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NP Billing Question

  1. Default NP Billing Question
    Medical Coding Books
    We have and NP that has started working with our group. She does not have ANY numbers. Do we bill under the physicians ID number until her numbers are issued?

    Thanks!

  2. #2
    Location
    Columbia, MO
    Posts
    12,858
    Default
    Only if they meet the definition of incident to, meaning followp encounters while the physician is on site.

  3. Default
    Thank you. I read the incident to quidelines and we do not qualify. I hvave found out that the physician is seeing patient's with our NP so I know how to bill for that. I do not know how to bill when she starts seeing patients by herself or even if she is allowed to until she has an NPI, PTAN, etc...

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    "Incident to" applies to Medicare, however, some commerical carriers follow these guidelines. Many commerical carriers have their own policies for credentialing NPPs and providing reimbursement for their services. Some plans credential NPPs and allow their services to be billed under the NPPs' provider number. Other plans do not and instruct practices to bill for services provided by NPPs using the physicians name and NPI number. I would check with your commerical carriers to see what the billing requirements are for your midlevels.

  5. #5
    Location
    Stuart Sailfish Chapter
    Posts
    867
    Default
    When and if your NP gets his/her own provider numbers you will bill out to medicare, (Im assuming that you will be credentialing with medicare) under his/her own Provider number/NPI. you will be reimbursed 85%of the Medicare Allowable, there are other commercial insurance companies that have there own definitions of incident to. so it would be best to check with your provider reps.

    hope this helps
    Candice Fenildo, CPC, CPMA, CPC-I, CPB, CENTC, CRHC, AAPC Fellow
    Director of Operations
    Ear, Nose and Throat Associates of South Florida, PA
    772-342-6976
    cfenildo@entsf.com


    "Nothing is stronger than the heart of a volunteer"

  6. Talking Npp insurance filing
    We have an npp. She has her own npi number, medicare number and medicaid number. However, with commercial insurance companies, we file under the doctor who is on call or in the office on the specific dates in question. Each carrier may have their own specs and you might want to verify with the carrier.::d

    G.WILLIAMS, CPC, SCP-OBGYN
    Last edited by GAILWILLIAMS; 06-17-2009 at 01:21 PM. Reason: ADD ADDITIONAL INFO

  7. Talking Npp insurance filing
    We have an npp. She has her own npi number, medicare number and medicaid number. However, with commercial insurance companies, we file under the doctor who is on call or in the office on the specific dates in question. Each carrier may have their own specs and you might want to verify with the carrier.::d

    G.WILLIAMS, CPC, SCP-OBGYN

  8. #8
    Default
    Would a PA fall under the same catagory? Follow up with each carrier?
    TJ Smith, CPC
    Cheyenne Physicians Group
    Cheyenne, WY

  9. #9
    Default
    Yes, PA billing is very similar to NP, it will vary carrier to carrier and state to state based on their scope of practice.

    Medicare classifies NPs and PAs as NPP (Non Physician Practicioners).

    Laura, CPC, CEMC

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