• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We're introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

Nurse practitioner billing

ecaissie

Networker
Messages
25
Best answers
0
Hi! I know that, for Medicare, nurse practitioners gets paid 85% of the fee schedule, but my question is - how does Medicare know that the provide is an NP? Is there something in their NPI that tells them? Or am I supposed to be using a special modifier (or something else) to clue them in? Thanks!
 
Messages
1
Location
Weston,Florida
Best answers
0
When they applied for their Medicare Provider Number they notified Medicare that they were a Nurse Practitioner. They had to send license and other forms of identification when they applied.
 

ecaissie

Networker
Messages
25
Best answers
0
Kathryn:

Thanks! But I'm being told that I also have to use Modifier SA on claims - do you know anything about that? When I looked on different websites, it seemed to indicate it wasn't appropriate to use it, but my client just had a meeting with Medicaid and was told I should be using it....

Elizabeth
 

ecaissie

Networker
Messages
25
Best answers
0
Thanks, but these are not "incident-to" claims. Here in NJ, nurse practitioners are permitted to see patients on their own if they have a supervising physician, who does not need to be onsite, just available for calls, etc. These are nurse practitioners who own their own practice. I believe their specific specialty is adult medicine.
 
Top