Just as background, this is a clinic that has two NPs that see 99.9% of the patients. Dr. P is one of the NP's husband and he comes in from time to time and sees a patient but this happens very rarely and he is not on site except on the rare occasions when he sees a patient. He has what they call a collaborative agreement with the practice. By the way, this practice is in Indiana.
I was given this instruction:
"Aetna will not contract with NP's therefor only Dr. P is contracted. Due to this, we can bill with the NP as a "rendering physician" but Dr. P has to be the "supervising physician". Please change the supervising physician on the superbill whenever the patient has Aetna. Is there anything Dr. P has to do with the chart for compliance?"
I told her that I thought that Dr. P needed to review and sign the chart.
They have called Aetna with this reply: "They wouldn't send me anything in writing but I called 888.632.3862 and spoke to Allison who stated that there is no limitations on how involved the MD needs to be in the care of a patient when treated by an NP (rendering) and billed by the MD (billing), meaning they have no guidelines." I said that I still thought he would need to sign the chart and they replied "He does not need to under his collaborative agreement with the practice. Since Aetna has no guidelines, I would assume following his collaborative agreement would be sufficient...".
Putting him as the billing provider just on claims going to an insurer that requires it for reimbursement, without any documentation indicating he had anything at all to do with the patient in general or with the visit in particular, seems very close to fraud. It makes me very uncomfortable since I would be the one clicking that box and making that determination on the claim. What are your thoughts?
I was given this instruction:
"Aetna will not contract with NP's therefor only Dr. P is contracted. Due to this, we can bill with the NP as a "rendering physician" but Dr. P has to be the "supervising physician". Please change the supervising physician on the superbill whenever the patient has Aetna. Is there anything Dr. P has to do with the chart for compliance?"
I told her that I thought that Dr. P needed to review and sign the chart.
They have called Aetna with this reply: "They wouldn't send me anything in writing but I called 888.632.3862 and spoke to Allison who stated that there is no limitations on how involved the MD needs to be in the care of a patient when treated by an NP (rendering) and billed by the MD (billing), meaning they have no guidelines." I said that I still thought he would need to sign the chart and they replied "He does not need to under his collaborative agreement with the practice. Since Aetna has no guidelines, I would assume following his collaborative agreement would be sufficient...".
Putting him as the billing provider just on claims going to an insurer that requires it for reimbursement, without any documentation indicating he had anything at all to do with the patient in general or with the visit in particular, seems very close to fraud. It makes me very uncomfortable since I would be the one clicking that box and making that determination on the claim. What are your thoughts?
Bill under MD or NP?
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