How does CIGNA audit records for evaluation and management visits in nursing facilities (skilled or otherwise)?
CMS stipulates that “incident to” is not covered in an inpatient setting. Therefore, if claims reviewed find that nonphysician practitioners (i.e. physician assistants, nurse practitioners, etc.) perform these visits and not the physician whose provider number the service is being billed under, the service will be denied. The nonphysician practitioners should bill their inpatient visits under their own provider numbers.
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