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Nurse Practioner

  1. #1
    Smile Nurse Practioner
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    Can anyone tell me how to find the guidelines for billing for a nurse practioner? Also billing for a NP under a Dr? I cant seem to find help.
    Thnx

  2. #2
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    North Carolina
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  3. #3
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    Is this guideline good for group insurances as well?
    Thnx

  4. #4
    Location
    North Carolina
    Posts
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    This will become carrier specific for commerical plans. Some carriers do not credential midlevels which would require you to report the service under the physicians name and NPI #...assuming the service is within the NPP's scope of service. I would contact the plan(s) in question for their guidance.

  5. #5
    Location
    Columbia, MO
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    Quote Originally Posted by bkwrmz7 View Post
    Is this guideline good for group insurances as well?
    Thnx
    Since Medicare is considered the gold standard then you should assume it is good across the board. The AMA has stated that if a payer indicates that you should "just bill under the physician" then you should request this writing with the stipulation that they are setting aside the medicare definition of incident to and will allow you to bill under the physician number when the definiton of incident to has not been met. I have question several commercial carriers on this point and all told me that they mean to follow incident to per Medicare when they state to bill under the physician it is just misinterpreted by the provider.

    Debra A. Mitchell, MSPH, CPC-H

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