# Nurse Practitioner Billing - Wondering if someone can point me



## cvand1972 (Feb 14, 2013)

Hi,
Wondering if someone can point me in the right direction for NP Billing.  Here is the question:
Hypothetically, if a NP saw a patient (with a Supervising MD in the office suite but not physically seeing the patient also), can we still bill with the MD provider # to capture 100% payment?
What if it was a new patient?  Could we still bill under the MD provider #?

I know Medicare has 'incident to' rules and all that so I'm not looking for that, but this question relates to how we do things in our practice overall.

Currently, in our practice, if an NP sees a patient, everyone feels that the only way we can bill with the MD's provider # is if the MD also comes in to the room and visits with the patient for a bit.
If an NP sees a patient and an MD does not come in to the room at all, everyone feels that we should bill under the NP provider #, even though the Supervising MD is in the Office.

What does everyone else do?


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## cassyn86 (Feb 14, 2013)

Our office has 5 Nurse Practioners and an oversight MD who also sees patients here. We never bill under the MD unless the MD was the actual one who saw the patient. If the Nurse Practioner sees the patient whether the patient is new or existing we bill under the NP.


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## Amanedmaiston (Feb 19, 2013)

We generally go by Medicare guidelines so I would bill under the NP. However I have seen commercial payers state you can bill under the doc as long as he is on site. There was also another commercial carrier that stated you could as long he reviewed 20% of the NP's charts. You really should check with all your non- Medicare carriers to see what they want. Some may allow you to bill it under the doctor and some may not. Also check your reimbursment because some carriers pay the NP's the same as they do the doctor so I would not even bother with those carriers.


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## mitchellde (Feb 19, 2013)

When you are discussing this with the commercial carriers you must be clear that you are wanting to bill under the physician even though he has never seen the patient for this same issue, or has never seen the patient at all, and the provider may be out of the building at the time of the visit.  Most carriers to go by the Medicare rule for incident to billing although they may not be familiar with the term incident to.  Also you may need to check you provider malpractice terms, most will not allow this to take place.


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## lisa92 (Feb 19, 2013)

So, an NP follwing up on physicans plan, can not bill under the physician?
What if physician is in the suite seeing other pt's, reviews NP's note, and signs off under NP?


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## mitchellde (Feb 19, 2013)

If the NP is following up on an established problem and established plan of cafre and the physician is on site then you may bill under either the physician or the NP.  If the physician is not on site and the payer does not credential NPs then you cannot just bill under the physician, you must have a policy from the provider in writing that states that they do not follow the Mcare definition of incident to and they understand that the patient may not have been seen for this same diagnosis by the physician or that the provider may not be onsite at the time of the visit.
You cannot just use the physician NPI to gain a higher reimbursement.
If this is a new patient or new problem you cannot just have the physician sign off on the documentation without him/her having a separate note indicating they have seen and examined the patient during this patient and what their specific findings and recommendations are.


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## lisa92 (Feb 19, 2013)

Great!


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## avilesbilling (Feb 20, 2013)

*Arnp*

I would like to know an ARNP can see eyes and bill code 92004 which is a new patient code for optometrist and opthalmologist


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## sammie06 (Jul 25, 2013)

*Incident TOO*

Can you provide me where you found these guidelines in order for me to show my providers. Thanks so much.


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## dtricia (Jul 29, 2013)

*NP billing incident to, using time statement*

I find guideline for both of these practices, and nothing state the NP cannot do both a the same time. Often times the NP is counseling regarding a new dx and plan. I am getting push back on this.
Tricia


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## mitchellde (Jul 29, 2013)

the incident -to guidelines are in the MCM and the IOM and the shared encounter guidelines are in CR1776.  An NP can counsel regarding new treatment but the NP must bill using his/her own NPI number.  The Shared services guidelines states you cannot share a new patient or a new patient and the physician must physically see the patient and document his/her own note to bill under the physician NPI.  Signing off on the NP documentation is insufficient to bill using the MD NPI.  
If the NP changes the physician treatment plan, or addresses a new problem, then it is not incident-to and must be billed under the NP NPI or the physician must physically see and evaluate the patient and write a separate note in order to use the MD NPI.


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