Billing Incident To

I wanted to get some clarification on a post from 2019 (Is there a setting for nurse practitioners and supervising physicians) related to billing an encounter under a supervisor. Some private insurers will allow for a credentialed supervisor to having billing submitted under them even thought the rendering provider is the supervisee.

On the fee sheet, if a supervisor is identified, does that mean the supervisor is added as the rendering? I guess the other option would be to change the rendering provider to the supervisor before submitting. From an audit perspective, the supervisee would have signed the note but it would be billed under the supervisor for billing. Not sure if that creates any secondary issues.

We are using 6.1.0 dev verson.

hi @dmnlbh , supervisor is added separately with the DQ indicator, rendering is marked with 82.

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Stephen, thanks for jumping in! From a user standpoint, how would I make billing under the supervisor happen using the fee sheet?

should probably customize with a global in billing if you’d like the supervisor to be listed as the only provider on the claim

If I understand the situation correctly, could it be as simple as a checkbox on the feesheet, ‘Supervisor is Billing Provider’ ? That way both providers are still listed for whatever record-keeping and audits might need it and the x12 generator could simply look at that checkbox to know which provider’s information to output as billing provider.

  • HT
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Harley - that would certainly make it user and workflow friendly!

Yeah it would seem so, but OpenEMR’s innards are a bit more complex than the Commodore Basic and VBA I last coded in… :slight_smile:

Harley, I thought I would revive this conversation as we’re still trying to work this out. I like the idea of a checkbox but having that selection be something that needs to be done manually per claim leaves a lot of room for human error. It would be ideal for our situation to have certain insurances able to be billed under a supervisor, and a checkbox would indicate this change in rendering provider to that supervisor for that insurance until the box is unchecked. Some insurances allow our associate-level clinicians to bill directly, but others require billing through a supervisor. The checkbox would hopefully allow us to route some insurances to bill through the supervisor instead. Thoughts?

I just thought I’d jump in here, if you want to do it after the claim is produced. My clearinghouse rules engine can make the change for you. you can set the payer id and if the rendering provider has NPI “1234” then you can change it to “4321” and all the relevant information along with it.

that’s a neat feature but the emr should have an accurate record of the claim