Wiki LPN and RN Billing to Third-Party Payers - medical services

[Rperry]

Good Morning Fellow Subject Matter Experts,

Can someone provide me with feedback regarding the following statement:

If your practice provides medical services to patients (regardless of the location), and no supervising physician or non-physician provider (PA or NP) is present, those services can not (I repeat, can not) be billed to any insurance carrier. This is considered a false claim and has serious ramifications under the Federal False Claims Act.

 

[LLovett]

Not sure what you are looking for but I agree with that statement, except for one thing. Thirdparty payers don't fall under the false claims act, only governmental payers.

RNs and LPNs are not credentialed providers thru insurance, at least none that I am aware of. It is also outside an RN or LPNs scope of practice to work independently like that. When you are billing for those services under a physician or NPP you are saying that provider was supervising and is responsible for the care/treatment rendered. How can they supervise or be responsible if they aren't there?

Even though false claims only apply to governmentals the scope of practice applies to the provider and doesn't change regardless of the payer in question.

Laura, CPC, CPMA, CEMC