Wiki Multispecialty Practice billing for CRNP's and PA's

[Romaine Suminski]

We are a large group multi-specialty practice, billing under the same Tax ID number, with a number of PA's and CRNP's (NPP's) in various practices. When a CRNP or a PA sees a new patient in one specialty practice, we know we must bill Medicare under that "NPP's" NPI and accept the reduced payment for the non-physician provider. However, because Medicare does not credential these NPP's in any specialty, they are only credentialed as PA's, CRNP's, etc., and when a physician in a different specialty sees a patient for the first time, Medicare does not allow for a new patient visit to be billed by that physician in the different specialty -- stating new patient requirements not met. We have appealed, providing documentation of speciatly training and contractual arrangements for the NPP's that they are only working in specified practices,etc., to no avail.
Are there any other Large Group Multi-specialty practices out there in this same situation and how do you handle the situation?
Sorry so lengthy...wanted to try to be as clear as possible...

Thanks so much for any assistance anyone can provide.

 

[Cherish79]

I also work at a multi-specialty clinic. However, we have not had any issues after sending dictations from both visits to show that it is two different specialties. We do always have to appeal, but after sending documentation they always get paid. Are you sending notes from both visits and indicating somehow that it is two different specialties? Our dictations have not only the doctor names but also the specialties, and that has seemed to be sufficient. We have tons of problems with Medicare Advantage plans though and it is always a struggle, especially with Humana and UHC. I hope that helps!

 

[kvangoor]

Is this straight medicare?