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Question regarding billing for a Provider that is out of office.

Tierni Posted Thu 12th of February, 2015 13:34:02 PM

We have 2 Doctors in our office. “Provider A” was gone for the day seeing patients at another clinic. “Provider B” remained at the office. A patient came in to the office and receive an injection. Provider “A” wants us to bill the injection under his NPI as the rendering Provider, even though he was out of the office. We just need confirmation that from an audit stand point, this is incorrect.

We have been telling the Provider he cannot do this, but he does not believe us. Please help!

SuperCoder Answered Thu 12th of February, 2015 15:13:21 PM

Thanks for your question. You are correct. You are unable to bill under a provider if they are not in the office. According to "incident to" billing guidelines the provider must be immediately available to assist and provide direction if needed. Telephone access is not consistent with "incident to" guidelines. See the attached Medicare document for the complete "incident to" requirements. You can use this as supporting documentation to give to your provider. Hope this helps.

http://www.wpsmedicare.com/j8macpartb/training/on_demand/_files/2013-0723-incident-to-services-handout.pdf

Tierni Posted Thu 12th of February, 2015 15:33:01 PM

Appreciate your feed back. I thought "Incident To" only dealt with NPP's??

SuperCoder Answered Thu 12th of February, 2015 16:57:30 PM

You are welcome.

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