Wiki Credentialed NPPs - Can they still bill incident to or under supervising physician?

[Kristin2914]

Good Morning,

I understand that if a NPP is independently credentialed with Medicare that they can still bill incident to if incident-to conditions are met? Is this the same with commercial payor, particularly those in NJ? Can a mid level who is credentialed and participating with a payor still bill under supervising provider if conditions are met or will they have to bill under their own NPI, no matter what the conditions, because they are independently participating with the payor. (i.e) a participating NP sees a BCBS patient and bills his or her NPI because incident-to conditions were "not" met, but then that same NP sees same patient at later date and bills BCBS under supervising provider because conditions were met.

Thank you.

 

[Pam Warren]

Yes, a NPP can perform services incident-to a physician, and bill under the physician's NPI, per CMS. Here's the guidance.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Medicare-Information-for-APRNs-AAs-PAs-Booklet-ICN-901623.pdf

However, you'll want to make sure this is OK with commercial payers. Some that credential mid-levels expect that the provider will bill under their own credentials, and some payers don't recognize the concept of incident-to at all.