DecisionHealth, DecisionHealth - 2012 Issue 4 (April)

Private payer, PHO policies may create a compliance risk for NPP services

Keep an eye on reimbursement policies for physician assistants and nurse practitioners and be ready to work with physician hospital organizations to prevent improper payments and compliance errors.

A private payer that doesn’t credential non-physician practitioners may allow you to bill your NPPs’ services under the physician’s national provider identifier (NPI). The payer might not require a supervising physician to be in the office suite during the service or visit. In this case the practice is able to receive the full fee schedule amount for the NPP’s work and the physician is free to provide other services.

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