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Question on Preventive Medicine and NPP's

  1. #1
    Default Question on Preventive Medicine and NPP's
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    The question we have is this:
    Can an NPP see patients for an established patient preventive medicine visit and still charge it as an "incident to" or would they need to enter that on their own NPI.
    We are having an ongoing discussion on this. Everything I have found says NPP's should not do a preventive without billing on their own NPI. Reasoning would be that it would be a new problem. However, there is also the feeling that if the physician saw the patient the first time or previously that it's not a new problem and since preventive are not problem focused it wouldn't matter, so it would be okay for the NPP to do a preventive visit. I haven't found any definitive documentation that says they can or cannot do this. Just that to bill incident to, they must not have a new problem, the physician must have seen them previously and have on going care of the patient.
    Any one out there have anything they can add and help us out here? Any documentation would be helpful!!!

  2. #2
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    Well if it is a Medicare visit they dont cover the preventative services. Any other insurance you would need to follow there contract you have with them.
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  3. #3
    Default Preventive and NPP's
    Quote Originally Posted by hlorona View Post
    Well if it is a Medicare visit they dont cover the preventative services. Any other insurance you would need to follow there contract you have with them.
    Thank you for your response. We are aware that Medicare won't pay for preventive, just the screens, but some insurances do pay. Our dilemma is whether an NPP should see preventive patients at all if we are billing incident to. We are also aware that some insurances do not want PA's, but will accept NP's. It's very confusing. But we have 2 sides debating whether the NPP's should even see preventive patients or have them all seen by the physician and have the NPP's do the follow-up visits.
    Again, Thanks!

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