Week 4 Discussion

Good afternoon,

I need assistance with the following:

As is discussed on page 127 of the text, Medicare Part B generally pays for services “incident to” a physician’s professional service. Typically, these are services that are rendered by a non-physician staff member in a physician’s office, as long as the circumstances support that the physician was physically present on the premises, supervised the service, and was available should a problem occur. An example of this may be a nurse administering flu shots when a doctor is present in the office.
42 C.F.R. 410.26(b)

We also learned this week that a physician who does note have an assigned provider number may NOT provide services and simply bill using another physician’s provider number; that would amount to fraud.

For our discussion this week, I’d like you to consider this situation. When a newly licensed physician joins a primary care medical practice, he or she must usually wait a while to receive their National Provider Identifier/Medicare enrollment number. During this time, could the new physician provide services and use another physician’s NPI under the “incident to” rules? If you don’t know the answer, how might you find out?

Thank you!

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