under the supervising physician’s pro- vider identifier may continue this billing arrangement.”
Billing under the NPP’s provider num- ber may be simpler than billing “incident to” from a documentation and supervi- sion standpoint, but it could result in lower payments and involve some ad- ministrative work in credentialing NPPs with health plans.
When an NPP is able to bill “incident to” using the physician’s provider num- ber, the practice receives 100 percent of the allowable charge. But if a physician isn’t available and the NPP has to bill un- der his or her own provider number, the practice receives a reduced percentage of the allowable charge.
Most payers, including Medicare and Medicaid, separately enroll NPPs. Obtaining a billing number for an NPP should involve the same credentialing steps as for a physician. Mr. Rivera says a practice should review payer policies for specific limitations related to NPPs. “Next, physicians need to analyze how
those requirements can be implemented efficiently within the practice. For in- stance, many payers require a physician to examine a new patient first before NPPs can initiate ‘incident to’ billing,” he said.
Billing “incident to” and billing un- der the NPP’s provider number have additional Medicare and Medicaid limi- tations, which TMA’s Nonphysician Pro- viders: Hiring, Billing and Delegation of Duties for a Nonphysician Practitioner addresses in detail. (See “TMA’s NPP Re- sources,” at right.)
NPP scope, supervision Texas licenses PAs and advanced prac- tice nurses (APNs), including nurse midwives and certified registered nurse anesthetists. PAs and APNs differ in their educational requirements, licensure, and regulation but often provide similar ser- vices, such as conducting physical ex- aminations, creating therapy plans, and counseling patients. The primary differ- ence between a PA and an APN is that, under certain circumstances, an APN can practice nursing independently of a physician while a PA cannot practice medicine independently.
Mr. Rivera describes NPPs as “exten- sions of the physician by law,” a distinc- tion that has advantages. “Many NPPs have very specialized training in a particular medical specialty in addition to tailored training they re-
ceive from supervising physicians in cer- tain practice settings,” he said. He stresses that it’s important for
NPPs to function as part of a physician- led team and within their scope. Generally, NPPs can provide acute
TMA’s NPP resources
TMA has myriad tools to help physicians manage nonphysician practitioners (NPPs) properly. The TMA Office of the General Counsel wrote a white paper titled “Delegation of Duties by a Physician to a Non-Physician” with information on delegation of medical acts and prescriptive authority, standing delegation orders, physician supervision, and other topics. View it at www
.texmed.org/npp or contact the TMA Knowledge Center at (800) 880-7955 or
knowledge@texmed.org to request a copy. In February, TMA began offering the seminar Nonphysician
Providers: Fundamentals of Billing and Supervision to inform physicians about recruiting and supervising NPPs, document- ing supervision and oversight, and billing appropriately for NPP services. Log on to
www.texmed.org/nppseminar2012 or call (800) 880-7955 to register. It offers 3 hours of continuing medi- cal education credit. Nonphysician Providers: Hiring, Billing and Delegation of
Duties for a Nonphysician Practitioner is also available for sale from TMA. The publication, by TMA Practice Management Consultant Laura Palmer and attorney Julian Rivera, JD, covers prescriptive authority, physician liability, NPP scope of practice, physician supervision, standing orders, documentation require- ments, hiring NPPs, billing, credentialing with government and private payers, and more. Call the TMA Knowledge Center, (800) 880-7955, for information about the publication. TMA Practice Consulting can also help physicians with their NPP needs in recruiting, billing, and coding. TMA Practice Consulting services are available for a fee. To schedule recruiting services, a billing and collections assess- ment, a coding and documentation review or training, or other services, call (800) 523-8776, or email
practice.consulting@
texmed.org. Additional information is available on the TMA Web site,
http://consulting.texmed.org.
March 2012 TEXAS MEDICINE 29
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60