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New patients and nurse practitioners/PAs

  1. Default New patients and nurse practitioners/PAs
    Medical Coding Books
    I work for a practice that currently has 1 PA employed and will soon be employing an NP. I am questioning whether or not they can see new patients with any insurance, including Medicare. I had always been under the impression that they could not see new Medicare patients, but could with all other carriers. Now, it seems that that only applies to "incident to" and therefore, could see new patients if billing under the NP/PAs number... is this correct?

    Also, with Worker's Comp claims, is it still the case that these always need to be addressed initially by the physician and can only then be seen and billed by the NP/PA?

    Any and all help will be greatly appreciated!! I would love any supporting documentation you might be able to provide as well. Thanks so much for your help!

  2. #2
    Default Depends on your state
    Medicare will pay for new patients under NPPs if it is allowable in your state. They pay 85% of the physician fee schedule.

    As far as insurances go, some don't even credential NPPs, so that will be carrier specific.

    I imagine that the workers comp will be the same thing, in that it will vary state to state.

    I know that doesn't seem very helpful, maybe if you list what state or states you deal with someone will have more specific info.

    Laura, CPC

  3. #3
    North Carolina
    In addition to Laura's statment......

    Review Sections: (CMS Manual)

    60: "incident to"
    190-PA billing
    200-NP billing

    On the AAPA website, the left hand side addresses WC, Private payers, etc.
    Last edited by RebeccaWoodward*; 06-17-2009 at 11:41 AM.

  4. Default
    Thanks for that tip, I'm in Virginia....

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