General Category > General Questions
Nurse Practitioner
camedbill:
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:
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:
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?
RichardP:
--- Quote from: rdmoore2003 on August 02, 2013, 12:01:55 PM ---... if so, then you can add the NP to the group contracts.
--- End quote ---
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:
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
Navigation
[0] Message Index
[#] Next page
Go to full version