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Thread: Direct Billing for Nurse Practitioners

  1. #1

    Default Direct Billing for Nurse Practitioners

    AAPC: Back to School
    With direct billing (Medicare) for NP in the hospital, are they allowed to admit for an inpatient stay and a SNF stay as well? Thank you - I have been researching all morning.

  2. #2
    Join Date
    Apr 2007
    North Carolina


    Inpatient hosptial stay...Yes...if it's within their scope of practice for that state.

    Section 200 (for the 1st link)




    Further, per the Long Term Care regulations at 42 CFR 483.40 (c) (4) and (e) (2), the physician may not delegate a task that the physician must personally perform. Therefore, as stated in S&C-04-08 the physician may not delegate the initial visit in a SNF. This also applies to the NF with one exception.

    The only exception, as to who performs the initial visit, relates to the NF setting. In the NF setting, a qualified NPP (i.e., a nurse practitioner (NP), physician assistant (PA), or a clinical nurse specialist (CNS), who is not employed by the facility, may perform the initial visit when the State law permits this. The evaluation and management (E/M) visit shall be within the State scope of practice and licensure requirements where the E/M visit is performed and the requirements for physician collaboration and physician supervision shall be met.

    Page 68 or section 30.6.13


  3. #3


    Thank you so much!

  4. #4


    I reread your response and it leads me to ask this question. Our NP works for our Hospitalist Group that is seperate from the hospital. Can we then bill for the inital SNF?

    Thank you again

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