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Billable nurses visits without Doctor present?

  1. #1
    Location
    Albuquerque, NM
    Posts
    52
    Question Billable nurses visits without Doctor present?
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    We are having an arguement at our 6 offices, as to whether we can bill out services rendered by a registered nurse without the physician being in the office.

  2. #2
    Default
    Absolutely not.... you can't send a claim with the nurse as a billing provider, and in order for this to qualify as "incident-to", the doctor must be present in the office suite.
    Walker Bachman, CPC, CPPM

  3. #3
    Location
    Albuquerque, NM
    Posts
    52
    Talking
    Thank you, they aren't even doing incident to they are just billing under the doctor. I keep telling them this is illegal.

  4. #4
    Default
    Technically, it's "insurance fraud". I wish you luck in convincing them to change this practice. Hang in there!
    Walker Bachman, CPC, CPPM

  5. #5
    Location
    Albuquerque, NM
    Posts
    52
    Default
    Thanks I have been trying to tell them that, if all else fails I am going to go to the compliance officer. That will stop it, mention the word "fraud" the officer panics.....

  6. #6
    Location
    Columbia, MO
    Posts
    12,570
    Default
    I agree with Walker, this is a bad practice. Think of your physician's malpractice carrier, how would they feel because if anything goes wrong it will come back on the physician's malpractice because according to the claim, the physician was there!

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    Milwaukee WI
    Posts
    4,466
    Default RN is not the same as NP
    An RN is not the same as an NP. The most that an RN can bill would be 99211 - if the doctor was present in the office suite. Per CPT this type of presenting problem "may not require the presence of a physician."

    Incident to billing requires that an qualified Allied Health Professional (such as an NP or PA) perform the service as a follow-up to an already established treatment plan. That's a different thing and the level of service may be higher than 99211.

    F Tessa Bartels, CPC, CEMC

  8. Default
    Does the ruling for nurses also apply to an outpatient hospital clinic setting?

  9. #9
    Location
    Milwaukee WI
    Posts
    4,466
    Default Who employs the nurses?
    Quote Originally Posted by mbell411 View Post
    Does the ruling for nurses also apply to an outpatient hospital clinic setting?
    Depends on who employs the nurses. If it's the doctor (professional practice), yes. If it's the hospital, the facility fee covers the nurse's work.

    F Tessa Bartels, CPC, CEMC

  10. #10
    Location
    Albuquerque, NM
    Posts
    52
    Default
    We are hospital owned practices.

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