Wiki Nurse Practitioner Credentialing

[Kimonae]

Hello,
Our NP credentialing status is still pending. However our physician leader wants to know :
1. If a patient is seen in our office by a Nurse Practitioner, can the claim be submitted under the supervising physician's name rather than the NP? The physician would not be directly involved in the care plan but would sign off on each note.

2. In this situation, does the NP need to be credentialed with insurance carriers?

Can you point out where I can find any related documentation from the major payers ?

Thanks!

Carine

 

[CodingKing]

If they payer recognizes incident-to. MD must see patient first and establish plan of care. Nurse must be administering physicians plan of care. MD must be present in the office suite and immediately available. If plan does not allow incident to or it doesn't meet incident to criteria, it must be billed under the NP's name.

 

[thomas7331]

I agree. Signing off on a note is not sufficient to meet 'incident to' requirements and bill under the supervising MD. If the MD is not otherwise involved in the care, the NP's services should be billed under his or her own credentials unless the payer directs otherwise. Here's a good article from CMS that spells out the requirements: https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/se0441.pdf