Wiki PA/NP insident to..

[tracid001]

I'm in a practice that has a PA and is looking into getting a NP. my issue is do i have to credential them with the insurance companies even if the Dr wants them to bill insident to???

 

[kandigrl79]

It depends upon the payer. Some do not want claims billed incident to. For example, in my state, Palmetto (Medicare), Tricare and Optima all want PAs and NPs to bill under their own NPI and to have their own names on the claim with AS modifier. They will not accept claims billed incident to. Others, allow claims to be billed incident to, so...unfortunately, it's not really up the doctor.

 

[kandigrl79]

It depends upon the payer. Some do not want claims billed incident to. For example, in my state, Palmetto (Medicare), Tricare and Optima all want PAs and NPs to bill under their own NPI and to have their own names on the claim with AS modifier (for surgeries that is). They will not accept claims billed incident to. Others, allow claims to be billed incident to, so...unfortunately, it's not really up the doctor.

 

[penguins11]

In order to bill incident to, you have to make sure the visit meets incident to guidelines the dr has to see the patient first and establish a plan of care in order to bill any additional visits as incident to. You also should check with each individual payor to see how they want the NP registered, some want them completely credentialed, some dont care and always want things billed under the dr. For incident to guidelines, you should be able to do a search on CMS website for a complete list of guidelines. Also, there might be some limitations as to what the NP can do based on your state guidelines.