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Medicare billing and Nurse Practitioners

  1. Smile Medicare billing and Nurse Practioners
    Medical Coding Books
    Is there any type ruling that a physician has to see a patient at any time during their continued care with a practice, if this patient is Medicare? In other words, can the NP provide care for all dates of service after the first initial establishment? Thanks

  2. Default
    I believe that you are correct if it's in an office setting. If the physician has seen the patient, the the NP can then provide services from there on. I believe that each state has guidelines on how often the physician has to review the NP's documentation.

  3. #3
    Kansas City, MO
    An NP must bill under their Medicare number if they see New Patients or Established Patients with New Problems. In order for the NP to bill incident-to the physician, the physician has to have seen that patient for the condition and documented that the patient can follow-up with the NP. If during that follow-up visit a new problem arises, the NP must bill under their own number or have the physician step in. When a physician is not involved the NP can see the patient as long as it is within their scope of care, they bill under their own number. Member7 is correct that states may have their own additional guidelines as well.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013

  4. Default
    It was also my understanding that NP cannot give prescriptions for any new medications or change the patients care plan without the physician examining and reviewing the NP documentation and agreeing with the change. Is this correct do you have any insite to this comment.


  5. Red face NP
    I Work In An Internal Med Office And Have 2 Nps. In The State Of Va. They Are Not Required To Check With The Phsicians. They Can Have Their Own Patients That They Solely Follow. They Can Even Have Their Own Offices. Hope This Helps. Thanks

    Nicole Wessell, Cpc

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