CME OnDemand: Crack the Codes Practice Management and Coding-Workbook: PA and NP Billing Strategies for Both the Office and Hospital

Workbook: PA and NP Billing Strategies for Both the Office and Hospital

Pdf Summary

The document discusses Medicare guidelines for billing the services of physician assistants (PAs) and nurse practitioners (NPs). "Incident to" and split/shared billing are terms used by Medicare to report the services of non-physician providers. These terms may not be acknowledged or followed by commercial insurance carriers who may have their own rules and require different modifiers. Medicare guidelines for "incident to" billing include requirements for an established patient with an established problem, service within the NPP's scope of practice, direct personal supervision by the physician, and being furnished by an employee of the physician. Certain places of service, such as provider-based clinics, inpatient services, and emergency room services, do not allow "incident to" reporting. The document also discusses direct billing, where the NPP bills under their own NPI, without the need for physician supervision. Direct billing is allowed in all places of service. The document also highlights the guidelines for split/shared billing, which require both the physician and the PA/NP to provide a portion of the service and document their respective work. Methods for measuring the substantive portion of split/shared visits vary and can be based on time or a provider who performed certain parts of the visit "in its entirety." The document also provides examples of how scenarios are reported to Medicare and whether modifiers are required. For split/shared billing in 2024 and beyond, time will be the sole method used to determine the substantive portion.

Keywords

Medicare guidelines

billing services

physician assistants

nurse practitioners

incident to

split/shared billing

commercial insurance carriers

modifiers

direct billing

split/shared visits