Hospital ownership, state rules just two stealth causes of NPP denials

Why This Topic Matters

NPP billing can be denied or paid differently depending on who provided the service, where it was provided, how the practice is structured, and which payer is involved. Understanding these differences helps practices reduce avoidable denials and align billing processes with applicable rules.

Article Sections

1. NPP billing

   Introduces billing considerations for services furnished by non-physician practitioners and frames the discussion around Medicare, state practice rules, and private payer policies.

2. Mind private payer rules

   Describes how private payer policies may differ from Medicare and why plan-specific terminology and requirements matter for billing review.