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Nurse Practitioner: A Case Study

Decent Essays

It is very important for the Nurse Practitioner (NP) to know how the employer is billing for NP services. There are several different ways for the NP to get reimbursed for the services they render to their patients. The reimbursement method can get complicated, and the NP must be aware of the rules and regulations prior. For example, “Medicare will pay 85% of the physician rate for the services”(Bupper. C, 2011), when the NP renders service and bills by using their own NPI. However, if the NP is working with the physician, the NP can bill under the physician’s provider number, and acquire reimbursement at the full rate. This can get complicated because there are certain rules and regulations that would need to be followed. See below:
• The …show more content…

• The physician must perform "the initial service and subsequent services of a frequency which reflect his or her active participation in the management of the course of treatment."
• The physician or other provider under whose name and number the bill is submitted must be the individual present in the office suite when the service is provided (Bupper. C, 2011).

For instance, the physician must start the initial treatment, and thereafter, the NP may conduct follow up visits with that patient. However, the incident to billing rules become ambiguous as to if the physician must perform service for every new problem or NP use their provider number (Bupper. C, 2011). This would need to be clarified and each interpretation may differ. Many facilities may consider the initial history and physical needing to be completed by the physician and then subsequent visits could be performed by the NP, and continue to use the physician’s provider number. If the NP is working at a facility where the physician is not present, then the NP must bill service under their provider’s number (Bupper. C, 2011). If they use the physician’s provider number, then this will be considered an illegal practice in regards to incident to billing rules. It is very important that the NP understands and follows the rules and regulations in respects to incident-to bills, and be able to perform services and practice under this legal

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