Dansk2011

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Looking to potential bring on NP to help inpatient on weekends when I'm call so I can effectively see more patients. Can I legally bill under my NPI if follow-ups are seen by NP and not me personally if I am in the building or do I have to physically see them with the NP to do so? I know outpatient you can bill "incident to" meeting certain requirements as long as the physician is present in the clinic/facility which allows you to bill under the physicians NPI and thus not have to collect at 85%. Wanting make sure it's worth my time and money.
 

DMBandFan86

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Can you bill insurance for services not performed? I wouldn’t

As far as I know you still have to go in and wave at the patient if that’s as little as you want to do.

BTW this sort of set up is another reason why NPs continue to get more scope of practice. If they can just substitute for you and you don’t need to see the patient then why do we need the doctor.
 
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Dansk2011

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Can you bill insurance for services not performed? I wouldn’t

As far as I know you still have to go in and wave at the patient if that’s as little as you want to do.

BTW this sort of set up is another reason why NPs continue to get more scope of practice. If they can just substitute for you and you don’t need to see the patient then why do we need the doctor.

Appreciate the input. I was planning on using someone to help me on my call weekends only so I can spend more time with my admits and sicker patientd and not have to spend my entire day seeing 30+ follow-ups. I was still going to be the primary decision maker. I was asking as in the outpatient world you can bill incident too for follow-ups under the "supervising" physicians NPI legally under certain circumstances one which is being present in the facility. Wasn't sure if the same applied for inpatient as well. It does not from my research. Although people still do it.

I don't think having a mid-level help to ease the burden of work in certain circumstances is the reason they are encroaching on scope of practice. I would argue that in many instances not only can they be a huge help but also increase patient care and safety in the right circumstances. If there were 40 patients to be seen, 1/3 of which were very sick and the rest were stable, care could be compromised if one was forced to see everyone as opposed to focusing attention on those that really need it while having a mid-level see those that don't require as much time or changes to their management. Allocation of resources.

To be honest, I feel that a majority of encroachment has more to do with lobbying, cost of care to payors, and number of physicians. Nurses tend to band together and physicians don't. Physicians are too busy complaining yet do very little to change anything. Unfortunately at this rate it's probably inevitable. Especially in a field like PM&R. Very few people want to do inpatient work with an ever aging population and a growing need. Supply cannot keep up with demand.

Do you fell the same about other specialties encroaching on PM&R because that seems to be a growing trend. Some of them have less experience then some of the midlevels I've seen.
 
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sloh

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I feel that a majority of encroachment has more to do with lobbying, cost of care to payors, and number of physicians. Nurses tend to band together and physicians don't. Physicians are too busy complaining yet do very little to change anything. Unfortunately at this rate it's probably inevitable. Especially in a field like PM&R. Very few people want to do inpatient work with an ever aging population and a growing need. Supply cannot keep up with demand.

Do you fell the same about other specialties encroaching on PM&R because that seems to be a growing trend. Some of them have less experience then some of the midlevels I've seen.
Number of physicians. We should learn from EM and RadOnc. Our job security is dictated by supply and demand.
 
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PMR2008

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Appreciate the input. I was planning on using someone to help me on my call weekends only so I can spend more time with my admits and sicker patientd and not have to spend my entire day seeing 30+ follow-ups. I was still going to be the primary decision maker. I was asking as in the outpatient world you can bill incident too for follow-ups under the "supervising" physicians NPI legally under certain circumstances one which is being present in the facility. Wasn't sure if the same applied for inpatient as well. It does not from my research. Although people still do it.

I don't think having a mid-level help to ease the burden of work in certain circumstances is the reason they are encroaching on scope of practice. I would argue that in many instances not only can they be a huge help but also increase patient care and safety in the right circumstances. If there were 40 patients to be seen, 1/3 of which were very sick and the rest were stable, care could be compromised if one was forced to see everyone as opposed to focusing attention on those that really need it while having a mid-level see those that don't require as much time or changes to their management. Allocation of resources.

To be honest, I feel that a majority of encroachment has more to do with lobbying, cost of care to payors, and number of physicians. Nurses tend to band together and physicians don't. Physicians are too busy complaining yet do very little to change anything. Unfortunately at this rate it's probably inevitable. Especially in a field like PM&R. Very few people want to do inpatient work with an ever aging population and a growing need. Supply cannot keep up with demand.

Do you fell the same about other specialties encroaching on PM&R because that seems to be a growing trend. Some of them have less experience then some of the midlevels I've seen.
Can not do incident incident to billing in the hospital or SNF setting. No grey area.
You can do shared/split visits
 
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DMBandFan86

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You could also request that your hospital not require you to see patients everyday and follow the 3 day week rule. That way you can just do admissions like most of us do on the weekends and not have to worry about follow ups.

personally I’d request an internal medicine NP for your help on the weekends. Then they could help with the complex medical problems so you don’t have to and you can be more efficient rounding on 30+ patients. You wouldn’t have to worry about split billing and productivity then.
 
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