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.
There are three main code sets and Healthcare Common Procedure Coding System (HCPCS), is the third most common code set used. They are often called Level II codes and are used to report non-physician products supplies and procedures not found in CPT, such as ambulance services, DME, drugs, orthotics, supplies, ...
We billed 2 units of L3020 but were denied for not using the right modifiers. What should we do?
Rather than submitting two units of the L3020 to indicate that the patient one orthotic for each foot, you would need to use modifiers identifying left foot and right foot. Appropriate coding ...
Two separate pieces of legislation introduced in the House of Representatives (H.R. 2883 and H.R. 3654) have the potential to change some of Medicare’s policies regarding doctors of chiropractic. Find out what these two bills are all about and how they could affect Medicare policies.
The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...
On July 29, 2019, CMS released their proposed rule for the Medicare Physician Fee Schedule for 2020. Last year’s final rule “finalized the assignment of a single payment rate for levels 2 through 4 office/outpatient E/M visits beginning in CY 2021.” It also changed some of the documentation requirements (e.g., ...
What if my Medicare patient refuses to fill out the outcome assessment questionnaire?
Inform the patient that Medicare requires that you demonstrate functional improvement in order for them to determine if the care is medically necessary. In other words, they may have to pay for the care out of pocket if ...
Who knew that when Jack & Jill when up the hill to fetch a pail of water, they would have to ensure that in order to keep the level of water the same on the way back down, they would need to both support the pail.
Many of you in this industry are ...