Author Topic: NPI for Nurse Practitioners  (Read 3076 times)

datwood

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NPI for Nurse Practitioners
« on: April 16, 2013, 12:24:54 PM »
Hi!  I would like to apologize first of all but I am new at this... I love your site!

I am trying to help out one of the office manager.  They just started using EHR and the e-script.  They received a phone call from their EHR software stating that the Nurse practitioner NP's number does not match the NPI.  What happened was they do not have NPI for the NP.  The NP is under the Dr.'s group number and NPI group number for billing.  The question we have is ~ does she need to get an NPI number even though she is not billing for Medicare because she is under the Dr's supervision while seeing patients?  If she needs to get NPI does she need to get Medicare PTAN number as well?

Your answer will make our day and is very very much appreciated!  I want to thank you in advance for any suggestions and answers.

D

RichardP

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Re: NPI for Nurse Practitioners
« Reply #1 on: April 16, 2013, 02:28:49 PM »
One of the points of the NPI numbers was to make this relationship more clear to CMS.  Hence the Type 1 (who did the work) and Type 2 (who gets paid) NPI numbers.  Both must be used on the CMS 1500 form that is submitted to Medicare.  One tells CMS who did the work, and the other tells CMS who gets paid.  In the case of a solo practitioner, both of the NPI numbers provided on the CMS 1500 form belong to him.  In the case where the work was actually performed by a hireling, the CMS 1500 form must contain the Type 1 NPI number for who did the work (the hireling), plus the Type 2 NPI number for who gets paid (the hirer).

On the CMS 1500 Form, the Type 2 NPI number for who gets paid goes in Box 33.  The Type 1 NPI number for who did the work goes in Box 24J.  The Type 1 NPI number for the referring doctor goes in Box 17a.  This is how we do it and we have no problems getting paid.


From here:  (you might want to read the entire post)
http://www.medicalbillinglive.com/members/index.php?topic=7087.msg21277#msg21277

When certain conditions are met, NPs can bill under their own authority - and payment will be sent to them in their name.  Based on what you have just read, the NP would need two NPI numbers - just as physicians do.  A Type 2 to show who gets paid, and a Type 1 to show who did the work.  Just as a physician does, if the NP is billing under their own authority, both NPI Numbers supplied would be their own - because they both did the work and they are the ones getting paid.

Even when not billing under their own name, a NP should get a Type 1 NPI Number.  The CMS 1500 Form would then contain the Type 2 NPI Number (who gets paid) of the supervising physician and the Type 1 NPI Number (who did the work) of the NP.

In your situation, if the Group gets paid, and if your NP does not have a Type 1 NPI Number - you would use the Type 2 NPI Number of your Group in Box 33A of the CMS 1500 Form.  The Type 1 NPI Number of the supervising physician should go in Box 24J.  If it is the supervising physician who gets paid, his Type 2 NPI Number would go in Box 33A.

We do not put any number in Box 24J when we bill commercial carriers.  So - if you are not billing Medicare, I don't really understand the problem.  Figure out who should get paid, and put their Type 2 NPI number in Box 33A.  But this number must belong to the name and address in Box 33.  That name and address in Box 33 should also belong to whoever is getting paid.

Did you fill in Box 17 (Referring Provider) on the rejected form?  If so, that should be the Type 1 NPI Number of the supervising physician (assuming s/he is the referring provider).  If the NP has no NPI number, the information on the CMS 1500 Form should all belong to the supervising physician and who gets paid.  Nothing about the NP should be on the Form.

In summary:  if you are billing a commercial carrier, and the NP is not billing in their own name, there should be nothing on the CMS 1500 Form about the NP.  If you are billing Medicare, and the NP is not billing in their own name, the NP's Type 1 NPI Number should show up in Box 24J only.  If the NPI has no NPI Number, then the Type 1 NPI Number of the supervising physician should show up in Box 24J (but only necessary when billing Medicare).

This can be confusing.  Come back if you need more clarification. 

I believe that a PTAN number is an issue only if the NP is billing under their own name.  Then they would need a PTAN.  If they are not billing under their own name, I believe the NP does not need a PTAN.
« Last Edit: April 16, 2013, 03:24:53 PM by RichardP »

datwood

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Re: NPI for Nurse Practitioners
« Reply #2 on: April 16, 2013, 05:07:42 PM »
Hi Richard!  I thank you for your reply.   :)