Wiki Full Practice Authority State rule

[TAM2029987]

I am currently employed in the state of Arizona. We are a FPAS and I've advised the company that I work for that if a Nurse Practitioner sees a new patient, then we must bill out the claim under the NP's NPI. I have cited the rule and sent it to her and she still disagrees with me. I can't even bill it correctly in our EHR software because the CEO won't change the edit. Can someone please help me verify this rule or explain it to me.

 

[amyjph]

Full Practice Authority in the state and payer rules, guidelines, the contract and how you bill may be different. It depends on the place of service, what health plan the patient has, what the contracts say, and credentialing may come into play. However, you are most likely correct in advising that they must bill under the APRN (NP) for a new patient IF the contract or health plan guidelines do not contradict this.

If you are talking about an office/outpatient visit, and the NP is credentialed with the health plan being billed, and the NP has their own NPI, and they see a new patient, it would most likely be billed under the NP. There would be no such concept as incident-to for a new patient. So, if this is the case and they are simply billing it under the MD because either the NP is not credentialed with the plan yet, or they want higher reimbursement, this could *possibly* be incorrect billing/abuse (or worse).

However, there can still be some health plans which allow billing of all NPP visits under the MD. I have seen it with some Medicaid plans.

Some resources: https://www.cms.gov/medicare/paymen...ers/advanced-practice-registered-nurses-aprns

https://azbn.gov/laws-rules/nurse-practice-act

So, there are a lot of if's and unknowns until you confirm the contracts and health plan, if the NP is credentialed, etc. Have you talked directly with the providers about it?