Nurse Practitioner billing- please advise

lscire722

New
Messages
3
Best answers
0
I am receiving conflicting information if they can work independently to see new patients.
We are an infertility clinic in the state of NY.

Any feedback would be appreciated!
 

csperoni

True Blue
Messages
652
Location
Selden
Best answers
2
Are you asking about whether they are permitted by scope of practice to see new patients independently?
Or whether you may bill for them to independently see new patients?
And by "independently" do you mean they are still in some way supervised or collaborate with a physician but are seeing the patient without the physician present?
If you are receiving conflicting information, it may be because you are confusing incident to billing and scope of work. My guess is you are seeing information as it relates to incident to billing and interpreting that as the NP may not see new patients. NPs and PAs may absolutely see a new patient without a supervising physician present, but must bill under their own credentials. Incident to billing is when the NP or PA sees the patient, but billing is done under the supervising physician. Incident to has several requirements, including the physician must be present in the suite, and it must be an established patient with an established problem with a plan of care. You will get less reimbursement billing with the NP credentials, but it is required for new patients.
If you could provide additional information, that may be helpful.
 

Bintmasria11

Contributor
Messages
11
Best answers
0
I actually have a similar question about scope of work vs. incident to billing. In the state of Arizona, if an NP works alongside an MD to see patients (new and established within same group), what are the signature requirements if the claim is to be billed under the MD? is it OK for the notes to not be signed by the MD simply due to the scope of work for NPs or?

I got conflicting answers also that because the state of AZ's NP scope of work, NPs are allowed to work independently (I read it as independently on their own) BUT others are reading it as it does not require notes be signed by an MD although they are billed under the MD, which sounds incorrect. thank you for your help.

thank you.
 

csperoni

True Blue
Messages
652
Location
Selden
Best answers
2
https://www.bartonassociates.com/locum-tenens-resources/nurse-practitioner-scope-of-practice-laws is the best link I have ever seen to determine scope of work for Nurse Practitioners by state. That site indicates NPs in AZ do NOT need physician sign off by scope of work.
Incident to billing does not require the MD/DO to sign off on the note, but many practices have it done as a policy. As a reminder, for incident to billing, it must be an established patient, existing problem with an established plan of care. If your NP is seeing new patients, or new problems, it cannot be billed under MD/DO even if they sign off.
 

Bintmasria11

Contributor
Messages
11
Best answers
0
https://www.bartonassociates.com/locum-tenens-resources/nurse-practitioner-scope-of-practice-laws is the best link I have ever seen to determine scope of work for Nurse Practitioners by state. That site indicates NPs in AZ do NOT need physician sign off by scope of work.
Incident to billing does not require the MD/DO to sign off on the note, but many practices have it done as a policy. As a reminder, for incident to billing, it must be an established patient, existing problem with an established plan of care. If your NP is seeing new patients, or new problems, it cannot be billed under MD/DO even if they sign off.
If the MD does not sign off, how is it indicated that it is an incident to visit (to justify the higher reimbursement)? since it would be billed under the MD in this case but the NP is the one who performed the visit?
 

csperoni

True Blue
Messages
652
Location
Selden
Best answers
2
You could supply other information (such as schedules) in an audit to show the provider was on site. And the previous physician note showing the problem is established and plan of care.
 
Top