Billing for Nurse Practioners

by Robert Campbell
(Jackson , MS)

I know NP's can now get and bill under their own provider numbers, but is the long time practice of billing NP services under a sponsoring (or collaborating) physician illegal or otherwise against any known rules?


Medicare is the only payor that I see that mandates NP using their own number in certain circumstances. I do not see this matter addressed in most of the other billing guidance. We have been doing it this way for many years in certain circumstances. i.e until NP got their numbers and were network credentialed or NP that was a transient and certian payers do not pay for NP billings , etc.

Response:

I don’t know of any guidelines, rules, or legislation that mandates Nurse Practitioners having to bill under their own provider number - other than Medicare's. I haven’t billed that much for NP’s but I understand it depends on the individual health plan - which sets their own policies.

As you probably know these policies are not always very clear or easy to find. I wouldn’t be surprised if many began following Medicare’s lead and mandating NP’s use and bill under their own provider number at something like 85% of the physician rate.

Here’s a good article from Nurse Practitioner World News that addresses reimbursement for NP’s and discusses that each carrier makes it’s own rules.

They state that when a payer doesn’t specifically require a Nurse Practitioners services be billed under a physician’s name or number, the practice does risk an improper billing charge if a payer comes back and claims it requires services to be billed under the name and provider number of the individual who actually performed the service.

Hope this answers your question - thanks for visiting the site.

Click here to post comments

Join in and write your own page! It's easy to do. How? Simply click here to return to Your Questions.

Recent Articles

  1. Is it possible to work in Medical Billing or Coding at night instead of during the day?

    Oct 23, 17 09:16 PM

    How common is it that a company would allow you to work from home as well as working at night so you can be with your children during the day? I'm an

    Read More

  2. Should I get my medical billing certificate from AAPC or somewhere else before I start my own business?

    Oct 23, 17 09:15 PM

    Hi! I am contemplating starting my own medical billing business and I was wondering if I should get my medical billing certificate from AAPC or some other

    Read More

  3. What is the CPT code for 'Male Hormone Panel'

    Oct 23, 17 08:57 PM

    What is the CPT code for 'Male Hormone Panel' ...testosterone/estrogen/PSA/IGF- 1 /DHEA -Sulfate/ Progesterone Response: We'll post in hopes our Visitors

    Read More

Disclaimer and Privacy

All-Things-Medical-Billing.com provides this website as a service. Please read our full Disclaimer and Privacy Policy here.


Copyright 2017 All-Things-Medical-Billing.com