Legal Tips
Provided by Carolyn Buppert, MSN, JD, ANP

Can a practice bill Medicare for an NP's office visits sometimes under the NP's number (for 85%) and sometimes under a physician's number (for 100%)?

Yes. Here are the rules: When an NP conducts a visit with a new patient (covered by Medicare), in the office setting, bill under the NP's number. And, when a physician is not physically within the office suite, bill under the NP's number, no matter whether the visit is with a new or an established patient.

Remember, "incident to" rules apply only to patients covered by Medicare.

And, there are separate billing rules when the visits take place in other settings--hospital, skilled nursing facility, or patient's home.

This tip is excerpted from a recent issue of The Gold Sheet, a monthly newsletter published by the Law Office of Carolyn Buppert. The Gold Sheet covers the latest news on quality for NPs. For a 12-month subscription, send a check for $25 to The Gold Sheet, Law Office of Carolyn Buppert, 1419 Forest Drive, Suite 205, Annapolis, MD 21403. A companion newsletter, The Green Sheet, offers the latest information on NP compensation and reimbursement.

Last updated: February 10, 2000


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