This question appeared in a recent list serve. My two responses are based upon two different assumptions: (1) both providers are physicians, and (2) one of the providers is not a physician. The principal points are that each physician has a unique National Provider Identifier (NPI), and a physician must be on site when a non-physician provider extends services under his or her NPI.
Regarding incident to billing or incident to service, is there ever an occasion where, let's say, Provider A is out of the office and Provider B is in the office. Provider B sees Provider A's patient and bills the visit under Provider A.
If there are only two providers in this practice and both are physicians, Provider B cannot ever bill under providers A’s NPI. Each physician must use his or her own NPI.
If Provider A is a physician and Provider B is a Nurse Practitioner or Physician Assistant, and no other providers are in the practice, Provider B cannot bill under provider A’s NPI because Provider A is not in the suite when the visit takes place.
In ICD-10-CM, hypertension code options do not distinguish between malignant and benign or between controlled and uncontrolled. What is important for code selection is knowing if the hypertension is caused by or related to another condition. The following table shows some of these options.
In 2020, Medicare will begin using a new Patient-Driven Groupings Model (PDGM) for calculating Medicare payment for home health care services. This is probably the biggest change to affect home health care since 2000.
How does the VA determine charges billed to third party payers for Veterans with private health insurance?
According to the VA. "38 C.F.R 17.101 stipulates the basic methodology by which VA bills third party insurance carriers. In order to generate a charge for medical services, VA establishes reasonable charges for five ...
It is agreed that TMJ disorders should be covered by insurance. There are often questions whether it is covered by medical insurance or dental insurance and where the line is that separates coverage.Medical Insurance typically is the primary insurance for TMJ disorders. The reason is that joints are found anywhere ...