decisionhealth Newsletters, Part B News - 2010 Issue 2 (February)
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Article Overview
This article answers a reader question about how non-physician practitioner consult services may be handled for private payers. It focuses on the need to check payer policies, contract terms, and state scope-of-practice requirements, and it discusses the general documentation and referral context associated with consult billing. The piece is intended for billing staff, coders, and practices that use nurse practitioners or other non-physician practitioners.
Why This Topic Matters
Private payer rules for non-physician practitioner services can differ from Medicare and from one payer to another, so practices need a clear way to evaluate consult billing in their own contracts and compliance environment.
What You Will Learn
- How private payer policies can affect whether a non-physician practitioner may bill consult services.
- Why payer contracts and state scope-of-practice laws matter for nurse practitioner service billing.
- What general documentation and request-related elements are discussed in the context of consult billing.
- Why patient- or family-initiated consult requests are treated differently from provider-requested consults.
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Non-physician practitioners
- Healthcare compliance staff
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