or treatment of an injury or illness.
    3) Billing 'incident to' the physician, the physician must initiate treatment and see the patient at a frequency that reflects his/her active involvement in the patient's case. This includes both new patients and established patients being seen for new problems. The claims are then billed under the physician's NPI.
    "

    In short:

    1. Cannot be a "New Patient", but must be an "Established Patient".
    2. Physician must be close by in the same building, and available to jump in if the need arises. For example: The physician cannot make rounds at the hospital while the NP is seeing patients Incident to in the Clinic.
    3. Physician must sign off the chart before billing, as the claim in under the physician's NPI number.
    4. Must be within the normal scope of the provider who is billing Incident-to.


    Hope this helps!
    "Without hard work, nothing grows but weeds"
    -Gordon B. Hinckley

  3. #3
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    I'd recommend reviewing the policies and talking with the network representatives for these two payers to get more information. First of all, it makes little sense to me that a payer would credential your provider but then not allow you to bill for that provider - this sounds like a misunderstanding of some sort. And for the payer that will not credential, they must have some kind of policy as to what criteria must be met for those services to be payable. The 'incident to' requirements, as in the post above, are understood for Medicare but other payers don't necessarily have to follow this. Since they are they ones making payments, and will be the ones that would recover those payments if they audit and determine your documentation did not meet their requirements, I would recommend that you get something in writing from them to guide you as to what their expectations are so that there are no misunderstanding and you are protected in the event of an audit or other problem down the road. You may get various answers here on the forum, but I personally would not rely on anything except something in writing from the payers.
    Thomas Field, CPC, CEMC

  4. #4
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    Checking your payers policies is always a smart idea, as commercial payers don't always follow Medicare, as Thomas mentioned above. If their policy is not clear on Incident-to, or you are having trouble even finding one, get a rep from the payer on the phone. Even better if you can get something on paper or writing, as even payer rep training can vary.
    "Without hard work, nothing grows but weeds"
    -Gordon B. Hinckley

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