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Incident To-Question

  1. #1
    Default Incident To - Question
    Medical Coding Books
    Help!

    If the NP sees Dr. A's patient and Dr. A is not on the premise but Dr. B is on the premise. Can we bill the service incident to and use Dr. A as the insurance Dr. and Dr. B as the supervising Dr.???

  2. #2
    Default
    I'm not exactly sure what you mean by "insurance" doctor. The doctor that you bill as the supervising physician is the doctor that the insurance company or payer will receive. Medicare says that in order to use a particular supervising physician he must have "direct supervision." This means that the physician must be present in the office suite and immediately available to provide assistance and direction while the is performing the service. If the doctor wasn't present on the premises then you can't use him to bill incident to. I hope this helps...
    K-CPC

  3. #3
    Default
    Thank you....that is what I thought...but you know how it is - sometimes you need verification because your brain is going "duh".

    Respectfully,
    Angela N. Andersen, CPC

  4. Default incident to question
    Ok, so I read this post and was thinking the same thing. It was recently asked in my office if Dr A is in the office when the incident to service happens, but we put Dr B's name on the claim, is that OK. I said No, Dr. A would have to be on the claim.

    My boss said at the MGMA conference she was just at in Oct one of the presenters said the rule was recently changed to state that any doctor in the group can be on site and any other doctor in the group can be on the claim. It didn't make any sense to me, but, I went to (with my boss) a presentation last night put on by the medical society and the presenter was a healthcare attorney who agreed with my boss. The attorney said that FCSO (our local carrier) did write a rule that allowed this type thing to be ok.

    I can't find anywhere on the local carrier's website or the CMS website to support this. Can anyone help me prove or disprove this.

    Thanks,
    Stacy

  5. #5
    Default stacey_cpc
    The rule is whoever is covering for the dr that is out of the office you would have a supervising dr for the day and bill under that drs # and that dr who is covering for that day would sign off on the chart. It can not be a new problem it has to be an established plan of care. What we have are NPS do is write on the fee slip who is covering that day and then we change it to that drs # and the NP gives the chart to the supevising physician to sign off.
    If the NP sees the pt for a new problem then it must be billed under the NPs medicare #
    If the DR is out of the office you can not bill under that DRs # you have to use the supervising DR no the claim
    Last edited by safnlp; 11-15-2007 at 02:07 PM.

  6. Default Supervising Physician
    The NCD from Medicare on Incident To services PHYS-004 states the following.

    2. In some cases the physician or nonphysician practitioner who performed an initial service and ordered the service that is subsequently performed by auxiliary personnel is not the same person who is supervising the service. Then the supervising physician must be identified on both the paper and electronic claim forms.
    a. When the paper Form CMS 1500 is used, follow the instructions for completing the form, found in Pub 100-04, chapter 26, §10.4 : When a service is incident to the service of a physician or non-physician practitioner, the name and assigned UPIN (the NPI shall be used when implemented) of the physician or non-physician practitioner who performs the initial service and orders the non-physician service must appear in items 17 and 17a.
    b. When filing electronic claims with incident to services, supply the ordering physician information for each line of service in the 2420E loop and supply the supervising physician information in loop 2310E. If the supervising physician information differs for a specific detail line, then supply that detail line supervising physician information in loop 2420D


    So you bill under the supervising physician that is present but note the physician who is following the patient in Box 17 and 17A

    I hope this helps

    Jill Young

  7. Default thanks
    Jill,

    Thanks for outlining it for me. I just needed to see it in official writing.

    Thanks a bunch,
    Stacy

  8. #8
    Default "Incident-to" services
    The billing of “incident-to” services must be reported under the supervising physician name and ID#. Therefore, services rendered “incident-to” can be ordered by one physician and supervised by another. The Medicare Benefit Policy Manual, Chapter 15, Section 60.3 provides the following information (see sections 60.1 through 60.3):


    “In highly organized clinics, particularly those that are departmentalized, direct physician supervision may be the responsibility of several physicians as opposed to an individual attending physician. In this situation, medical management of all services provided in the clinic is assured. The physician ordering a particular service need not be the physician who is supervising the service. Therefore, services performed by auxiliary personnel and other aides are covered even though they are performed in another department of the clinic.”

  9. #9
    Location
    Jacksonville, Florida - 90417
    Posts
    187
    Default
    Quote Originally Posted by Angela Andersen View Post
    Help!

    If the NP sees Dr. A's patient and Dr. A is not on the premise but Dr. B is on the premise. Can we bill the service incident to and use Dr. A as the insurance Dr. and Dr. B as the supervising Dr.???
    Hi Angela,

    I think you will find the answer you are looking for in the Medicare Benefit Policy Manual Chapter 15, Section 60.3 where it is stated:

    In highly organized clinics, particularly those that are departmentalized, direct physician supervision may be the responsibility of several physicians as opposed to an individual attending physician. In this situation, medical management of all services provided in the clinic is assured. The physician ordering a particular service need not be the physician who is supervising the service. Therefore, services performed by auxiliary personnel and other aides are covered even though they are performed in another department of the
    clinic.

    Further guidance on whose NPI needs to be reported where can be found in the Medicare Claims Processing Manual, Chapter 26, Section 10.4 Items 17, 17a, 17b, and Item 24J.

    These guidelines instruct on where to enter the NPI of the provider who ordered the service and where to enter the NPI of the provider supervising the service if the supervising provider is other than the physician who ordered the service (i.e., if the supervising provider is other than the physician who the service is being rendered incident to).

    Best regards,

    Maryann Palmeter

  10. #10
    Default Incident-To- question
    Another thing to be aware of is that you will want to make sure that all the physicians in the group, other than the supervisiing physician, are listed as assistant supervising physicians within your supervision/employment agreement with the PA and that this is filed with your state medical/osteopathic board. If you use a physician as a supervisor and they are not listed with your medical board as a supervising physician, then you are not compliant with state laws. This is the way it works in several states in which I have clients. You will need to check the state code and medical or ostepathic board regulations as these are usually more stringent than Medicare reimbursement regulations.

    Hope this helps.

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