Wiki Nurse practitioner billing

[ecaissie]

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!

 

[kathrynejones417]

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]

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

 

[mssalemny]

What type of practice? I have provided a link from an earlier thread that had the same discussion. We have not had the requirement as of yet but it appears to be carrier specific


https://www.aapc.com/memberarea/forums/showthread.php?t=101711

 

[ecaissie]

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.