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
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.