Billing for Nurse Practitioner

[cearnest]

Looking for any guidance/helpful tips for billing for a nurse practitioner under a collaborative agreement. Any advice on what would be considered direct vs incident to billing. Any information would be greatly appreciated.

 

[csperoni]

The collaborative agreement does not impact billing.
Incident-to billing has several requirements. Among them are:
1) Payor follows incident-to billing. Not all do.
2) Physician must be physically onsite in the suite and immediately available.
3) Must be an established problem with an established plan of care from the physician that the NP is following.
4) Services must be non-facility location (like office).
There are also some other requirements, but honestly, for many practices, these 4 requirements above eliminate 98% of a practice's NP/PA services from being billed incident to.

Here are some links to additional information:
https://www.aapc.com/blog/44912-seven-incident-to-billing-requirements/
https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00004947

https://www.aafp.org/fpm/2015/0300/p15.html

https://med.noridianmedicare.com/web/jeb/topics/incident-to-services

I have seem many people misinterpret incident-to that the NP/PA cannot provide services unless they meet these requirements. Incident-to only refers to how they are billed, not whether or not the NP/PA may provide them. If the incident-to requirements are not met, you just simply bill the services under the clinician who provided them.