Guest guest Posted January 19, 2011 Report Share Posted January 19, 2011 Lucrative for you as you get $112/99214. I bill that for most visits anyway without paying a nutritionist. I also only get about $65 for a 99214 on most plans but Medicare which pays closer to the $112. But I wonder why you don’t just let the nutritonist bill the patient directly rather than you paying her. I would find $40 a visit to her as all my profit for not only that patient but about 3-4 who don’t see her. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of yogievanh Sent: Wednesday, January 19, 2011 12:53 AM To: Subject: nutrition program Hi everyone, I've started a nutrition program with the nutritionists in our office and it's turning out to be low overhead and lucrative. here's the skinny: the nutritionist rents space next door. I see a patient and then refer that patient to the nutritionist as part of our care plan. i then contract with the nutritionist for a fee to provide the care and i pop in at the end of the visit for 'decision making'. the nutritionist schedules the followup with the patient. i then bill insurance as 'incident to' billing. it's a win-win-win and legal. the nutritionist gets more patients, the patient gets to use their insurance and I submit the bill as an office visit since it's a " part of the care plan " and " i was supervising " . this is according to CMS incident to billing. I have to see the patient first to start the process. I pay the nutritionist $40/visit and bill a 99214 for face to face 30-59 mins. I collect avg $112. nice profit for 5 mins and low overhead! you could pay as % of collections to decrease your risk, but nutritionist might not go for it. checkout our website and click on " nutrition program " . i'd love y'all's opinions on it. oh, the best part....The patient gets better! nutritional counseling has pretty amazing results when done by a good one. CyberDefender has scanned this email for potential threats. Version 2.0 / Build 4.03.29.01 Get free PC security at http://www.cyberdefender.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2011 Report Share Posted January 19, 2011 Dear Yogievanh (sorry don't know your name),Any recommendations on how to find a good/helpful nutritionist?SharonSharon McCoy MDRenaissance Family Medicine 10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com Hi everyone, I've started a nutrition program with the nutritionists in our office and it's turning out to be low overhead and lucrative. here's the skinny: the nutritionist rents space next door. I see a patient and then refer that patient to the nutritionist as part of our care plan. i then contract with the nutritionist for a fee to provide the care and i pop in at the end of the visit for 'decision making'. the nutritionist schedules the followup with the patient. i then bill insurance as 'incident to' billing. it's a win-win-win and legal. the nutritionist gets more patients, the patient gets to use their insurance and I submit the bill as an office visit since it's a " part of the care plan " and " i was supervising " . this is according to CMS incident to billing. I have to see the patient first to start the process. I pay the nutritionist $40/visit and bill a 99214 for face to face 30-59 mins. I collect avg $112. nice profit for 5 mins and low overhead! you could pay as % of collections to decrease your risk, but nutritionist might not go for it. checkout our website and click on " nutrition program " . i'd love y'all's opinions on it. oh, the best part....The patient gets better! nutritional counseling has pretty amazing results when done by a good one. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2011 Report Share Posted January 19, 2011 So Evan , what about medical necessity I mean icd9? Hi everyone, I've started a nutrition program with the nutritionists in our office and it's turning out to be low overhead and lucrative. here's the skinny: the nutritionist rents space next door. I see a patient and then refer that patient to the nutritionist as part of our care plan. i then contract with the nutritionist for a fee to provide the care and i pop in at the end of the visit for 'decision making'. the nutritionist schedules the followup with the patient. i then bill insurance as 'incident to' billing. it's a win-win-win and legal. the nutritionist gets more patients, the patient gets to use their insurance and I submit the bill as an office visit since it's a " part of the care plan " and " i was supervising " . this is according to CMS incident to billing. I have to see the patient first to start the process. I pay the nutritionist $40/visit and bill a 99214 for face to face 30-59 mins. I collect avg $112. nice profit for 5 mins and low overhead! you could pay as % of collections to decrease your risk, but nutritionist might not go for it. checkout our website and click on " nutrition program " . i'd love y'all's opinions on it. oh, the best part....The patient gets better! nutritional counseling has pretty amazing results when done by a good one. -- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2011 Report Share Posted January 20, 2011 Are you billing Medicare or other payors? Medicare used to require the non-physician be an employee but liberalized their definition in 1996 and now:"Key CriteriaIn order to qualify as “incident-to†services for billing purposes, an NPP’s services must meet several criteria. These include:(1) the NPP must be licensed or certified to provide professional