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Incident To Billing

  1. #1
    Default Incident To Billing
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    I'm looking for any tips/hints for billing for a CNP and PA for our practice. Does the physician that is on site need to sign off on each visit? Thanks for your help!

  2. #2
    Short answer: Yes.

    Longer answer
    : Yes, and here are some more explanations:

    • 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).
    • 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.
    • 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.
    • Billing 'incident to' the CP, NP, CNM, CNS or PA, the nonphysician practitioners may initiate treatment and see the patient at a frequency that reflects his/her active involvement in the patient's case. The claims are then billed under the nonphysician practitioner's NPI.

    Generally the provider who is billing Incident-To can only see Established patients with no new problems as noted below:

    • Established patient with no new problems: NPP
    • If 'incident to' requirements have been met service may be billed under supervising physician's NPI.
    • Established patient with new problem: NPP (only)
    • Must be billed under NPP's NPI.
    • Established patient with new problem: NPP and Physician
    • May be billed under physician if "incident to" requirements have been met. Documentation must support a face-to-face occurred with physician (during the encounter) and that he/she has initiated course of treatment. Physician must sign his/her entry.

    Hope this helps!

    Source: Noridian (local MAC)
    "When you have exhausted all possibilities, remember this: You haven't!"
    -Thomas Edison

  3. #3
    Red face Thank you!
    Thank you, that helps! Debbie

  4. Default Appropriate modifer for billing NP's w/o physician on location
    I have been researching and was hoping you could help with input on the correct modifier to bill in this situation. From what I'm reading I see that SA would be the most appropriate. To make it clear, our NP's have their own schedule and it is not always possible that the physician will be there on location because we have more than two offices. What are your thoughts? Is the modifier even necessary?

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