Author Topic: billing nurse practitioners  (Read 4343 times)

becca051

  • Newbie
  • *
  • Posts: 2
billing nurse practitioners
« on: February 13, 2014, 12:17:08 PM »
i have a question about billing nurse practitioners....we are in the state of mo and coventry, umr and uhc do not credential nurse practitioners....we were told by the insurance companies since they do not credential them to bill under the physician in the office and that incident to billing doesnt apply since they dont credential them....our auditors say otherwise...Is there a specific rule for billing nurse practitioners in this situation or does incident to billing actually apply? The ins gave us verbal instructions to bill under the physician but nothing in writing and the auditors want it in writing.

Any information would be great

PMRNC

  • Hero Member
  • *****
  • Posts: 4217
    • One Stop Resources & Networking for Medical Billers
Re: billing nurse practitioners
« Reply #1 on: February 13, 2014, 02:23:01 PM »
The insurance company should never tell you how to file a claim and they are in correct. The NP would have to be listed as the rendering provider, there's now way around that legally.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Merry

  • Sr. Member
  • ****
  • Posts: 363
Re: billing nurse practitioners
« Reply #2 on: February 14, 2014, 10:59:00 AM »
I did some research on this and I was surprised to see how many insurance companies tell you one thing yet refuse to put it in writing.
Since the NP's are not credentialed, they cannot be put in as a rendering provider, but my question would be why couldn't they be billed as "incident to".

Would like to see this conversation continue as I am perplexed.

Merry


shanbull

  • Full Member
  • ***
  • Posts: 176
Re: billing nurse practitioners
« Reply #3 on: February 14, 2014, 12:14:05 PM »
I did some research on this and I was surprised to see how many insurance companies tell you one thing yet refuse to put it in writing.
Since the NP's are not credentialed, they cannot be put in as a rendering provider, but my question would be why couldn't they be billed as "incident to".

Would like to see this conversation continue as I am perplexed.

Merry

We had this situation with an NP when she first started, everyone including Medicare told us to bill with our MD as both the billing and rendering provider until the NP had her own credentials sorted out. Even after that, some insurance companies kept telling us they weren't going to credential her individually and they would accept claims only if the billing and rendering provider were the MD and the NP was listed as the "resource". We thought this was all crazy and made our network managers assure us this was the only option. I still think it's crazy but we actually did have some of these claims audited by one of the insurance companies (Medica, owned by UHC) and they were fine with it. I still wouldn't recommend doing it without getting instructions to do so in writing from each insurance company. And I still don't understand the logic behind it. Seems much less messy to just credential the NP's. Especially because more and more are going to be coming down the pipeline due to MD shortages. I don't think the MD's are going to continue to be ok with it either. Someone else billing under your NPI is a great way to get nailed for fraud over something the other person did. The credentials on the line are the MD's.
« Last Edit: February 14, 2014, 12:16:18 PM by shanbull »

RichardP

  • Hero Member
  • *****
  • Posts: 688
Re: billing nurse practitioners
« Reply #4 on: February 14, 2014, 01:43:39 PM »
The insurance company should never tell you how to file a claim and they are in correct. The NP would have to be listed as the rendering provider, there's now way around that legally.

Traditionally, Federal law supersedes State law, unless the State law is more strict (contains everything the Federal law does, plus more).  I don't know if State law supersedes CMS regulations in this instance, but I invite you to read through my comment(s) at the following link.

In California, we operate according to the info in the attached blurb, and have no trouble getting paid by anybody.  That is, we bill the work done by the NP under the name of the doctor.  We put no info in Box 24J for Commercial carriers and they have nothing to indicate that the work was done by anyone other than the doctor.  For Medicare, they require the NPs Type 1 NPI Number (who did the work) in Box 24J - but we still bill under the doctor's Type 2 NPI Number (who gets paid).

The info from the link down to the [end quote] is a direct quote from the CMS Manual.

http://www.medicalbillinglive.com/members/index.php?topic=7045.msg21031#msg21031

This is the relevant bit:

A supplier [of medical services; a physician] may be an individual, partnership, corporation, trust, or estate. Any services furnished by an employee of the supplier are considered furnished by the supplier if those services are within the scope of the employment.

Think in terms of the doctor's nurse.  She does many things that the doctor bills for.  But the doctor bills for them in his name.  Same general idea applies to PAs, NPs, etc.  The difference here being that, if they qualify for it and have the appropriate NPI Number, PAs, NPs, etc. can bill in their own name if they want to - they will just get paid less than if the doctor bills for their work under his name.

becca051 - the link to that quote is given inside the link provided above.  That should cover your need for something in writing.
« Last Edit: February 14, 2014, 01:55:07 PM by RichardP »

Merry

  • Sr. Member
  • ****
  • Posts: 363
Re: billing nurse practitioners
« Reply #5 on: February 14, 2014, 01:50:40 PM »
I knew that you,  Richard, would come to the rescue. Thanks so much. Since I am in CA also, I am careful to post what I know for this state as everyone knows we do things so differently. :)

Merry
« Last Edit: February 14, 2014, 10:05:31 PM by Merry »

RichardP

  • Hero Member
  • *****
  • Posts: 688
Re: billing nurse practitioners
« Reply #6 on: February 14, 2014, 01:52:43 PM »
Merry - this type of question comes up quite a bit, and I refer the questioner to that link.  But the question of whether State law can supersede CMS regulations in this instance suddenly confronts me.  That is something I had not thought of before.  I know California allows us to bill like this.  Do you or anyone else know whether other State laws might forbid billing like this?