health care services in the state where the physician practiceis located; (2) generally, the NPP must be a full-time, part-time or leased employee of the physician or physician group practice(although in limited cases, the NPP may be an independent contractor of the physician or physician group practice); (3) theNPP must provide services as an integral part of and incident-to the physician’s services; and (4) the NPP must provide suchservices under the direct supervision of the physician." http://www.practicesupport.com/Avoiding%20Pitfalls.pdfYour nutritionist would qualify as an independent contractor? What are the limited cases where that is ok?There is also something in Medicare incident to language about the services being on-site of the physician's practice.. if she is leasing the room, is it still on-site for your practice?Blue Cross of Montana does not allow incident-to billing for NPPs- at all. I would be careful about making sure each insurance billed allows incident to billing.CarlaTo: Sent: Tue, January 18, 2011 10:52:33 PMSubject: nutrition program Hi everyone, I've started a nutrition program with the nutritionists in our office and it's turning out to be low overhead and lucrative. here's the skinny: the nutritionist rents space next door. I see a patient and then refer that patient to the nutritionist as part of our care plan. i then contract with the nutritionist for a fee to provide the care and i pop in at the end of the visit for 'decision making'. the nutritionist schedules the followup with the patient. i then bill insurance as 'incident to' billing. it's a win-win-win and legal. the nutritionist gets more patients, the patient gets to use their insurance and I submit the bill as an office visit since it's a "part of the care plan" and "i was supervising". this is according to CMS incident to billing. I have to see the patient first to start the process. I pay the nutritionist $40/visit and bill a 99214 for face to face 30-59 mins. I collect avg $112. nice profit for 5 mins and low overhead! you could pay as % of collections to decrease your risk, but nutritionist might not go for it. checkout our website and click on "nutrition program". i'd love y'all's opinions on it. oh, the best part....The patient gets better! nutritional counseling has pretty amazing results when done by a good one. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 27, 2011 Report Share Posted January 27, 2011 i FOUND THIS HERE...http://www.aafp.org/fpm/2001/1100/p23.html " During subsequent visits in which a physician is not involved, most nonphysician providers’ incident-to services may never be billed higher than a 99211. However, Medicare states that the services of certain non-physician providers (nurse practitioners, physician assistants, certified nurse midwives and clinical nurse specialists) can be billed incident-to a physician’s services using the highest level of evaluation and management (E/M) code they are licensed to render under state law, even when no physician has been involved in the visit at all on that day. It’s also important to note that, when billing incident-to, nonphysician providers cannot be reimbursed for consultations or time-based E/M services when more than 50 percent of the service is counseling or coordination of care (according to the r’s Manual, the only time that counts is face-to-face time between the physician and the patient in the office) " Are you billing Medicare or other payors? Medicare used to require the non-physician be an employee but liberalized their definition in 1996 and now: " Key CriteriaIn order to qualify as “incident-to” services for billing purposes, an NPP’s services must meet several criteria. These include:(1) the NPP must be licensed or certified to provide professional health care services in the state where the physician practice is located; (2) generally, the NPP must be a full-time, part-time or leased employee of the physician or physician group practice(although in limited cases, the NPP may be an independent contractor of the physician or physician group practice); (3) the NPP must provide services as an integral part of and incident-to the physician’s services; and (4) the NPP must provide suchservices under the direct supervision of the physician. " http://www.practicesupport.com/Avoiding%20Pitfalls.pdf Your nutritionist would qualify as an independent contractor? What are the limited cases where that is ok?There is also something in Medicare incident to language about the services being on-site of the physician's practice.. if she is leasing the room, is it still on-site for your practice? Blue Cross of Montana does not allow incident-to billing for NPPs- at all. I would be careful about making sure each insurance billed allows incident to billing. Carla To: Sent: Tue, January 18, 2011 10:52:33 PM Subject: nutrition program Hi everyone, I've started a nutrition program with the nutritionists in our office and it's turning out to be low overhead and lucrative. here's the skinny: the nutritionist rents space next door. I see a patient and then refer that patient to the nutritionist as part of our care plan. i then contract with the nutritionist for a fee to provide the care and i pop in at the end of the visit for 'decision making'. the nutritionist schedules the followup with the patient. i then bill insurance as 'incident to' billing. it's a win-win-win and legal. the nutritionist gets more patients, the patient gets to use their insurance and I submit the bill