In almost every medical practice, Physician Assistants (PAs) and Nurse Practitioners (NPs), also known as physician extenders or non-physician practitioners, are used (NPPs). Understanding how to use medical office software for NPP services correctly is essential for running a profitable and efficient medical practice. Because regulations vary by insurance company and state, both the physician and the NPP must stay current on practice guidelines and ongoing developments. Nurse practitioners (NPs) are nurses who have earned a Master's or Doctor of Nursing Practice degree (DNP). PAs are licensed (PA-C) and frequently hold a Master's degree. These mid-level clinicians are used in medical offices for a variety of reasons, including:
- Lower salary expenditures (as compared to a physician).
- Lower overhead costs.
- Increased patient volume.
- Lower insurance and liability costs.
These non-physician providers are reimbursed in three ways by medical office software (NPPs).
Direct Pay
When an NPP has their own Provider Identification Number, this is what it means (PIN). The NPP (or practice) is reimbursed at 85 percent of the billable physician rate. Medical claims software automates the processing of claims and reduces the risk of fraudulent claims. Many players, however, will not accredit NPPs. The NPP certificate allows practices to bill insurance companies directly when the “supervising physician” is not present or has not provided any care or input into the patient's plan of care.
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“In relation to”
This billing method is used to bill for outpatient services provided by a non-physician practitioner at a physician's office located in another office, an institution, or a patient's home (NPP). During billing, the physician bills and receives the full amount of Medicare's allowable payment. This billing method is used when an NPP sees a patient after the physician has completed the initial service and established a Plan of Care or treatment plan. This type of billing is subject to additional restrictions; the physician must be present on-site, in the suite rather than just in the building, and provide direct supervision (the rules for home visits vary). Systemization at the tool position, similar to medical office software, is a more realistic practice operating posture.
By filing a claim “Incident to,” the web-based practice management solution physician can receive 100 percent of the Medicare Physician Fee Schedule (MPFS) instead of 85 percent of the MPFS for care provided by a qualified NPP.
Because “Incident to” billing was designed by Medicare and not all commercial insurance carriers follow Medicare requirements, knowing payer restrictions surrounding “Incident-to” billing is critical before delivering patient treatment.
Expenses Split/Shared
Cloud billing software for shared/split services enables the practice to charge under the qualified physician rather than the NPP, which has a lower reimbursement rate. Cloud based medical billing software for billing in healthcare offers excellent data-loss prevention safeguards. Billing for shared/split services entitles you to an additional 15% reimbursement as long as the conditions are met.
In this form of billing, documentation is critical. Each practitioner must properly document the care they provided in order to prove compensation under the split/share criteria that allow both parties to claim for services.
Shared/split visits are permitted for services provided in the following settings, according to the Centers for Medicare and Medicaid Services (CMS):
- Inpatient or outpatient hospitalization.
- Emergency department.
- Hospital observation.
- Hospital discharge.
- Office or clinic (where the “incident-to” criteria is satisfied).
Shared/divided visits are not permitted:
- In a nursing home or skilled nursing facility.
- For consulting services.
- For critical care services.
- For procedures.
Conclusion
With changes in healthcare costs, patient care, and reimbursement, as well as physician shortages, there is a greater demand than ever for Nurse Practitioners and Physician Assistants. Individual payers must be well-versed in the billing and reimbursement criteria. The charting and documentation standards must be met. billrMD speeds up your billing process while increasing overall practice efficiency. To learn more about medical office software, contact us immediately without delay!
