Nurse Practitioner Billing - I have a doc who is a PhD

bill2doc

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I have a doc who is a PhD, NP. She works in our family practice and recently asked if I could take over her billing. I currently bill for one of the other docs as part B fee-for-service. I'm just not sure if NP billing is that much different from primary care billing. Sorry if that sounds strange but I'm so use to just seeing MD and the PhD NP is confusing me. This doc is providing office visits and such just like my other.

Can someone give me the low down on NP billing. What I need to know. What obsticles I might encounter. Any help would be greatly appreciated!

Thanks in advance
Lynn
 

mshay134

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NP billing the same as MD billing. The reimbursement for the NP is 85% of what the MD would receive. Other than the difference in reimbursement, everything else is the same
 

Joyf

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What about as a physician extender service. Do you happen to know what I bill in the case that the physician and the NP see the patient on the same day? Is there a specific modifier that I am suppossed to use?
 

mitchellde

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if they both see the patient on the same day you bill as a shared service, you bill one E&M under the physician NPI.
 

donna_vig

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I wanted to add something to this. You only need to consider the NP services as incidental services if they have the same taxonomy code as the MD. There needs to be a supervising physician that has contracted with the NP. If they have the same Tax ID# and taxonomy code, then their documentation is combined and you bill under the MD for 100% reimbursement of the PFS. If not, then I would ask who her supervising physician is? If the NP see's the patient, the reimbursement is 85% PFS.

In the clinic, its the "Incident To" rules and in the facility setting, it's the "shared services". Medicare and Medicare replacement payers are the only payers that recognizes the "Incident To" rule so we always have to keep that in mind. Check out Medicare Manual 100-04, chapter 12, section 30.6. It has all the direction you need for this! Good luck!
 

mitchellde

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Medicare and Medicaid are not the ONLY payers that recognize and follow incident-to rules. Most other payers follow this as well. Medicare is recognized as the gold standard. If a payer professes to not follow this reg then you will need a payer specific policy in writing. Also shared service does not apply only to the inpatient setting, but incident-to applies only in the office setting.
 

kvangoor

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I would also be aware of the payer that do not accept/credential mid-level providers. There are many payers in MI that do not (medicaid, BCN and PH). We have to bill these under the supervising MD even though they were seen by the mid-level.
 

mitchellde

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When billing under the MD number and incident to conditions have not been met for a non medicare payer, be sure to get a policy in writing that allows you to do this, the AMA stresses that this policy needs to address the fact that this patient may not have been examined by the provider for this same problem and the provider may be out of the office at the time of the encounter.
 
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