SchoolofMedicineComplianceHeatherScottMay.pptVIP

Compliance Office Billing Non-physician Provider Services School of Medicine Compliance Heather Scott May 16, 2007 Things to Consider… Employment License Payer Involvement of physician General Principles NC law requires payers to reimburse certain non-physician services How it is paid is based on payer Scope of practice No physician co-signature required No supervision of residents for Medicare and Medicaid Employment criteria Salary support from physician practice. Percentage of salary = billable time Direct or “incident to” billing Exceptions for some specially designated funding Not included on Hospitals cost reports Medicare in the Inpatient Setting Licensed non-physicians that may bill Medicare directly Nurse Practitioner Physician Assistant Clinical Nurse Specialist Clinical Psychologist Reimbursed at 85% of the physician allowable Services of non-physicians ineligible to bill directly are not reimbursable via Part B Medicare Shared Visit Option NPP and MD make individual evaluations on the same day Each documents his service May bill in MD’s name combining notes for level for established patients and problems May not bill consults “Shared” initial evaluations billed in NPP’s name Rules are currently being reconsidered by Medicare Physician must document detail beyond a resident attestation NPP collaboration with an MD makes service billable as subsequent daily care, even without an MD note “Incident to” Billing Principles Option for billing non-physician provider services to Medicare outpatients and Medicaid patients The billing provider (usually a physician) is the only named provider on the bill The third party payer does not know who rendered the service The billing provider and supervising physician retain liability for all “incident to” services “Incident to” - Medicare “Incident to” services may not be billed in an inpatient setting or hospital-based clinic The billing provider must perform and document the initial visit Thereafter,