Billing for Nurse Practitioners or Physicians assistant in General Medical Billing Questions Forum

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Billing for Nurse Practitioners or Physicians assistant

Author	Comment
antony	Billing for Nurse Practitioners or Physicians assistant	Lead	[-]
Posts: 33 Oct 1 09 11:19 AM Reply Quote More My Recent Posts	Tags : nurse practitioners, physicians assistant Hi, My doctor is a specialist Contracted under a group with Medicare and is planing to recruit a nurse practitioner / physicians assistant my question is If a patient is seen by the Nurse Practitioners or Physicians assistant 1. Can we billed under the specialist name? 2. If we bill under the Nurse Practitioners or Physicians assistant we would mention the individual (Nurse Practitioners or Physicians assistant) info in Box 24J and Group info in Box 33. 3. If the specialist is not in the office at the time when the Nurse Practitioners or Physicians assistant seeing the Pt does the Billing change. Regards Antony Sequeira you can also reach me @ tonycoorg@hotmail.com
Doo		#1	[-]
Posts: 6238 Oct 1 09 1:42 PM Reply Quote More My Recent Posts	1. Yes, if the services meet the incident-to rules. Otherwise, you bill under the NP or PA's name and license number. 2. Yes. 3. Yes, you cannot bill incident-to (under the specialist) if the specialist is not in the office. In that case you must bill under the NP or PA. One of the things that cannot be billed incident-to is a new patient or new problem. So if, like many practices, you adopt a policy that all new patients must see the NP first, you must bill all those under the NP (and accept the lesser reimbursement that comes with it). Sharon Moderator Nothing I say shall be construed as legal advice; always check with your own financial or legal advisors for your specific situation.
antony		#2	[-]
Posts: 33 Oct 2 09 10:18 AM Reply Quote More My Recent Posts	Thank you Sharon for you help. Regards Antony Sequeira.
ReikiBoy		#3	[-]
Posts: 346 Oct 6 09 10:58 AM Reply Quote More My Recent Posts	Some insurance companies credential PA's and NP's and some don't. Medicare does. In my state Medicaid credentials NP's but not PA's. Some insurance companies offer you the option of credentialing the NP or billing with a modifier under the doctor's name. Medicaid wants SA modifier when the NP renders or HN when the PA renders. BS wants modifier AM for PA's. The modifier reduces payment to the NP/PA fee schedule (15% of the physician). Per the Medicare rep after my last go-round with them, you cannot bill an NP's work to Medicare as incident-to. Medicare wants the NP credentialed. If the NP hasn't been credentialed yet with Medicare you wait until credentialing is done and then bill it. If the date of service was prior to the date Medicare gave as credentialed you lose that money. They used to allow you to back bill but not anymore; you can only go back 30 days. If the provider was credentialed on 10/1 you won't be paid for anything prior to 9/1. Medicare credentialing can take up to 90 days. I suggest not letting new providers start employment until they're initially credentialed in your state.
Doo		#4	[-]
Posts: 6238 Oct 6 09 2:20 PM Reply Quote More My Recent Posts	Reikiboy: Just to clarify - we bill the NP as incident-to AFTER credentialling. If the MD is not in the office, we bill directly under the NP. If the MD is in the office and it's a followup visit, we bill incident-to. But I agree... they must be credentialed. Sharon Moderator Nothing I say shall be construed as legal advice; always check with your own financial or legal advisors for your specific situation.
antony		#5	[-]
Posts: 33 Oct 12 09 9:27 AM Reply Quote More My Recent Posts	Hi, I had one more question on the same Can PA's render service to Subacute patients / Skilled Nursing Facility patients. Thanks Antony Sequeira
ReikiBoy		#6	[-]
Posts: 346 Oct 14 09 4:21 AM Reply Quote More My Recent Posts	Yes and no. PA's may render and bill for subsequent nursing home visits. Medicare regulations state that they may not bill the initial assessment (99304 - 99306). That must be performed by the physician. That means that PA's can't admit, same as in hospitals. I'm kind of remembering that PA's can't bill the highest code (99310) but I'm not sure. In addition your state's dept of public health may require the physician to see the pt every so often instead of only the PA. Here's a link to a billing guide produced by the Medicare intermediary in my state. You may need to click on "accept" before you get to it: http://www.medicarenhic.com/providers/pubs/nonphyguide.pdf
antony		#7	[-]
Posts: 33 Oct 14 09 12:48 PM Reply Quote More My Recent Posts	Thank you

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