Wiki Billing guidelines for NP

[Lori22]

I work for a surgeon & we have a new NP who we are in the process of getting credentialed. I know that until that happens, the NP can see patients when my doctor is in the office & we can bill under the doctor's provider numbers. Is there any other way for this NP to be seeing patients on days when my doc is not in the office? Can another credentialed NP supervise?
Also, my practice manager (who is not a certified coder)is telling me that we can cover ourselves by just putting the patients on the doctor's schedule (even though he is not in the office)& then letting the un-credentialed NP see the patient & bill the claim under the doctor's provider numbers. I feel like this is false billing. Can anyone please advise?

 

[mitchellde]

In order to bill under a provider that is not face to face to face with the patient at the time of the encounter, you must meet all of the incident -to rule, even if the payer is not Medicare. Medicare is the gold standard and unless a payer has a policy in writing that is different you must assume they follow Medicare. So for the NP to see patients and use the MD NPI , these must be visits where the provider has already evaluated the patient for this same diagnosis in a previous visit and established a written plan of care that the NP is simply following at this encounter, and the provider you are billing under must be physically present in the office suite area at the time of the encounter. Putting the patient on the doctors schedule and then using the NP to conduct the encounter is definitely out. The provider you bill under can be any provider in the practice as long as they are in the same specialty and physically present.

 

[Ranasebai@aol.com]

NP Billing

I work for a surgeon & we have a new NP who we are in the process of getting credentialed. I know that until that happens, the NP can see patients when my doctor is in the office & we can bill under the doctor's provider numbers. Is there any other way for this NP to be seeing patients on days when my doc is not in the office? Can another credentialed NP supervise?
Also, my practice manager (who is not a certified coder)is telling me that we can cover ourselves by just putting the patients on the doctor's schedule (even though he is not in the office)& then letting the un-credentialed NP see the patient & bill the claim under the doctor's provider numbers. I feel like this is false billing. Can anyone please advise?

Lori, NP should be credentialed before she see patients on her own if the physician is not in the office, an NP can't supervise another NP, That applies to all insurance companies from Medicare to BCBS, Aetna and even Cigna is more complicated than other insurance companies. They could penalize your physicians for wrongful/fraud billing.

Rana Sebai RN, CPC, CPPM