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
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!