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Best Practices for Billing NPP Services

Best Practices for Billing NPP Services

NPPs (Non-Physician Practitioners) such as physician assistants and/or nurse practitioners can be helpful in saving time and money. This is one of the reasons why the use of NPPs is rising in the healthcare sector at a fast pace. The NPPs can even help in increasing the practice revenue. When managed from the beginning, NPPs can turn out to be profitable. Have a quick look at what benefits NPP can provide you:

  • High-quality patient care
  • Assistance in the facility quality control development
  • Remarkable patient education support
  • Minimizing the length of stay
  • Increased focus on evidence-based care

These are just a few from the long list of benefits that NPP can offer. The success, however, depends on how you bill them. If you want NPPs to offer more benefits than just to cost more to your practice, it is crucial for you to know how to bill for their services.

In this blog, we will explore which are the best practices for Billing the NPP services. There are three different ways in which the NPPs can receive their reimbursement:

  • Incident-To Billing
  • Shared/ Split Visits Billing
  • Direct Billing

Let us explore each one of them:

Incident-To Billing

Incident-To Billing is a billing procedure for services provided by an NPP to a physician in a separate office or in a separate institution or even in the patient’s home. Incident-to is a Medicare phrase that doesn’t necessarily apply to any other payer. A commercial insurer might even have a completely different definition of the term.

These services are billed under the physician’s name under whose direct supervision everything is performed.

Criteria for Incident-To Billing

The services must meet with the criteria mentioned below:

  • The service is furnished by a clinician who has qualified as an employee of the physician
  • All the services are to be provided in the physician’s office
  • The services provided should be within the NPP’s scope of practice
  • Physician and NPP services are not billed separately
  • The service must be furnished under the direct personal supervision of the physician
  • The course of the treatment is started by the physician and their involvement reflects in their continuing active participation and management of care

When billing for the incident-to services, make sure that you follow the Medicare guidelines to maximize the reimbursements.

Shared/Split Visits Billing

Shared Split Visits Billing

In a shared or split visit, the NPP works either under the supervision of the physician or in collaboration to provide the shared or incident-to services, or provide support to the physician in extending the following services:

  • Physical exams
  • Ordering and interpreting the tests
  • Diagnosing and treating the illnesses
  • Assisting in surgery
  • Counselling on preventive healthcare
  • Prescribing medication

Organizations that employ NPPs must have knowledge of state and federal regulations. They must also know the billing and documentation standards associated with the NPP services.

Rules for Shared/split Visit Documentation

  • The split/shared E/M visit doesn’t apply to critical care services or consultation services.
  • The billing regulations for split or shared visits recognize only E/M services offered in special facility-based settings i.e. outpatient hospital clinics, EDs, or inpatient hospitals.
  • Split or shared services should only be billed when both the physician and NPP provide the services during the visit.
  • The services performed by the NPP should be clearly stated in the documentation.
  • For a shared or split service, only one claim can be submitted which can either be done by physician’s NPI or NPP’s NPI.

The physician’s note must be linked to the NPP’s notes while documenting a split/shared visit and it should also be confirmed whether the physician provided an E/M element or not.

Proper documentation can help the providers with accurate reporting of shared/split services for attaining maximum reimbursements. Medical billing companies can turn out to be very helpful for the same.

Direct Billing for NPP Services

Direct Billing for NPP Services

As defined by the State Law, the services rendered by the NPPs may be billed directly to the Medicare program given that the service falls under the NPP’s scope of practice. To directly bill the services, the NPPs must be enrolled and have their own provider numbers.

Payment for the NPPs services is 85 percent of the physician’s fee schedule amount. The NPPs may be employees or can be independent contractors of either a physician or a physician group practice.

Rules for Direct Billing:

  • The NPP provides the complete services
  • For the critical care services, E&M services are included, procedures and other services that are not bundled under the critical care are included
  • Each procedure performed by the NPP in a hospital setting must be billed under the name and number of NPP directly
  • The physician doesn’t have to be in the office suite if it isn’t an office visit
  • There is no prior visit required

Getting to know how to bill for the NPP is critical for your medical practice. Physicians and the groups hiring NPPs must know the varying required billings for NPPs and what compliances do they have to follow.

Not understanding the whole billing procedure can result in serious errors in the revenue cycles. Get in touch with VisioniKnowledge for the hassle-free billing of NPPs.