Wiki NP billing

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scuatro4

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hi everyone, I am having a bit of a confusion here. I am trying to research billing for NP that has recently opened her own location, (with the assistance of a provider). the only thing is that this provider will never be available in office, but the NP wants to bill for her services under providers NPI but get reimbursed under her address/office location. Are there any helpful links/guidelines that provide more information on how to bill for an NP that has opened own practice? anything is helpful. :)
 
If this NP will be practicing in a separate location, then she will have to bill under her own NPI - mid-level providers may only bill under a supervising provider's NPI if all of the 'incident to' rules have been met, and one of those requirements is that the supervising provider must be on site at the time the service was performed. (The only exception to this might be for a particular payer that does not credential NPs and may require that NP services be billed under the credentials.) Beyond that, billing for services of the NP will be pretty much the same as billing for a physician. The scope of practice for NPs is set by laws of the state in which they practice and there may be some state-specific restrictions. I don't have any links to share with you, but I'd recommend reviewing the CMS 'incident to' rules - you'll find many articles about this if you do a search - and also find your state's board of nursing web site to review any applicable state regulations that may apply.
 
I agree with Thomas. Also if this NP has opened her own practice, then you will need to treat this as her own practice and credential her as if there were no other provider in the practice because there is not. You need to be upfront with the payers on this. I do not know of any payer that will allow an NP in a separate practice/location to bill the services under a provider in a different practice. You cannot represent these visits as visits by the physician when that physician is not a part of the practice. Check you state laws also, I imagine that the NP will need to obtain a separate tax ID as well.
 
Thank you very much, this is very helpful in clearing up doubts I had. I've been reviewing CMS incident to rule guidelines, but I really wasn't coming across anything that helped clear my doubts with NP billing under own practice. And I know I need to contact each individual payer for specific coverage/billing requirements they have. But in the case a provider is adding the NP to malpractice insurance, is there anything about this that changes billing for NP? Ive just been trying to research billing for NP and now my eyes are crossed . thank you all
 
you should check with the malpractice provider. Again an NP in her own practice with a different site and address... I am not sure the malpractice holder will allow her to be added to the physician policy. also be sure the claims reflect the different address, even if it is just a suite number difference. I honestly do not believe there is anyway a payer will allow this NP to bill services using the provider NPI when this is an entirely separate practice. And I believe the same will be true with the malpractice insurance.
 
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mitchellde said:
you should check with the malpractice provider. Again an NP in her own practice with a different site and address... I am not sure the malpractice holder will allow her to be added to the physician policy. also be sure the claims reflect the different address, even if it is just a suite number difference. I honestly do not believe there is anyway a payer will allow this NP to bill services using the provider NPI when this is an entirely separate practice. And I believe the same will be true with the malpractice insurance.
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Thank you very much
 
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