Wiki Nurse Practitioner Scheduling Rules

[janyhopkins]

If you have a practice that has only one DR and one NP and they have Saturday clinic once a month and the NP is seeing those patients can those patients be placed on the Dr's schedule?
This is my first month working for this practice and they just had their first of the month Saturday clinic. All the encounters have the DR name on them as they were placed on his schedule under his name even though he wasn't in the office and is off. The NP seen the patients and she has dictated and signed off on them. Should he sign off on them or is it acceptable for them to be on his schedule with her signing off on the charts? Should they all be reviewed by him?

Thank you,
Jan

 

[thomas7331]

It doesn't matter which provider's schedule is used as that's something that is internal to your practice. But if the NP is seeing a patient when the physician isn't in the office, you need to make sure it's billed under the NP's credentials on the claim and not the physician's, because one of the requirements for 'incident to' billing of mid-level providers' services under the physician is that the physician must be on site during the services.

Whether or not the physician reviews and 'signs off' on the chart is not really relevant to coding and billing. NPs in most states are allowed to practice independently. This is something that would depend on your NP's supervision arrangement with this physician and doesn't change the way you would code or bill any of the visits.

 

[janyhopkins]

It doesn't matter which provider's schedule is used as that's something that is internal to your practice. But if the NP is seeing a patient when the physician isn't in the office, you need to make sure it's billed under the NP's credentials on the claim and not the physician's, because one of the requirements for 'incident to' billing of mid-level providers' services under the physician is that the physician must be on site during the services.

Whether or not the physician reviews and 'signs off' on the chart is not really relevant to coding and billing. NPs in most states are allowed to practice independently. This is something that would depend on your NP's supervision arrangement with this physician and doesn't change the way you would code or bill any of the visits.

Thank you so much for this information! If she is only BC/BS credentialed and is allowed to work independently would she only be allowed to see patients with the insurance payor of BC/BS?

 

[csperoni]

Tricky question there. Whether she is "allowed" and/or whether you will be paid are 2 separate questions.
If she is only credentialed with BCBS and billing is under her name, any other insurance will be processed as out of network (which could mean denied, applied to deductible, etc.)
She is "allowed" by her training and state policies to treat and care for patients.
I STRONGLY recommend you immediately begin the process of her credentialing with any other insurances that your physician participates with.

From a previous of my posts - Here is my personal recommendation when you have a new provider (whether NPP or physician) who is not yet credentialed.
1) Submit credentialing ASAP. I try to do this before provider has even started. I start the process the day the employment contract is signed.
2) Until that provider is credentialed, you need to make a business decision about what work they provide. I try to maximize the amount of work they provide that is either not paid or billable correctly. Examples of work not paid: postop visits, rx renewals, patient phone calls for triage or results, afternoon hospital rounds after another clinician rounded in the morning. Once they start becoming credentialed, keep an updated list of those insurances and funnel patients with those plans to the new provider. Schedule all self pay patients with this new clinician.
3) If the new provider is an NPP, schedule as much as possible that could be billed incident-to a physician. There are a few rules about this, so make sure you are following them. For example: physician must be onsite, treatment plan must already be determined by physician, etc.
4) If you have any commercial carriers that do not credential NPPs and want services billed under physician, that is another option. Side note: this used to be common, but none of my current carriers want this. Your contracts/carriers could vary.
5) You may decide it is in the best interest of patient care and the practice for this clinician to sometimes provide care that you know you will not be covered under insurance. You could decide to provide the services for free. Create a dummy code in your system that does not get billed to insurance to track the work for your own knowledge (provider metrics, etc.) You could inform patients that the provider is not credentialed and they would be billed for any insurance applied deductible/co-insurance. I would have them sign an acknowledgement of this. Some carriers could require a specific form for this.

 

[janyhopkins]

Tricky question there. Whether she is "allowed" and/or whether you will be paid are 2 separate questions.
If she is only credentialed with BCBS and billing is under her name, any other insurance will be processed as out of network (which could mean denied, applied to deductible, etc.)
She is "allowed" by her training and state policies to treat and care for patients.
I STRONGLY recommend you immediately begin the process of her credentialing with any other insurances that your physician participates with.

From a previous of my posts - Here is my personal recommendation when you have a new provider (whether NPP or physician) who is not yet credentialed.
1) Submit credentialing ASAP. I try to do this before provider has even started. I start the process the day the employment contract is signed.
2) Until that provider is credentialed, you need to make a business decision about what work they provide. I try to maximize the amount of work they provide that is either not paid or billable correctly. Examples of work not paid: postop visits, rx renewals, patient phone calls for triage or results, afternoon hospital rounds after another clinician rounded in the morning. Once they start becoming credentialed, keep an updated list of those insurances and funnel patients with those plans to the new provider. Schedule all self pay patients with this new clinician.
3) If the new provider is an NPP, schedule as much as possible that could be billed incident-to a physician. There are a few rules about this, so make sure you are following them. For example: physician must be onsite, treatment plan must already be determined by physician, etc.
4) If you have any commercial carriers that do not credential NPPs and want services billed under physician, that is another option. Side note: this used to be common, but none of my current carriers want this. Your contracts/carriers could vary.
5) You may decide it is in the best interest of patient care and the practice for this clinician to sometimes provide care that you know you will not be covered under insurance. You could decide to provide the services for free. Create a dummy code in your system that does not get billed to insurance to track the work for your own knowledge (provider metrics, etc.) You could inform patients that the provider is not credentialed and they would be billed for any insurance applied deductible/co-insurance. I would have them sign an acknowledgement of this. Some carriers could require a specific form for this.

Thank you very much for this wealth of information. I'll will discuss this with the NP and get started on the credentials!