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NPP~nurse practitioner/PA~IOV versus estab in a multi-specialty practice

Debra Posted Thu 24th of July, 2014 10:56:36 AM

Help,

(I just posted this in orthopedics, but it should have been directed to compliance instead. Sorry for the error.)

I work in a small multi-specialty practice; we have family care, orthopedics, physical therapy, general surgery, internal medicine, and rheumatology.

A question just arose today in our office about billing for a nurse practitioner and physicians assistant.

I need to get the correct response. But I must also find out where it is documented so that I can give it to the Dr. that I work for. He also owns the practice.

This is IOV versus established visit.

If a patient comes in and sees a patient in family care. After the patient becomes established, he sees a family care nurse practitioner and the claim is billed in her name.

The patient later is referred to our orthopedics department.

QUESTION?????

Because the patient was seen in family care and the claim was billed in the nurse practitioner's name, I have always been told I cannot bill an IOV for the orthopedic visit. (or vise versa-if our physician's assistant sees a patient in orthopedics, and it is billed in her name, than the patient wants to be seen in family for the first time- we cannot bill an IOV for family care either).

The reason why I was told we cannot bill an IOV when the nurse practitioner/physician assistant was seen is because "NPP's are not afforded the opportunity to designate a sub-specialty. A NPP can only designate their primary licensure."

But the Dr. this morning is questioning if this is correct. Since both the nurse practitioner and the physician assistant have different primary specialty. Neither have a subspecialty assigned to their name.

PLEASE, ANY HELP WITH THIS WILL BE GREATLY APPRECIATED.

BUT I ALSO NEED TO KNOW WHERE THIS INFORMATION IS DOCUMENTED AS WELL SO THAT I CAN FORWARD THIS TO MY SUPERVISOR AND THE PHYSICIAN THAT I WORK FOR.

Each specialty uses the same tax id# in our practice. I am not sure if this makes a difference or not.

SuperCoder Answered Fri 25th of July, 2014 08:45:33 AM

Thank you for your question. Currently researching.

I just want to clarify a few things:

1. Is the same NPP/PA seeing the patient in Orthopedics that saw the patient in family care?
OR
2. Is the NPP/PA referring the patient to Orthopedics?

SuperCoder Answered Fri 25th of July, 2014 08:45:33 AM
Thank you for your question. Currently researching. I just want to clarify a few things: 1. Is the same NPP/PA seeing the patient in Orthopedics that saw the patient in family care? OR 2. Is the NPP/PA referring the patient to Orthopedics? Researching.
SuperCoder Answered Fri 25th of July, 2014 09:27:11 AM

Thank you for your question. Currently researching.

I just want to clarify a few things:

1. Is the same NPP/PA seeing the patient in Orthopedics that saw the patient in family care?
OR
2. Is the NPP/PA referring the patient to Orthopedics?

Debra Posted Fri 25th of July, 2014 13:43:41 PM

The NPP (a nurse practitioner who works in Family Medicine and is assigned under a family care MD) is NOT the same NPP (a PA who works in orthopedics and is assigned under an orthopedics MD). They are separate people.

As a matter of fact, in family care we have a nurse practitioner, and a PA. We also have a PA assigned to the internal medicine.

So in our small multi-specialty (family care, internal medicine, orthopedics, general surgery, and rheumatology) we have 4 NPP's.

Debra Posted Thu 31st of July, 2014 09:43:25 AM

Hi,
I am just checking if you are still researching this for me.
Thanks,

Debra Posted Mon 11th of August, 2014 09:18:47 AM

Hello,
Did you find an answer to the NPP question.
Thank you!

SuperCoder Answered Mon 11th of August, 2014 11:21:57 AM

Thanks for your patience and I apologize for taking so long to get this response to you. According to CMS, "a new patient is defined as an individual who has not received professional services from the physician/non-physician practitioner (NPP) or another physician of the same specialty who belongs to the same group practice within the previous three years".

In this case the specialty designation of your NPPs will determine whether the patient is considered new or established. Your tax id will not be an issue. If your PA or NP initially saw the patient and they are not designated a sub-specialty, you will have to bill as established if the patient is seeing a PA or NP within the group. Double check your PA and NP specialty designations and if they happen to have a sub-specialty. If the physician initially sees the patient, for example in Internal Medicine and then the PA follows up and refers to Orthopedics where the patient is seen by the Orthopedics physician, in this case you can bill a new patient visit for the Orthopedics physician.

The question you have asked is not written anywhere specifically in a CMS publication that I can find, but there are a few links that I have provided that give information on new versus established patients, NPP specialty designations, and definitions. I hope this helps you.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf

http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Jurisdiction-11-Home-Health-and-Hospice~8GKMQC6571

http://wpsmedicare.com/j5macpartb/departments/enrollment/specialty_codes.shtml

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