Author Topic: NP billing  (Read 2629 times)

jlgorske

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NP billing
« on: January 06, 2009, 04:14:58 PM »
We are in Texas and the nurse practitioner owns her own family practice clinic.  She hired a collaborating physician as required by law.  So the NP is NOT an employee of the MD.  Now, to bill claims for the NP can she bill using the MD's numbers (incident-to) as long as she states she is the servicing provider (SA modifier) or is that fraudulant since the NP is not working for the MD????

We are being told by one side that it's fraudulant and by another that it's not.  We of course don't want to bill anything incorrectly. 

If the NP owns the clinic and simply has an MD b/c the law requires it, can she bill using the MD's numbers?  And if so, would the NPs tax-id or NPI be ANYWHERE on the claim?  Is using the SA modifier enough to tell the insurance company that the NP saw the patient? 

One major concern is that if filed this way, the income is reported on the MD's tax-id number.

PLEASE HELP!!!!  thanks....

Michele

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Re: NP billing
« Reply #1 on: January 06, 2009, 07:38:31 PM »
It is ok for the NP to own the practice.  Billing under the MD does not depend upon who the boss is.  As long as they are following the guidelines of what needs to be done for the NP to bill under the MD.  As far as what numbers go on the claim, that depends on the insurance carrier.  If the NP is credentialed under her own name then she would use her numbers on the claim.  Some insurance carriers don't credential the NP's independently and they have to bill under the collaborating physician.  In that case the MD's numbers would go on the claim with the SA modifier. 

No matter whose numbers are on the claim the tax ID should be the NP's for her group.  The MD is an employee of the group and all billing should be done under the group's tax ID.  You just need to make sure the MD is linked to the group name, tax ID and group NPI (which also should be in box 33 on the cms, the MD's group npi should not be on the claim) with all the insurance carriers.

Michele
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jlgorske

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Re: NP billing
« Reply #2 on: January 06, 2009, 07:52:35 PM »
Say the NP is credentialed with United Healthcare.  Can the NP not bill under the MDs numbers to get the higher pay rate?  Or must the NP always bill with her numbers if she is credentialed with that insurance?

Thanks for your help!

Michele

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Re: NP billing
« Reply #3 on: January 07, 2009, 06:46:44 AM »
If the NP is credentialed independently with the carrier being billed the claim should be submitted with her numbers.

Michele
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jlgorske

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Re: NP billing
« Reply #4 on: January 13, 2009, 03:50:16 PM »
OK I know to bill under the NPs numbers for those insurances that have credentialed her.  However, our issue is with Cigna.  They will not credential a NP, so can she see Cigna patients and if so, how do we bill?  You stated previously that we should add the MD to the NPs tax-id.  If I read that correctly, how do I do that?  It that something I do with Cigna?  You stated that I always want to bill under the NPs tax-id but can a tax-id be registered to more than 1 person? 

Thanks for helping!

Michele

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Re: NP billing
« Reply #5 on: January 14, 2009, 07:38:42 AM »
You just need to make sure the MD's NPI is linked to the NP's practice.  The MD can have his individual NPI linked to more than one tax ID# and more than one practice.  So if he has a private practice in addition to working for the NP that is ok.  When he works for her, she bills his individual NPI and her group name, address, tax ID and group NPI.  When he works for himself he bills under his name, address, tax Id, individual and group NPI's.

Just call Cigna and make sure they recognize him under her group.

Michele
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jlgorske

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Re: NP billing
« Reply #6 on: January 14, 2009, 09:34:08 AM »
Does the insurance company look at the NPI to determine the pay rate?  Or do they look at the tax-id?  I guess I am asking what specific field (25, 24j or 33a) does the insurance company use to determine what to pay out?

Thanks again for all of your help!

Julie

Michele

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Re: NP billing
« Reply #7 on: January 14, 2009, 09:52:26 AM »
I can't speak for all insurance carriers, but usually they go by 24j which tells them the specific provider who performed the services.

Michele
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jlgorske

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Re: NP billing
« Reply #8 on: January 14, 2009, 10:10:43 AM »
Thank you - your help has been MOST appreciated!!!!