According to a 2017 survey by the Medical Group Management Association, wise use of non-physician practitioners (NPPs), such as nurse practitioners and physician assistants, can increase practice revenue. They can also improve physician satisfaction. Physicians who are suffering from burnout often find that sharing the load with these professionals increases the amount of face-to-face time physicians have with the patients they see, removing one of the most common causes of burnout.
However, if you want NPPs to provide more benefit than cost to your practice, you must know how to bill properly for these professionals.
“Using NPPs can be very profitable,” says Barbie Hays, coding and compliance strategist for the American Academy of Family physicians, “if managed very carefully from the beginning.”
Services provided by an NPP can be billed under his or her own National Provider Identifier (NPI)). With Medicare, there will be a 15 percent reduction in reimbursement, and with most commercial payers the reduction is about the same.
However, in most cases you can bill “incident to.” This means that you bill for NPPs services under the physician’s NPI—but you have to meet certain requirements.
“The physician must initiate the patient’s care and any changes in care plan; the physician has to be present in the office suite and immediately available during the time the care is given; and a physician must actively participate in and manage the patient’s course of treatment,” explains Tammie Olson, of Management Resource Group, an Ocean Springs, Miss., firm offering financial management and support services for the healthcare community. Though a physician does have to be available at the time of care and must manage the care, the supervising physician can be any doctor in the group—it does not have to be the one who initiated and manages the patient’s care.
“Incident to” is Medicare language, explains Hays, but she adds that typically you’re fine with most payers if you bill NPPs according to Medicare’s incident-to rules. However the rules can vary from payer to payer and even plan to plan with a given payer. “Just make sure that you understand what’s in the contract [with the payer],” Hays says.
Check the Boards
Beyond what payers will cover, there are differences in how state medical boards govern the use of NPPs.
“For example, some states require collaboration agreements and some set limits on how many NPPs can be managed by one physician,” explains Hays. It can be confusing, but help is available.
“If you don’t understand, ask,” says Hays, “Information is available from the state medical and nursing boards, and guidelines are available from Medicare publications.”
She also suggests that when examining contracts and studying state regulations, it’s ideal to involve someone from the billing and the clinical side of your practice, for example a billing manager and a physician or nurse manager. Sorting out the rules and regulations takes a deep understanding of both worlds—clinical and billing—and it’s important to make sure these worlds communicate.
It can be confusing—and time-consuming—to master the ins and outs of properly billing for NPPs, but if you can get it right, there are many benefits to using these supplementary professionals in your practice.