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billing nurse practitioners

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becca051:
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:
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.

Merry:
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:

--- Quote from: Merry on February 14, 2014, 01:59:00 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

--- End quote ---

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.

RichardP:

--- Quote from: PMRNC on February 13, 2014, 05:23:01 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.
--- End quote ---

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.

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