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.

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