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Billing for NP's without Supervising Attendee on location


Best answers
Is the proper modifier to bill SA? Or is there another more appropriate modifier to use?

Pam Brooks

True Blue
Local Chapter Officer
Dover Seacoast New Hampshire
Best answers
if you're talking about billing incident-to, this is a Medicare concept, although many commercial payers expect that we follow incident-to guidelines as well.

If your payer will credential a NP, then you can bill under the NP's NPI (Medicare will credential a nurse practitioner). Yes you have a reduction in payment, but you don't have to worry about all the incident-to guidelines (like no new patients, having a treament plan in place, supervising on site, etc.).

If you payer does not credential Nurse practitioners, then typically they are OK with billing under a 'supervising' MD, who does not need to be on site; just available for consult/supervision by phone or electronic communication. Check with specific payers for details.

But if your NP is not credentialed with any of the payers, then you will have to follow incident-to guidelines for those payers who expect them to be followed. Incident-to is not just a billing rule, where you simply bill under a supervising MD, it's a patient care rule, where you have to follow very specific guidelines in order to bill under the better-paying MD's name.

I wrote a recent article in Healthcare Business Monthly (Jan or Feb 2018, I believe) with regards to Incident-to billing. This explains in more detail what you need to do for those payers that expect you follow the incident to guidelines in order to bill under the MD when a NP sees the patient.