as an office visit since it's a " part of the care plan " and " i was supervising " . this is according to CMS incident to billing. I have to see the patient first to start the process. I pay the nutritionist $40/visit and bill a 99214 for face to face 30-59 mins. I collect avg $112. nice profit for 5 mins and low overhead! you could pay as % of collections to decrease your risk, but nutritionist might not go for it. checkout our website and click on " nutrition program " . i'd love y'all's opinions on it. oh, the best part....The patient gets better! nutritional counseling has pretty amazing results when done by a good one. -- -- Sangeetha Murthy M.D7830 mont Mesa Blvd #287San Diego, CA 92111www.mypcponline.com PS PATIENTS-please remember that email may not be entirely secure, Email is best used for brief questions Email replies can be expected within 24 hours-Please CALL if the matter is more urgent . Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 28, 2011 Report Share Posted January 28, 2011 very good questions Sangeetha and Carla. we are not doing MNT or qualifying as a NPP. NPPs and MNTs are LICENSED providers and are contracted with insurance companies. when you are using unlicensed providers, then are auxiliary to the practice and an extension of our services. allergy docs do this alot with their allergy techs; they enter the room for 5 mins and go over the plan in order to bill an OV. i will post the incident-to CMS manual under 'files'. Please email me off listserve at drevanhirsch@... if I'm not responding to posts as I'm not reading regularly. onward! > > > >> > >> > >> Are you billing Medicare or other payors? > >> > >> Medicare used to require the non-physician be an employee but liberalized > >> their definition in 1996 and now: > >> " Key Criteria > >> In order to qualify as " incident-to " services for billing purposes, an > >> NPP's services must meet several criteria. These include: > >> (1) the NPP must be licensed or certified to provide professional health > >> care services in the state where the physician practice > >> is located; (2) generally, the NPP must be a full-time, part-time or > >> leased employee of the physician or physician group practice > >> (although in limited cases, the NPP may be an independent contractor of > >> the physician or physician group practice); (3) the > >> NPP must provide services as an integral part of and incident-to the > >> physician's services; and (4) the NPP must provide such > >> services under the direct supervision of the physician. " > >> http://www.practicesupport.com/Avoiding%20Pitfalls.pdf > >> > >> Your nutritionist would qualify as an independent contractor? What are > >> the limited cases where that is ok? > >> > >> There is also something in Medicare incident to language about the > >> services being on-site of the physician's practice.. if she is leasing the > >> room, is it still on-site for your practice? > >> > >> Blue Cross of Montana does not allow incident-to billing for NPPs- at > >> all. I would be careful about making sure each insurance billed allows > >> incident to billing. > >> > >> Carla > >> ------------------------------ > >> *From:* yogievanh > >> *To:* > >> *Sent:* Tue, January 18, 2011 10:52:33 PM > >> *Subject:* nutrition program > >> > >> > >> > >> Hi everyone, > >> > >> I've started a nutrition program with the nutritionists in our office and > >> it's turning out to be low overhead and lucrative. here's the skinny: the > >> nutritionist rents space next door. I see a patient and then refer that > >> patient to the nutritionist as part of our care plan. i then contract with > >> the nutritionist for a fee to provide the care and i pop in at the end of > >> the visit for 'decision making'. the nutritionist schedules the followup > >> with the patient. i then bill insurance as 'incident to' billing. > >> > >> it's a win-win-win and legal. the nutritionist gets more patients, the > >> patient gets to use their insurance and I submit the bill as an office visit > >> since it's a " part of the care plan " and " i was supervising " . this is > >> according to CMS incident to billing. I have to see the patient first to > >> start the process. > >> > >> I pay the nutritionist $40/visit and bill a 99214 for face to face 30-59 > >> mins. I collect avg $112. nice profit for 5 mins and low overhead! you could > >> pay as % of collections to decrease your risk, but nutritionist might not go > >> for it. > >> > >> checkout our website and click on " nutrition program " . i'd love y'all's > >> opinions on it. > >> > >> oh, the best part....The patient gets better! nutritional counseling has > >> pretty amazing results when done by a good one. > >> > >> > >> > > > > > > > > -- > > > > > > -- > > > > Sangeetha Murthy M.D > > 7830 mont Mesa Blvd #287 > > San Diego, CA 92111 > > www.mypcponline.com > > PS PATIENTS-please remember that email may not be entirely secure, > > Email is best used for brief questions > > Email replies can be expected within 24 hours-Please CALL if the matter > > is more urgent . > > > > > > > -- > > > -- > Sangeetha Murthy M.D > 7830 mont Mesa Blvd #287 > San Diego, CA 92111 > www.mypcponline.com > PS PATIENTS-please remember that email may not be entirely secure, > Email is best used for brief questions > Email replies can be expected within 24 hours-Please CALL if the matter is > more urgent . > Quote Link to comment Share on other sites More sharing options...
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