Medical Billing by Non Physician Practitioners (NPP)

by | Last updated Jul 6, 2023 | Published on Feb 9, 2008 | Medical Billing

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Who are the Non-Physician Practitioners and can they also bill the patients? Well by non physicians we are referring to the,

  • Physician Assistants (PA)
  • Nurse Practitioners (NP)

Yes they can also bill the patient. There are two concepts in billing here. They are,

  • Direct method – Here the PA or NP is provided a unique number and services are billed under the non-physician practitioner’s name itself.
  • Incident-to billing method – Here service is provided under a physician’s supervision and billing is in the Physician’s name.

What are the criteria for an “incident-to” billing? According to Medicare Manual, the PA or NP services may be billed “incident-to” a physician’s care if they are:

  • An integral, although incidental part of the physician’s professional service.
  • Commonly rendered without charge or included in the physician’s bill.
  • Of a type commonly furnished in physicians’ office or clinics.
  • Furnished by the Physician or by auxiliary personnel under the physician’s direct supervision.

A PA or NP cannot bill for a new patient even if it is under the direct supervision of a physician. Billing is possible only if the PA/NP are licensed in their respective States and have the required qualification and certification set by Medicare.

Under the ‘Direct Billing’ method, while PAs are permitted to bill independently, NPs are not permitted to bill on their own.

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