When can a practice bill a nurse practitioner's services under a physician's name?

Carolyn Buppert, attorney and former nurse practitioner, talks about how to comply with Medicare's incident-to billing rules and get 100% of the physician rate for services provided by a nurse practitioner.
For more information on the legal issues affecting nurse practitioners and their employers visit her website, www.buppert.com

[@danimarie9002]

Does incident to apply from one nurse practitioner to another nurse practitioner

[@amyq6343]

This was a fabulous explanation. I was finally able to understand the basics of incident to billing easily! I am currently a CPC and am studying for my CPB (Certified Professional Biller) exam. I will pass the information along to my collogues for reference, as well. Thank you so much!!

[@Tonnie31]

Thank you for all of your videos they are so helpful

[@bcsmedconsults29]

This is wonderful, thank you. I just got a case referral about this question today. Best Regards and Subscribed.

[@bcsmedconsults29]

Question Carolyn, does the NP or APN need to put a modifier on the claim if they are billing using the MD NPI number? In the case I am citing, there is a NP who is billing using the MDs NPI number, but they are doing the entire evaluation and management service.

[@mayraz7436]

So I heard in CPC class that “incident to” was no longer going to effective as of 2020, is this correct?

[@carolynbuppert268]

No that isn't correct. "Incident to" (applicable in offices and clinics) will continue. It is the rules on "shared visits" (applicable to hospital visits) that CMS proposes to change starting January 1, 2022.

[@mayraz7436]

@@carolynbuppert268 Thanks Carolyn, so the only time we can actually bill under the physician even if an NPP is seeing them as long as they are actively involved in the patient's care (eg. when a physician would do an eval and re-eval)

[@carolynbuppert268]

@@mayraz7436 Yes, to bill under a physician's name when the NP is providing evaluation and management in an office setting, the physician needs to do an evaluation and remain involved in the care of the patient, plus the physician needs to be in the office suite at the time of the service, and the physician must employ or have a contract with the NP (or the MD and NP must be employed by the same entity).