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Ask the Expert

Hospitalist Leadership Connection, August 8, 2007

Q: For a subsequent day, we occasionally see instances where both a nurse practitioner (NP) and a physician have seen the patient and documented this in the progress notes. The NP has documented the exam, but the MD has signed behind him or her and/or has ordered more tests or made a note at the bottom of the progress notes. Whose services should we bill for, the NP or the physician?

A: If the physician writes "chart reviewed, patient seen, agree with above" or just co-signs the NP note, then the service should be billed under the NP. To maximize billing (e.g., Medicare), and for medico-legal purposes, the physician should write a complete note. (This service could then be billed under the physician.)

Unrelated to billing, one should review the hospital bylaws and medical staff requirements and compliance concerning the mid-level/physician relationship and chart responsibilities.

Kenneth G. Simone, DO, founder and president of Hospitalist and Practice Solutions, which specializes in hospitalist program development, fielded this question. He can be reached at ksimone@sunburypc.com. Send your questions to mcoler@hcpro.com.

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