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Incident to Billing

  1. Default Incident to Billing
    Medical Coding Books
    There is a debate on what the specific guidelines are for a nurse practioner to see patients in a family practice. Does this depend on type of insurance? Is it correct that no matter what the insurance is, the patient needs to be seen by the physician on the initial visit? What about when the Doctor is out of the office? What are the correct guidelines for the NP? Are there any resources that I can confirm with?
    Thank you, Sharon

  2. Default
    One thing you can do is to check the state guidelines for NPs. Then check the carrier's guidelines. Hope this helps.

  3. #3
    There is not one easy answer to this. It depends on the insurance carrier and if they credential the NP's and also their scope of practice.

    It sounds overwhelming at first but to successfully and compliantly bill for these type of services you need to check with each carrier and research what their specific policy is. Once that is done you need to make sure you are aware of what your State's scope of practice is for the NP to make sure it follows along.

    Once you do that you want to make sure that you have a way to track when it is incident to and not so that you get appropriate reimbursement.
    Rhonda Buckholtz, CPC, CPC-I, CGSC, COBGC, CEPDC, CENTC
    Vice President, ICD-10
    800-626-2633 ext 183
    Fax: 814-217-0447

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