Wiki NP/PA billing

[ejthornton]

If a NP/PA is credentialed with an insurance company, we are suppose to bill under them right? If so does just their name go out on the claim or does their name and supervising provider go out? This is very confusing.

 

[csperoni]

Medicare's guideline for ACP billing in an office setting is known as "incident-to". Under certain specific circumstances, ACP claims may be billed as the physician if ALL requirements are met.

For commercial insurances, they set their own individual rules. Some follow Medicare's "incident-to". Some want all ACP claims billed under the ACP. Some (very rare nowadays) want all ACP claims billed under the physician.

You need to find out for the specific carrier you are billing to what guideline they follow.

 

[ejthornton]

Ok thanks, this is for a pediatrican billing.