decisionhealth Newsletters, Part B News - 2017 Issue 1 (January)
If NPP’s not yet enrolled in Medicare, only do incident-to billing
Subscribe or sign in to view the full article.
Article Overview
This article explains a Medicare billing question involving a nurse practitioner who is shadowing in a practice before enrollment or credentialing is complete. It covers the general compliance concerns around supervising-provider billing, incident-to service requirements, locum tenens exceptions, and the related liability insurance issue. The piece is aimed at medical practices, billing staff, and compliance-focused providers who need to understand when a service can be billed under a physician versus when a practitioner must be separately credentialed.
Why This Topic Matters
Practices often need to know how to handle services furnished by new non-physician practitioners while enrollment and credentialing are pending. The article highlights the compliance and reimbursement risks that can arise when billing arrangements do not match Medicare expectations.
Article Sections
-
Question
A practice asks about billing arrangements for a newly starting nurse practitioner who is shadowing physicians and participating in services before credentialing is complete.
-
Answer
The response addresses Medicare enrollment, credentialing, incident-to billing, supervisory presence, and related compliance concerns for non-physician practitioners.
-
Licensure, credentialing, and insurance considerations
The article closes with a discussion of professional coverage and liability issues that can arise when a practitioner is providing services in a practice setting.
What You Will Learn
- How the article frames Medicare enrollment and credentialing issues for a new non-physician practitioner.
- What broad compliance areas are associated with billing services under a supervising provider.
- Why incident-to billing and liability coverage are discussed together in the article.
- What general risk considerations are raised when a practitioner is working before full enrollment is complete.
Who Should Read This
- Medical practice administrators
- Billing and coding professionals
- Compliance staff
- Physicians supervising non-physician practitioners
- Nurse practitioners and physician assistants
Modifiers Discussed
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com