[NPInfo] Shared Visits

[David Carpenter]

Number one would be a consult assuming there was communication from another
provider asking for an opinion.

The second would probably be a new patient. Ie the patient has a problem and
being sent to you for management of the problem. Here is a breakdown between
the two:
http://www.medscape.com/viewarticle/403732_6
(free registration may be required)
A lot of times it is unclear and the patient may be referred to you for a
consult ie anemia and then continue with care ie the anemia is caused by
cancer. In this case if there is a clear consult you code it as a consult
(which pays better).

As far as the initial evaluation there are two situations. One is Medicare
and Medicaid. The other is essentially all other insurances.

For Medicare and Medicaid, the provider who does the work bills for the
work. The provider has to do all the elements to be able to bill at the
appropriate level. There is no shared or split billing for new patients or
consults. Therefore there is really no reason for both providers to see
them. In some specialty practices the physician will do a handshake visit
but they cannot bill under the physicians NPI. It has to be billed under the
NPP's NPI. If the physician saw the patient for the initial visit you can do
incident to visits for that problem provided you meet all the incident to
requirements. You could also do shared visit for follow up if you wanted to.
Bottom line no billing for shared visits for new patients or consults.

For everybody else, for the most part NPPs are not credentialled in
specialty care with the insurance companies. Most insurance companies
instruct the practice to bill under the physicians NPI at the normal rate.
There are a few companies (Blues of Minnesota if I recall) that are trying
to reimburse NPPs at 85%. Unlike Medicare/Caid which is all or nothing,
payment from an insurance company is subject to negotiation. A practice
could simply refuse to sign a contract that did not pay an NPP the same as
the physician. In the case of private insurance there are generally no rule
on who does what documentation or services. Given that most of the billing
is done under the physician there is no reason that you could not do a
shared visit type of visit. Again this depends on specific insurance company
rules and regulations.

David Carpenter, PA-C

On Wed, Jun 18, 2008 at 7:34 PM, Rogers, Barbara <BB_Rogers at fccc.edu> wrote:

> So I have been told that in a lot of specialty practices, both the NP/PA
> as well as the physician see the patient to do the initial evaluation.
> How is that handled if it is not a shared visit? In our practice, there
> are primarily two types of new patients:
>        1.  Ones that are here specifically for a second opinion and
> plan to return to an outside oncologist (consultation?)
>        2.  Ones who are coming to us to receive care.
>
>
> Any NP/PAs in specialty practices out there who have been successful
> with this?
>
> Barbara Rogers CRNP, MN, AOCN
> Adult Hematology-Oncology Nurse Practitioner
> barbara.rogers at fccc.edu
> -----Original Message-----
> From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On
> Behalf Of David Carpenter
> Sent: Wednesday, June 18, 2008 5:48 PM
> To: NP Info
> Subject: Re: [NPInfo] Shared Visits
>
> Its not allowed for new patient visit. While you can do shared visits in
> the
> clinic, generally the same rules as for an incident to visit apply. In
> this
> case this means that the physician would have to do the initial visit
> and
> begin management which rules out a shared visit. Here is the pinnacle
> form I
> usually use:
> http://www.ouhsc.edu/bc/documents/ClarificationofIncidenttoandsplit-shar
> edservices.pdf<http://www.ouhsc.edu/bc/documents/ClarificationofIncidenttoandsplit-sharedservices.pdf>
> And medicare guidance on shared visits:
> http://www.cms.hhs.gov/MLNMattersArticles/downloads/mm4215.pdf
>
> Essentially shared visits are for follow up visits after an initial
> consult
> (which cannot be a shared visit).
>
> You could do a shared visit after an initial new patient visit or
> consult
> for a clinic visit but you could also do an incident to visit in that
> case.
>
>
> David Carpenter, PA-C
>
>
>