Wiki How to bill for a contracted, temporary nurse practitioner filling in for a NP on maternity leave

[allison.n.elliott14@gmail.com]

Hi all! The practice I bill for will have a temporary NP filling in for 3 months for a provider on maternity leave. How do we bill this? Can we bill under the group NPI for the practice or can we bill under the other provider that will be present?

Thanks!

 

[csperoni]

This is a very sticky situation and you may not like my answer. For physicians, locum tenens (aka Fee-for-Service time compensation) guidelines allow you to bill under the absent physician with a modifier. This rule does NOT apply to NPs or PAs.
You may only bill under the NP actually rendering the service unless:
1) The carrier accepts Medicare's Incident-to billing guidelines (some do not), or has other guidelines (IN WRITING) that you may bill under the physician.
2) The visit meets ALL incident-to billing guidelines (including but not limited to established patient, established problem, no change to plan of care, physician must be onsite and immediately available.)
If all that applies, you may be able to bill the NP services under the onsite supervising physician as incident to. Here is Noridian's incident-to guide: https://med.noridianmedicare.com/web/jeb/topics/incident-to-services

In all honesty, you really should be IMMEDIATELY credentialing the covering NP. Or simply realize that the fill-in NP will be providing a lot of unbillable services.