# nurse pratitioner/physician assistant billing



## svms (Jul 24, 2014)

Help,

I work in a small multi-specialty practice; we have family care, orthopedics, physical therapy, general surgery, internal medicine, and rheumatology.

A question just arose today in our office about billing for a nurse practitioner and physicians assistant.

I need to get the correct response. But I must also find out where it is documented so that I can give it to the Dr. that I work for. He also owns the practice.

This is IOV versus established visit. 

If a patient comes in and sees a patient in family care. After the patient becomes established, he sees a family care nurse practitioner and the claim is billed in her name. 

The patient later is referred to our orthopedics department.

QUESTION?????

Because the patient was seen in family care and the claim was billed in the nurse practitioner's name, I have always been told I cannot bill an IOV for the orthopedic visit. (or vise versa-if our physician's assistant sees a patient in orthopedics, and it is billed in her name, than the patient wants to be seen in family for the first time- we cannot bill an IOV for family care either). 

The reason why I was told we cannot bill an IOV when the nurse practitioner/physician assistant was seen is because "NPP's are not afforded the opportunity to designate a sub-specialty. A NPP can only designate their primary licensure."

But the Dr. this morning is questioning if this is correct. Since both the nurse practitioner and the physician assistant have different primary specialty. Neither have a subspecialty assigned to their name.

PLEASE, ANY HELP WITH THIS WILL BE GREATLY APPRECIATED.

BUT I ALSO NEED TO KNOW WHERE THIS INFORMATION IS DOCUMENTED AS WELL SO THAT I CAN FORWARD THIS TO MY SUPERVISOR AND THE PHYSICIAN THAT I WORK FOR.


----------



## mhstrauss (Jul 24, 2014)

TeaTime said:


> Help,
> 
> I work in a small multi-specialty practice; we have family care, orthopedics, physical therapy, general surgery, internal medicine, and rheumatology.
> 
> ...





I think I can help, but not sure what an IOV is ??

It sounds like a problem similar to what we have here.  See Question #12 in this link; there is a reference to a CMS Manual there:

http://www.novitas-solutions.com/we...es%2FMedicareJH&_adf.ctrl-state=1v4ptl5b0_177

Basically, NPP's are all registered with a supervising physician.  You are not limited to billing established visits for the second specialty a patient sees within your clinic (if patient saw MD and NP infamily care first, then referred to ortho, ortho is not limited to established visits).  You will probably have to appeal proving that the NP from family care practices in a different specialty.  It takes some work, but we have been successful in getting the new patient visits from subsequent specialties paid.

Hope this helps!


----------



## svms (Jul 24, 2014)

mhstrauss said:


> I think I can help, but not sure what an IOV is ??
> 
> It sounds like a problem similar to what we have here.  See Question #12 in this link; there is a reference to a CMS Manual there:
> 
> ...



How did you appeal this? What info do you use to prove the NPP specialty. Is the office note sufficient or do you have something else you use for appealing?

I have a coworker that did appeal to Medicare probably about 3-4 years ago. As a result of the answer she received, we have changed the way we have been billing.

If our patient sees the NP in family care, and than at a later time visits a physician in orthopedics specialty we have not been billing the IOV (initial office visit) for orthopedics. (or visa versa). 

Have we been loosing revenue all this time?


----------



## mhstrauss (Jul 24, 2014)

TeaTime said:


> How did you appeal this? What info do you use to prove the NPP specialty. Is the office note sufficient or do you have something else you use for appealing?
> 
> I have a coworker that did appeal to Medicare probably about 3-4 years ago. As a result of the answer she received, we have changed the way we have been billing.
> 
> ...





When an NPP is registered with Medicare, their supervising (for PA's) or collaborative (for NP's) physician is assigned.  You can search each MD involved on the NPPES website, and print the page showing which taxonomy the MD is registered under.  We appealed with the office note, the taxonomy info on both MD's, and a statement to the effect of "the NPP that the patient was seen by previously is in specialty Family Care, under Dr. A; the denied service is with Dr. B, which is an Ortho.  The patient has not seen any other Ortho providers prior to DOS XXXXXX with Dr. B."  I don't have any specific examples right now that I can look through for better verbiage of the appeal, but I do know that we have won most of our appeals, and were paid for the "new patient" MD visit for each different specialty.


----------

