Author Topic: Nurse Practitioner  (Read 2182 times)

camedbill

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Nurse Practitioner
« on: August 01, 2013, 05:44:46 PM »
We have a psychiatrist MD who wants to add a nurse practitioner.  Does anyone know if a board certified NP can get credentialed with behavioral health insurance companies?  and can the NP use the same codes as the MD?
Thanks in advance for your help

RichardP

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Re: Nurse Practitioner
« Reply #1 on: August 02, 2013, 02:26:12 AM »
Generally, a doctor can hire and pay employees for helping him provide his services.  An NP can be such an employee.  In this case, the doctor is the billing entity: his Type 2 NPI Number (who gets paid) goes in Box 33a and the NP's Type 1 NPI Number (who did the work) goes in Box 24J when required (Boxes on the CMS 1500 form).  It is the billing entity (the doctor) who has the contractual relationship with the insurance carriers, and he can bill for whatever his contract allows him to bill - even though it may have been the NP who did the actual work.

If certain requirements are met, an NP can get their own NPI numbers and bill under their own name and NPI numbers.  But payment is higher if the NP bills under the name and the NPI number of the supervising physician.

Your question seems to imply that the NP will be hired under the scenario presented in the first paragraph.  If the scenario is actually the second paragraph, please say so, because then the criteria are different.

Also, this is the general truth for regular medicine.  I understand that mental health billing is a different animal, and so there may be some truths for mental health billing that my first paragraph above doesn't cover.  Linda and others who know can speak to that.

rdmoore2003

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Re: Nurse Practitioner
« Reply #2 on: August 02, 2013, 09:01:55 AM »
you need to contact each insurance carrier that you are contracted with to see if they cover a NP and if so, then you can add the NP to the group contracts.  Does the NP have a specialty for mental health or are they just a general NP?
Regina

RichardP

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Re: Nurse Practitioner
« Reply #3 on: August 02, 2013, 10:52:48 AM »
... if so, then you can add the NP to the group contracts.

Regina, we have clients who use NPs in the manner I described in the first paragraph of my first post above.  They are individual practitioners.  Your advice would be for a situation where there is a legally-established Group that is the billing entity.  There are no group contracts involved with a solo practitioner, unless I am missing something or unless this is particular to mental health billing.

camedbill

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Re: Nurse Practitioner
« Reply #4 on: August 02, 2013, 10:57:59 AM »
Sorry I forgot to mention that the NP is board certified in family medicine not mental health and she will be billing under the MD as 'incident to' services.  The MD does have a billing corporate entity.  Do I still need to add the NP to the MD corp billing entity? and is it possible to add if the MD is a psychiatrist?
I thought when you bill 'incident to' services, both box 24 & 33 goes under the billing provider

RichardP

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Re: Nurse Practitioner
« Reply #5 on: August 02, 2013, 05:23:26 PM »
Not all carriers require an NPI Number in Box 24J.  But when a number is required, it must be the Type 1 NPI Number - which designates who did the work.  In the case of a sole proprietor (incorporated or not), both numbers (Box 33a and 24J if required) belong to the sole proprietor.  If the sole proprietor hires someone to help him, the Type 1 NPI Number of the employee who did the work goes in Box 24J, if a number is required.  The Type 2 NPI Number of the sole proprietor (the billing entity who gets paid) goes in Box 33a.

Again - a service provider, regardless of whether individual or coporate, can hire folks to help get the work done.  The billing entity would be the entity doing the hiring.  The billing entity's Type 2 NPI Number (who gets paid) goes in Box 33a.  That billing entity's contractual relationship with each insurance carrier governs the billing transaction - regardless of who actually does the work.  The Type 1 NPI Number of whoever does the work goes in Box 24J only if it is required by the insurance carrier.  If the carrier does not require an NPI Number in Box 24J, they will have no reason to know that the doctor was not the one who did the work.  With regular medical care, so long as the MD (or his corporation of one) is the billing entity, and bills under his Type 2 NPI Number, it does not matter what field the NP is board certified in.

Again, mental health billing has some requirements that are different from billing for regular medical care, so what I have said may need to be tweaked by someone who knows mental health billing.

rdmoore2003

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Re: Nurse Practitioner
« Reply #6 on: August 05, 2013, 02:42:25 PM »
With the insurance companies that we are paneled with, do require NPI's across the board.  We just had a couple of providers leave our office and new ones came in.  When I had to panel with our insurances, we just had to add to our group contracts since they are already credentialled.  It really depends on the situation.  I had 1 provider that just got licensed and had to credential then add to our group.   I would suggest to contact your panelled insurances and see what they require.   As for the requirements on the NPI, I just make it standard practice to set each insurance to show the billing entity and also the rendering.  Seems more streamline and I have had absolutely no problems.  even when the 2013 codes changed, I had more stories of mental health providers all over the country not getting reimbursed and our office never really had any issue.
Regina

RichardP

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Re: Nurse Practitioner
« Reply #7 on: August 05, 2013, 05:50:09 PM »
We just had a couple of providers leave our office and new ones came in.  When I had to panel with our insurances, we just had to add to our group contracts since they are already credentialled. ...  I would suggest to contact your panelled insurances and see what they require.

Again, Regina, you are talking about the requirements for billing when the Group is the billing entity.  These requirements are different from the requirements for billing when a sole proprietor is the billing entity.  All indications are that the original question concerned a sole proprietor who has incorporated his business.  That is still a sole proprietorship, not a group.

Can you explain briefly what you mean by "... I had to panel with our insurances .  That phrasing is not familiar to me, but I assume you are describing something I know by another name or phrase.

rdmoore2003

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Re: Nurse Practitioner
« Reply #8 on: August 06, 2013, 08:46:06 AM »
join network, panel, contracted
Regina

RichardP

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Re: Nurse Practitioner
« Reply #9 on: August 06, 2013, 12:19:56 PM »
Thanks.