Q&A: How to bill for nurse practitioners

Q: Our practice employs a nurse practitioner. She sees patients-usually same-day, call-in acute visits-while my partner and I make our rounds at the rural hospitals we cover. We would like her to start seeing our house-call patients. We are currently billing her services with the provider number of the doctor whose patient she is treating in the office. Would that change, since she would be seeing patients in their homes?

A: The billing scenario you describe for the office services provided by your nurse practitioner is governed by the "Incident To" rules for Medicare and other insurers. For Medicare, "Incident To" requires a physician to be in the suite, and the nurse practitioner cannot see new patients or existing patients with new problems. If the physician treats the patient for an acute problem and wants the patient evaluated post-treatment, the nurse practitioner could provide this service, because it is a documented part of treatment. The services provided by the nurse practitioner must be billed under the provider number of the supervising physician-not the physician whose patient is being treated. (Private insurers may have their own rules.)

For home visits, the nurse practitioner would require direct supervision under Medicare rules, meaning the physician has to be in the patient's home. The best solution is to credential your nurse practitioner independently and bill her services with her own provider number.

The author, vice president of operations for Reed Medical Systems in Monroe, Michigan, has more than 30 years of experience as a practice management consultant, and is also a certified coding specialist, certified compliance officer, and a certified medical assistant.