Hello everyone. We have a practice in Massachusetts (full NP scope state)that is owned by an NP. She employed a new NP to work with her who is not yet credentialed. How or can you bill for the services provided by the new employed NP. Thank you all in advance.
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Wiki NP owned practice / billing for employed NP staff
- Thread starter rmorgan@mailchs.com
- Start date
thomas7331
Guest
I don't know of any legal way to do this since the rules for 'incident to' billing apply only to physician-owned practices. I would recommend the new NP be scheduled only with patients who have the insurance plans with whom he or she is credentialed.
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I fully agree with @thomas7331. This type of issue occurs in all types of practices.
Here is my personal recommendation when you have a new provider (whether NPP or physician) who is not yet credentialed. Some of this (like #3 & #4) does not apply to your situation, but is my credentialing advice in general.
1) Submit credentialing ASAP. I try to do this before provider has even started. I start the process the day the employment contract is signed.
2) Until that provider is credentialed, you need to make a business decision about what work they provide. I try to maximize the amount of work they provide that is either not paid or billable correctly. Examples of work not paid: postop visits, rx renewals, patient phone calls for triage or results, afternoon hospital rounds after another clinician rounded in the morning. Once they start becoming credentialed, keep an updated list of those insurances and funnel patients with those plans to the new provider. Schedule all self pay patients with this new clinician.
3) If the new provider is an NPP, schedule as much as possible that could be billed incident-to a physician. There are a few rules about this, so make sure you are following them. For example: physician must be onsite, treatment plan must already be determined by physician, etc.
4) If you have any commercial carriers that do not credential NPPs and want services billed under physician, that is another option. Side note: this used to be common, but none of my current carriers want this. Your contracts/carriers could vary.
5) You may decide it is in the best interest of patient care and the practice for this clinician to sometimes provide care that you know you will not be covered under insurance. You could decide to provide the services for free. Create a dummy code in your system that does not get billed to insurance to track the work for your own knowledge (provider metrics, etc.) You could inform patients that the provider is not credentialed and they would be billed for any insurance applied deductible/co-insurance. I would have them sign an acknowledgement of this. Some carriers could require a specific form for this.
Here is my personal recommendation when you have a new provider (whether NPP or physician) who is not yet credentialed. Some of this (like #3 & #4) does not apply to your situation, but is my credentialing advice in general.
1) Submit credentialing ASAP. I try to do this before provider has even started. I start the process the day the employment contract is signed.
2) Until that provider is credentialed, you need to make a business decision about what work they provide. I try to maximize the amount of work they provide that is either not paid or billable correctly. Examples of work not paid: postop visits, rx renewals, patient phone calls for triage or results, afternoon hospital rounds after another clinician rounded in the morning. Once they start becoming credentialed, keep an updated list of those insurances and funnel patients with those plans to the new provider. Schedule all self pay patients with this new clinician.
3) If the new provider is an NPP, schedule as much as possible that could be billed incident-to a physician. There are a few rules about this, so make sure you are following them. For example: physician must be onsite, treatment plan must already be determined by physician, etc.
4) If you have any commercial carriers that do not credential NPPs and want services billed under physician, that is another option. Side note: this used to be common, but none of my current carriers want this. Your contracts/carriers could vary.
5) You may decide it is in the best interest of patient care and the practice for this clinician to sometimes provide care that you know you will not be covered under insurance. You could decide to provide the services for free. Create a dummy code in your system that does not get billed to insurance to track the work for your own knowledge (provider metrics, etc.) You could inform patients that the provider is not credentialed and they would be billed for any insurance applied deductible/co-insurance. I would have them sign an acknowledgement of this. Some carriers could require a specific form for this.
Thank you so much for your reply. That was our thought as well, and you've confirmed it. Enjoy your day!
Thank you for taking the time with your excellent recommendations! We appreciate this information very much. The NP that owns the practice did not research thoroughly ahead of time and is now paying the price, unfortunately. Grateful for your response.