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Office Managers, Medical Billers and Medical Coders
How Do I bill for the Nurse Practioner's service?
Incident-to versus Own NPI?

    There are 2 possible scenarious here:

    1.) If you are billing for the NP service without a physician's supervision, and
    if the physician is not physically in the office (same office suite - not different
    floors!) you will bill using the Nurse Practioner's NPI (National Provider
    Identification) number.

    2.) If the NP service is under a physician's supervision, you can bill for this
    service as "incident to".  The rule is, the supervising physician MUST be in
    the same office suite as the NP. By billing this, you will bill undert the
    physician's NPI number.

    What is the difference?  the nurse practioner who is billing under her own
    NPI number will be reimbursed for her service at NP's percentage rate
    (85% with Medicare).  While the Incident-to (billing under the supervising
    physician's NPI) will be reimbursed at the physician's percentage rate.
    (100% with Medicare). Check with your other payors regarding

    Rule of thumb:  
    "Incident-to" billing must follow all current Medicare guidelines (established
    only patient, physician's treatment plan/plan of care). Check with your other
    payors regarding their guidelines and policies on how to bill incident-to. I
    know most of these payors follow Medicare's guidelines!