for Nurse Practitioners医生护士的帐单课件.pptVIP

Billing for Non-Physician Practitioners Presented by NYU School of Medicine Office of Physician Reimbursement Compliance Gretchen L. Segado, MS, CPC, Director 316 East 30th Street New York, NY 10016 (212) 263-2446 (212) 263-6445 fax Gretchen.Segado@med.nyu.edu Goals for This Session Understand the difference between Direct Billing and Incident-to Billing Understand need to learn CPT and ICD-9 coding principles i.e. Understand EM coding Be aware of documentation requirements Understand how services are reimbursed Be aware of differences between insurance companies and their coverage And….it is very important to remember…… Two Different Billing Scenarios Direct Billing Certain NP Practitioners can be credentialed and can bill under their own provider number Nurse Practitioners, Physician’s Assistants, Certified Nurse Specialists, Clinical Psychologists, Medicare reimburses on a percentage of the Physician Fee Schedule Incident-to Billing Physician directed team Service is billed under physician’s provider number Direct Billing Criteria for Medicare Non-Physician Practitioner bills services directly to Medicare Must meet Medicare’s credentialing requirements Can bill in any setting allowable under scope of practice (office, inpatient and outpatient hospital, etc) Direct Billing Criteria for Medicare Can provide any services allowed under their scope of practice, but will only be reimbursed for covered services. Should have a collaborative agreement with physician or group of physicians Refer to Non-Physician Practitioner Direct Billing Guide Please note: Diagnostic testing rules have a different set of regulations and supervision levels…… What Is an Incident-to Service? When services are provided by auxiliary personnel under direct physician supervision, they may be covered as “incident-to” services Non-physician practitioner bills for services “under physician’s name” Incident-to Requirements Integral though incidental part of physician’s professi