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Incident to

  1. #1
    Question Incident to
    Exam Training Packages
    I have a patient that was seen by our nurse practitioner. The issue that I have is that the MD signed the super bill only, it was his day in clinic. The dictation does not indicate that the MD signed, reviewed, or had any part in this visit. The NP is credentialed with the patients insurance. My question is, should this be billed under the MD who only just signed the super bill, or should it be billed under the NP who actually saw the pt and dictated the note.


    Any input would be helpful...

    Thanks,
    Kristen
    Kristen Richard, CPC

  2. #2
    Location
    Columbia, MO
    Posts
    12,570
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    definitely bill under the NP!

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Smile Incident To
    Was this a first visit for a new patient or a first visit for a "new" problem? Then definitely bill under the NP as it does not qualify for incident-to services. However, if it was a follow-up, established patient visit for an existing problem treated prior by the physician, then you can bill under the physician who was in the office that day. Hope this helps to further clarify!

    V. Davis, CPC

  4. #4
    Default
    This was a follow up visit for an existing problem. The last time the MD actually saw the patient was in December of 09.

    v. Davis,
    what you are saying is that the because the MD was on the floor in the clinic that day, the NP can see the patient, dictate the note, and bill under MD even though the MD did not have any part of the visit that day, and did not sign the actual dictation, only signed the super bill for billing purposes?

    Both of these answers are different, so I am trying to distinguish, which answer is correct??????
    Kristen Richard, CPC

  5. #5
    Location
    Columbia, MO
    Posts
    12,570
    Default
    Incident to states that to bill under the physicians number:
    The physician must have seen the patient in a prior visit for the same problem and must have in the medical record a plan of care that includes this visit to be perfomed as follow up, and must be present with the defined confines of the office suite area.
    So if this were a followup orderd by the physician from a previous encounter and the physician is on site then yes you may bill using the physicians NPI.

    Debra A. Mitchell, MSPH, CPC-H

  6. Default
    I agree I would bill under the physician as long as it's a followup to an existing problem with no new problems. If there is a new problem then you need to bill under the NP.

  7. #7
    Default
    http://www.cms.gov/manuals/Downloads/bp102c15.pdf

    From the Internet only manuals, Benefit Policy manual Chapter 15
    has a lot on incident to billing.

  8. #8
    Location
    Central Pittsburgh
    Posts
    164
    Default
    "Incident to" applies to Medicare. Was this a Medicare patient?

    If so, then billing under the MD is appropriate. The signing of the super bill is insignificant as it is not part of the medical record. (If the MD was in the office at the time of the service.)

    As long as the NP was following the established course of treatment, it is totally ok to bill under the MD.

    If however, this is not Medicare and the NP is credentialed and has his/her own provider number that insurance is probably expecting the claim under the NP.

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