NPPs

Why This Topic Matters

Correct handling of nonphysician practitioner billing affects claim submission, payment distribution, and compliance with Medicare rules. The topic is especially relevant for practices that use nurse practitioners, physician assistants, and other NPPs in office, hospital, and incident-to settings.

Article Sections

1. Billing questions involving physician and NPP services

   An opening scenario addresses how a mixed-service encounter may be reported and processed under Medicare. It introduces the general billing issue the article discusses.

2. NPP billing guidance and categories

   This section outlines broad Medicare guidance on nonphysician practitioners and identifies the categories of practitioners discussed in the article. It also notes the need to confirm state and carrier requirements.

3. Billing under provider number

   This section covers general billing under an NPP’s own provider number and the administrative steps involved in obtaining one. It also notes the payment framework referenced in the article.

4. NP requirements for a Medicare billing number

   This section summarizes the article’s overview of qualifications associated with obtaining a Medicare billing number for nurse practitioners. It focuses on credentialing and licensure topics.

5. E/M coding levels

   This section discusses the broader controversy around evaluation and management billing by NPPs. It references policy context and concerns practices may have about billing levels.

6. Hospital services

   This section addresses hospital-based professional services performed by NPPs and how Medicare payment considerations differ in that setting. It distinguishes professional services from facility-inclusive services.

7. Incident to

   This section provides an overview of the article’s discussion of incident-to billing in office-based care. It focuses on supervision, physician participation, and employment relationships at a high level.