15% More Pay Awaits Coders Who Can Max Out NPP Benefit
Posted on 14. Aug, 2009 by Editor in Hot Coding Topics
Correctly code NPP’s hospital services, or you’ll sell the practice short.
If you don’t take advantage of all the E/M services a nonphysician practitioner (NPP) can provide, you are missing out on a serious revenue stream, as these providers can simultaneously lighten physicians’ loads and fatten the practice’s bottom line.
Check out these FAQs to get the lowdown on when it’s OK to take the higher-paying path for your NPP’s services.
What Is Incident-To Billing?
Incident-to billing occurs when you report an office E/M service the NPP provides under the physician’s National Provider Identifier (NPI). Using the physician’s NPI garners you 100 percent reimbursement for the E/M, while an NPP’s NPI pays 15 percent less.
The NPP must perform incident-to services “under the direct supervision of the physician as an integral part of the physician’s personal in-office service,” confirms Melanie Witt, RN, CPC-OGS, MA, an independent coding consultant in Guadalupita, N.M.
Incident-to billing is not legitimate unless the FP has seen the patient and established a plan of care for the problem; further, there should be “subsequent services by the physician of a frequency that reflects the physician’s continuing active participation in and management of the course of treatment,” Witt continues.
Remember this pair of rules when you consider billing incident-to:
• Incident-to billing is confined to Medicare payers and payers that observe Medicare rules. If a payer does not typically follow Medicare rules, it probably won’t accept incident-to claims.
• Medicare takes the “direct supervision” rule quite literally, so make sure you meet the supervision requirement before considering incident-to. In short, “direct supervision means the physician is on site and immediately available” during the NPP’s service, explains Susan Garrison, PCS, FCS, CCS-P, CHC, CPC, CPCH, CPAR, executive vice president of Magnus Confidential Inc. in Atlanta.
Example: A 67-year-old...
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