You stated that the physician "does not always initially see the patient"...and, 2.) the physician does not necessarily play an active part in the ongoing care of the patient.
Who initially see's the patient? Who establishes and maintains the plan of care? Are your midlevels credentialed with the Medicare program? If so...you would file those type of claims under the midlevels NPI number. However...if they (midlevels) aren't credentialed with Medicare...the provider MUST see the patient's initially and establish the plan of care as well as staying active in that plan of treatment.
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