Wiki Does Anyone know how to bill for Nurse Practitioners?

[JLuz]

I may be billing for a group of nurse practitioners. There is no physician on site, but they are under contract as kind of an 'advisor'. Does anyone know if there are any different coding requirements or anything specifically different when billing for this type of provider or practice?

 

[mitchellde]

You must credential them as you would all providers and all services must be billed using their NPI number not the physicians for all carriers. In other words you bill exactly like you would for a physician.

 

[KathyJohnson]

That's interesting. My personal Dr office (well, former. They've been fired) billed my insurance company with the physicians name and NOT the ARNP's name. No place on my EOB's is the ARNP indicated as the attending. Even the billing office says you saw Dr xxx and not he ARNP. Uh no I didn't.

Anyway, we bill for NP's and ARNP's every day and just enter in their own NPI number.

 

[mitchellde]

They can do that IF the visit meets incident to criteria

 

[stacei]

You must credential them as you would all providers and all services must be billed using their NPI number not the physicians for all carriers. In other words you bill exactly like you would for a physician.

Question: If a CRNP is not crdentialed is it appropriate to bill under another CRNP or a physician? I work for a hospital and the manager is telling me that a CRNP can sign off on another uncredentialed CRNP's Note? somebody clear this up for me.

 

[CodingKing]

Question: If a CRNP is not crdentialed is it appropriate to bill under another CRNP or a physician? I work for a hospital and the manager is telling me that a CRNP can sign off on another uncredentialed CRNP's Note? somebody clear this up for me.

A nurse cannot bill incident to under another nurse.

 

[cmasters]

Can we bill claims out under our ACNP when an RN saw the patient for allergy testing?

 

[sandyreedemg]

You must credential them as you would all providers and all services must be billed using their NPI number not the physicians for all carriers. In other words you bill exactly like you would for a physician.

Are they limited to what they can do as a Nurse unlike a MD? In an office setting? From what I am reading it does not seem so.

 

[cgaston]

Their scope of practice varies by state so you should google "nurse practitioner scope of practice in ___________ " <---whatever state you are in

 

[Pathos]

Generally a NP is considered a Non Physician Provider (NPP), and just like PAs, they can practice medicine as long as they are doing this within their scope (often set by the state they are practicing in...and I agree with Carol here). Most NPs can bill under their own NPI number (again, check your local state rules and regulations), but the practice usually takes a payment reduction on this vs. a "regular" doctor (MD, DO, etc). NPs are usually eligible for "Incident to" billings, but you need to follow the patient's payer rules on this type of billing too.

Here are some good guidelines regarding NPs (by my local MAC), however keep in mind you need to verify any of this by checking your state's rules and regulations when it comes to what a NP can and cannot do.

Noridian - Nurse Practitioner