Different MDs. Same NP. Does anyone know the rules?


I came across an interesting scenario in the clinic the other day and wanted to get some feedback from others. I don't know if the issue at hand is related to company policy, State or Federal legislation, CMS rules or what. Here's the situation:

Stardust is a WHNP who worked for Dr. Moon Crater. Dr. Moon Crater moved away and many of her patients transferred their care to Dr. Sun Spot, another physician in the group. Therefore, Dr. Moon Crater's patients were already established at the clinic, but they had never actually seen Dr. Sun Spot. Although in the same group, both doctors ran independent practices within the clinic and Stardust was not shared by the group. When Dr. Moon Crater left, Stardust went to work for Dr. Sun Spot.

One of Dr. Moon Crater's former patients, now under the care of Dr. Sun Spot, called the clinic to request a refill of her Vagifem. The patient was told since she had never actually seen Dr. Sun Spot, they could not refill her medication. The patient made an appointment with Dr. Sun Spot's clinic. When she arrived, who did she see? None other than Stardust, the same WHNP who cared for her in the previous practice. But this counted as actually being seen by Dr. Sun Spot, so she was able to get her refill.

When Stardust was working for Dr. Moon Crater, she functioned as an extension of Dr. Moon Crater. Now, working for Dr. Sun Spot, she serves as an extension of Dr. Sun Spot. Therefore, many of the patients who moved over are being cared for by the same WHNP, a provider with whom there is already a patient-provider relationship. Why then did this patient have to come in if she didn't actually have to see Dr. Sun Spot? If Stardust was considered adequate and Stardust already knew the patient and the patient was already established at the clinic, why couldn't Stardust just refill the cream?


137 Posts

ok. if i read this right. Yes she has to come in to be seen by the MD because the inital visit is suppose to be performed by the MD, who has to lay eyes on that patient.


137 Posts

when this happened before ive seen nps conduct visits and the go to their collabs and say hey this is a first visit or there new to the practice, will you go introduced and lay eyes on the patient.


727 Posts

Depends whether Stardust is billing his/her own patients and using his/her own numbers for insurance, Medicare, Medicaid, etc.

If Stardust is billing "incident to" then the MD must see the patient and establish a diagnosis and a plan of care, which Stardust can then follow and prescribe for in future.

If Stardust uses his/her own billing numbers then there is no "incident to" and there would be no need for this patient to be seen for a refill of a routine or chronic med.

nursetim, NP

493 Posts

Specializes in ER, HH, CTICU, corrections, cardiology, hospice. Has 21 years experience.

Doesn't pass the smell test to me. Same NP, different colab doc? NP is still using their judgement. Generate fees. Dicey. The "laying eyes on Pt. even a quick intro is not an initial visit in my book. I think we are to driven by numbers. I'm not a Pollyanna, just claiming to know right from wrong.