Wiki Billing for NP services under the physician

[ellistneal]

Hi everyone,

I was asked what are the minimum requirements of documentation for billing services of a NP visit under the physician. Scenario: The NP performs the visit in an outpatient setting but the practice wants this billed under the physician instead of the NP. Is this possible or legal?

 

[thomas7331]

This question is asked so frequently here on this forum that I'm not going to try to answer it again here. If you do a search for 'incident to' billing and 'split/shared' visits, you will find that this question is discussed extensively on this site and in many other places on the internet and you should easily be able to find the answers to your questions. Take a look at the resources that are available and if you still have questions, perhaps post again with your specific concerns.

 

[jkyles]

Hi everyone,

I was asked what are the minimum requirements of documentation for billing services of a NP visit under the physician. Scenario: The NP performs the visit in an outpatient setting but the practice wants this billed under the physician instead of the NP. Is this possible or legal?

Hi there,
Based on the information you gave, you could not bill that under the physician.

Here is Palmetto GBA's Incident-to fact sheet. https://www.palmettogba.com/palmetto/jmb.nsf/DID/3MD3AMSNOO.

I recommend giving it a close read and sharing it with the person who asked you the question.

 

[WiLaura2013]

Hi everyone,

I was asked what are the minimum requirements of documentation for billing services of a NP visit under the physician. Scenario: The NP performs the visit in an outpatient setting but the practice wants this billed under the physician instead of the NP. Is this possible or legal?

Where were the outpatient services provided, hospital or office? If hospital follow the rules for split-shared billing, if office follow the rule for incident-to billing. If hospital and the physician doesn't provide the substantive portion of the visit, then the physician can't bill, it would be filed under the NP (direct billing).

 

[ellistneal]

Thanks everyone for the response. The services were performed in an office setting so I will read the information for incident to billing. I did read some of the posts for the split/shared visits and knew this didn't apply. I also saw the posts for incident billing but was unsure if that applied to my situation. I am very thankful for the feedback.

 

[MelodyCPC]

Thanks everyone for the response. The services were performed in an office setting so I will read the information for incident to billing. I did read some of the posts for the split/shared visits and knew this didn't apply. I also saw the posts for incident billing but was unsure if that applied to my situation. I am very thankful for the feedback.

I would also determine who the payer is and research their reimbursement policies and/or your contract with them. Many payers now have their own policies regarding "incident to" and it is not always in alignment with the CMS policy.