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How to bill for a Nurse Practitioner in a medical office is a frequent question we receive. To answer the question, we look towards Medicare policy. Under Medicare, doctors have 2 options of how to bill for Nurse Practitioner services: (1) bill for Nurse Practitioner services as an "incident to" service under the doctor's provider number; or (2) bill for Nurse Practitioner services under the Nurse Practitioner's own National Provider Identifier (NPI).
"Incident to": Reimbursement for "incident to" services allows the office to 100% of the physician fee schedule for services rendered by the Nurse Practitioner. Notably, under Medicare, to bill "incident to" the Nurse Practitioner services must be furnished as an integral-incidental part of the physician's personal professional services in the course of diagnosis or treatment of an injury or illness commonly furnished in the office. Further, the doctor must provide "direct supervision" of the Nurse Practitioner, which requires the doctor be present in the office suite and immediately available to provide assistance and direction while the Nurse Practitioner is performing services. Be advised that "incident to" billing only applies to medical offices, and it is not permitted in hospitals, skilled nursing facilities, or in the home.
Nurse Practitioner's own NPI: Reimbursement for Nurse Practitioner services billed under the Nurse Practitioner's own NPI allows the office to receive 85% of the physician fee schedule. For such billing there is no supervision requirement. However, before hiring and allowing a Nurse Practitioner to treat patients in your practice, double check that the Nurse Practitioner is legally authorized to perform required services in the state your practice is located, and that all additional supervision and licensure requirements are followed.
The above information is a general overview of Medicare policy for billing Nurse Practitioner services and is does not include all required standards for Nurse Practitioner billing. In addition, the above discusses Medicare policy, which in many instances is the policy followed by third party payors, however, third party payors may adopt their own policies and procedures that must be followed should you be submitting bills for reimbursement.
For additional information on this topic, contact Jennifer Kirschenbaum at (516)-747-6700 ext. 302 or at Jennifer@Kirschenbaumesq.com.
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