Inpatient billing

A patient presents to the ER and our NP sees them, they decide that the patient needs to be admitted and will be admitted to our service, NP dictates the note and at the end states... Discussed case with Dr A . The patient was seen and examined with Dr. A and signs the dictation... ABC, NP dictating for Dr. A
Don't I have to physically see the chart note that Dr. A should have written concurring with her findings, stating he saw the pt face-to-face?

Shouldn't it be within 24hrs of the NP seeing the patient?

Can I bill under the NP if it is Medicare? What if it is commerical insurance?

These are admits to the hospital, so they are intial visits/contact with the patient, so don't they have to billed under the dr and doesn't the doctor have to see the patient?

Thanks

Inpatient billing

Lots of questions here, I'll try to answer.

For Medicare, this is a shared services. Unlike the incident to services, the MD doesn't have to see the patient first and establish the plan of care. But, the MD must have a face-to-face service with the patient on the same calendar date and document their own involvement. Take a look at the article in Codapedia on shared services. (Not very imaginatively, it's titled "Shared Services."

It is not sufficient for the NPP to document the MD's involvement or for the MD to write "seen and agreed" or countersign. The MD must document that he/she saw and examined the patient, and must write a clinically relevant (if brief note) and tie to the NPP. Then, add the documentation together to select the level of service.

If not, bill a Medicare patient with the NPP's own provider number, and be reimbursed at 85% of the fee schedule amount.

Commercial insurances will vary: do they credential NPPs? What have they told you to do.

The billing is a separate issue from the hospital's by laws. Only an MD can admit a patient, per the by laws, but you can have an NPP do the admission and bill for it.