[NPInfo] Incident to Billing for Shelby

[Carla Anderson]

Shelby,
   
  Tracy may go into detail more about "incident to" billing. It is spelled out in detail in articles written by Carolyn Buppert and on the Medicare CMS website.  It essentially means that the doctor can only bill this when he/she is in the suite, and is involved on a regular basis with the care of the patient. For example, a patient has diabetes. The doctor sees this patient ever 3rd or 4th visit. When the np sees the patient the doctor if in the building can bill incident to. But if the NP has their own Medicare billing number (which they all should have) and they are the one seeing the patient primarily, the office should be billing under the NP number. The offices dont like to do that because when they bill under the physician name they get 20% more money for the same service. Regardless it is illegal and fraud to keep billing all Medicare patients under the phsyician name if they are disregarding the "incident to" rules.. Especially on new Medicare patients, that the
 doctor has never seen, they cannot do this.
   
  In my state of Oregon, I have my own practice. I get paid promptly by Medicare, under my own billing number, but they do pay 80% of physician rates. I get paid well by BCBS, Aetna, Providence.  Health NET took 6 months but I am finally credentialed. United is a nightmare, and hard to get into. I also take Care Oregon (Oregon medicaid, but am waiting to get patients as my practice is in an affluent area)  A few others are "closed" to new providers but I am trying to go through the back door by joining an IPA..   Cigna is "confused" as they normally do not recognize NPs as providers, and they think the term "ARNP" means you are a specialist, so for a while they called me that and billed me as a specialist, whoo hoo.. but for the most part, I have not had any trouble with getting reimbursement directly to me as a NP. Only problems with coding, and reimbursement issues surrounding that and patient covereage and deductibles..
   
  Anyway, wherever you work, research your "incident to" laws, also well spelled out on the AAFP website, and make sure your doc is acting legally!
   
  Carla Anderson, FNP/Oregon

"Havens, Shelby" <havens.shelby at mail.dc.state.fl.us> wrote:
  
Dear Tracey:

Doesn't "incident to" billing mean more money coming in under the
physician's name? It still renders the NP invisible, with no direct way
to prove our productivity and our worth. We are simply bringing in more
money for the doctor under this arrangement. 

I am an "out of network" provider for BC/BC of Florida. I can't be a
network or preferred provider since I am not a physician. When I was in
a private practice with two psychiatrists and a mental health counselor,
we billed the Blues for my services. Yes, we could get reimbursed at a
higher rate since we had not signed an agreement to accept only a
certain rate for our services, but most of the patients didn't like this
because their co-pay was higher. The majority of them elected to see
providers who were in the network, so that they were responsible for
only a $20.00 co-pay, so we were not able to retain those patients. The
private practice suffered financially as a result. 

There are about 9000 nurse practitioners in Florida, and our NP
organizations and attorneys have not been able to convince the Blues to
contract with us as network providers. We'll see what 2008 brings. 


Best Regards,

Shelby Havens, ARNP 


-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On
Behalf Of Tracy Klein
Sent: Thursday, January 03, 2008 10:24 PM
To: npinfo at nurse.net
Subject: [NPInfo] Incident to Billing


"Incident to" billing earns plenty of money for the
physician practice. In fact, they get reimbursed at a
higher rate in many states than direct reimbursement.

It just doesnt earn YOU money as the NP. Especially if
you are salaried.

Tracy Klein, WHCNP, FNP
Portland, Oregon







----------------------------------------------------
Actually, he would have a very valid point in Florida.
The largest
health 
insurance company down here is Blue Cross Blue Shield
of Florida, and
they 
do not contract with nurse practitioners. Everything
gets billed
"incidental 
to" the physician's work. A nurse practitioner cannot
earn money for a 
physician's practice under this arrangement.

Best Regards,

Shelby Havens, ARNP
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Carla R. Anderson, FNP-C
  Healing Presence Family Practice, PC  
  carla_rayne at yahoo.com
  503 819 9726