?Nurse Practioner Billing protocol

imiuru69

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My ? is if there are Np's in your office do they absolutely have to be signed up witht he inurances or can they remain billied under the physician? I am in PA in case that makes a difference in policy & procedure. Thank you in advance for any insight.
 

mitchellde

True Blue
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Columbia, MO
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Id the PA/NP is not credentialed with the carrier then these visits cannot be billed under the MD unless they meet the incident to definition. Some carriers say they do not follow Medicare policy in which case you need a written policy clearly outlining that this may be an initial encounter and the provider may be out of the office at the time of the encounter and still bill under the MD.
 

mshay134

Networker
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Id the PA/NP is not credentialed with the carrier then these visits cannot be billed under the MD unless they meet the incident to definition. Some carriers say they do not follow Medicare policy in which case you need a written policy clearly outlining that this may be an initial encounter and the provider may be out of the office at the time of the encounter and still bill under the MD.
My understanding is that under the incident to rule the MD/DO needs to be available in the office suite, then the NPP can bill under the provider's NPI whether or not the NPP is credentialed with the payer. The only way a NPP can bill under their own NPI number (which would be if the MD/DO is out of the office) is if they are credentialed with the payers.
 

cheermom68

Expert
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NP

Some insurances do need credential NP's and require the encounters to be billed under the MD's NPI. They may or may not follow incident to guidelines, it is payer specific. Some insurances only allow NP's to bill under their number and never allow them to bill under the NP, again payer specific.
LeeAnn
 
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