NP Insurance Enrollment Question – From Forum

I recently joined a practice where the NPs are billed under the physician even though the doctor is not always in the building. The doctor was told verbally by an insurance company that as long as he is available by phone they may bill under him. Is this correct? It would seem they can only bill under the MD when present and when not changing a plan of care (in a pt previously seen by an MD) – as per Medicare. The NPs are not currently credentialed on their own for insurance other than Medicare/Medicaid. I assume each NP also needs to be credentialed for each insurance…

This is a very interesting topic and is encountered by our clients repeatedly throughout the year. There is no simple answer because state regulations and individual insurance regs govern the rules regarding incident-to billing. Medicare has standard regs regarding this which you have correctly stated. With Medicare the Physician needs to see the patient every so often and also see the patient when there is a new chief complaint or new patient. Some commercial insurance companies follow these incident-to guidelines but most of them have their own policies that are dictated by the group’s contract with the company, location, specialty, network need, etc… I cannot say without equivocation that you can bill on your own if he/she is available by phone but I would say that he is ultimately the person at risk by doing this so I would not worry too much about it. (My opinion) There is a real lack of consistency with the insurers but we always recommend that the NP/PA be credentialed just to be on the safe side. We have seen a pattern from insurance companies in the past 2-3 years where they have started adapting Medicare incident-to regs and wanting NPPs credentialed but I do not know when this will be industry-wide.