Billing for non-credentialed Nurse Practicioner

fltbaroque

Guru
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Longview, TX
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We have a new NP that is not yet credentialed with all payers (only MCR and MCD). The physician wants to bill everything under his NPI. Not all of the encounters meet incident to requirements, some are new patient visits or new chief complaints. Also, not all payers go by MCR guidelines on incident to billing.
Is there any LEGAL way to bill under the doctor's NPI until the credentialing comes through for the NP? I've searched exhaustively and I can't find any clear answer.
Can these charges be billed with SA modifier?

Please help!
 

mitchellde

True Blue
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Columbia, MO
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you would need a written policy from those carriers that do not go by Medicare policy on incident to as to their version. however I do not believe there is any carrier that will allow you to bill new patients and new problems using the NPI of a provider that was not face to face with the patient. You would need to check with the carriers and be specific on your needs.
 

TThivierge

Guru
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Lithonia, GA
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Bill for NP list NPI and their Name on claim

We have a new NP that is not yet credentialed with all payers (only MCR and MCD). The physician wants to bill everything under his NPI. Not all of the encounters meet incident to requirements, some are new patient visits or new chief complaints. Also, not all payers go by MCR guidelines on incident to billing.
Is there any LEGAL way to bill under the doctor's NPI until the credentialing comes through for the NP? I've searched exhaustively and I can't find any clear answer.
Can these charges be billed with SA modifier?

Please help!

Hi
i believe you can but must have the MD's name on med record stating agree with the care provided for the patient on bottom of medical record by the NP. Then on claim list MD and NP names and NPI numbers. Check out CMS 1500 fields 33 and 24 D for Med doctor name and NPI and for fields 17a & 17 b Name and NPI of Nurse Practioner to document the claim sent in. Also put modifier SA for the NP provider on claim line

I hope this info helps you

Lady T
 
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