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4707
    • Solutions Medical Billing
Re: billing nurse practitioners
« Reply #7 on: February 14, 2014, 05:59:35 PM »
We bill like that in NY too, but I don't personally do any now.  In the past, with the insurance carriers that did not credential NPs they just billed out services under the md.  I just had no place to refer them to as to why that is so. 
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Merry

  • Sr. Member
  • ****
  • Posts: 363
Re: billing nurse practitioners
« Reply #8 on: February 14, 2014, 10:06:43 PM »
I don't know the different state laws. I do know whichever law is more stringent is the one that "counts". How is that for legalese?

becca051

  • Newbie
  • *
  • Posts: 2
Re: billing nurse practitioners
« Reply #9 on: February 17, 2014, 10:17:57 AM »
this is all great info and i appreciate it! so lets say the physician isnt in that day and our nurse practitioner sees a patient with one of these insurances can we actually bill with the physicians name since he isnt in office that day? our auditor says that we would have to bill alond incident to guidelines in order to bill under the physicians name and he isnt always in the office.

thanks again!

RichardP

  • Hero Member
  • *****
  • Posts: 688
Re: billing nurse practitioners
« Reply #10 on: February 17, 2014, 11:55:55 AM »
We researched this issue for our clients who wanted to add NPs to their office.  The term "supervision" has a specific meaning and is defined by each State.  A health-care attorney familiar with your State laws can help you determine how your State defines supervision.

For California, "supervision" is defined as being in the same room with the NP all the way up to being in the same city and immediately available by phone.  That is, the NP is considered to be "supervised" by the doctor so long as the doctor is in the same city as the office the NP is practicing in, and the doctor is immediately available by phone.

As an aside, think how this could work in California.  Doctor could have two offices.  Sees the wealthier patients in one office.  Sees the Obamacare patients in the other, where the NP does the work.  Has iPads in each office, connected by Skype.  NP doesn't know what s/he is looking at.  Skypes the doctor, and points the iPad camera at the target issue.  Doctor sees the image on his iPad screen and offers his informed opinion.  NP says "thanks", breaks the connection, and gets on with the work.

Billers - sell that idea to your clients.  They can increase their patient load and make money off of Obamacare, all without increasing their own level of stress.  But only if your State defines supervision as "being in the same city, immediately available by phone".  And only if the income from the Obamacare office is high enough to cover all expenses associated with the second office and the NP, etc.  (That idea is presented with tongue only slightly in cheek.)
« Last Edit: February 17, 2014, 12:06:27 PM by RichardP »

Merry

  • Sr. Member
  • ****
  • Posts: 363
Re: billing nurse practitioners
« Reply #11 on: February 17, 2014, 03:11:56 PM »
Love it..You are definitely the creative one.

PMRNC

  • Hero Member
  • *****
  • Posts: 4217
    • One Stop Resources & Networking for Medical Billers
Re: billing nurse practitioners
« Reply #12 on: February 17, 2014, 03:12:57 PM »
This is not related to NP however I once did a big whistleblower case on a provider not following the "supervision rules". He was going away on vacations and still I was getting charge slips for the type of provider that had to be supervised.     Be careful.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

PMRNC

  • Hero Member
  • *****
  • Posts: 4217
    • One Stop Resources & Networking for Medical Billers
Re: billing nurse practitioners
« Reply #13 on: February 17, 2014, 03:14:35 PM »
Quote
Billers - sell that idea to your clients.  They can increase their patient load and make money off of Obamacare,

There is no such thing as "OBAMACARE"   EVERY practice has to take a look and review very carefully ALL plan contracts for the "All products clause".  THERE is no Obamacare.   
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

dermbillerPA

  • Newbie
  • *
  • Posts: 6
Re: billing nurse practitioners
« Reply #14 on: March 04, 2014, 09:18:44 AM »
Quote
Billers - sell that idea to your clients.  They can increase their patient load and make money off of Obamacare,

There is no such thing as "OBAMACARE"   EVERY practice has to take a look and review very carefully ALL plan contracts for the "All products clause".  THERE is no Obamacare.   

Thank you for saying that!!!!
I just went through this process.  MD adding a PA.  I had to research/call every MD contracted carrier to get their requirements.  About 50% don't credential NPP's so must be billed as incident to.  Some just wanted the MD to update his demographics and the others wanted new applications.  There is a CMS MLN Matters Article Number SE0441 regarding incident to.  I was not able to attach the pdf article to this msg.  CMS does require direct supervision.