Incidence to billing

HOW DOES CMS KNOW IF THE PA OR NP IS BILLING INSTEAD OF THE DOCTOR? I can not find an identifier/modifier that is current. Do we bill under the Doctors info with no notation on the claim. Just document it in the file?

Thanks

re: INCIDENCE TO BILLING

A PA or NP can provide services under their own Medicare provider number (no supervisor). They are supposed to be paid 85% of the Medicare allowable.
To bill incident to they must follow incident to rules. These should be published on the Medicare contractor website. Incident to requires a physician supervisor. Your practice billing software should have a place for the supervisor. When you bill CMS this info passes to them so they know the service is supervised or, if no supervisor, unsupervised. Hope this helps.

re: INCIDENCE TO BILLING

What if the PA is not Credentialed with Medicare? I understand the physician bills initial and H & P. Is there a set rule for how often the physcian has to review and see the patient?

re: INCIDENCE TO BILLING

If the PA does not have a Medicare provider number then they will not be paid to see Medicare patients. The physician must be the provider of care. Not sure of the venue so cannot say how ofter the patients must be seen.
I would recommend the PA make application for a Medicare provider number if they have not already applied.

re: INCIDENCE TO BILLING

SO what is the advantage about incidence to billing. This is a MD/Psychiatrist office. We see a substancal amount of Medicare patients. The PA does not have a Medicare number.. She has just joined the practice. We also have a NP who does have a Medicare number tied to the md's NPI. We bill Medicare with the md as the billing physcian and np as the rendering provider. I didn't think that was considered incidence to. I am really confused. Of course we want to bill correctly.

re: INCIDENCE TO BILLING

You can bill the NP's work under the physician, and get the higher reimbursement. The physician *must* be physically present in clinic as the supervisor. It helps to document the latter in the note(s) and/or have the MD review and countersign the NP's note(s). The NP can only follow an assessment and treatment plan outlined by the MD. New problems must be remanded back to the MD. CMS has wonderfully dry guidance on this, and this has bounced around Codapedia several times. Search the archives for "incident".

re: INCIDENCE TO BILLING

is the NP's name on the claim or all all the numbers billed as the physcian?

re: INCIDENCE TO BILLING

What block does the supervising physcian's name and number go in?