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How Does a Nurse Practitioner Obtain a Medicare/Medicaid Number for Billing Purposes?

Response from Carolyn Buppert, NP, JD



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Nurse practitioners (NPs) call or write to say that they want to go into independent practice and need to know how to go about it. Students ask, "What are your recommendations for developing independent practice in a state?"
The first hurdle is to figure out what NPs mean when they say "independent practice." Few NPs are ever going to be truly independent in practice. Neither are physicians. Everyone relies on others—staff, colleagues, consultants. So does "independent" mean:

In Search of NP Independent Practice

Carolyn Buppert, NP, JD, offers advice on NP independent practice

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From Medscape:

An NP can bring the following to a practice:

• Profit;
• Respite for a sole practitioner;
• Patient satisfaction;
• High-quality care; and
• A choice for the patient.

NP as employee -- expenses to consider. NP salaries vary by geographic region. The NP national salary average is approximately $75,000. If full benefits at 25% of salary are offered, the personnel expense runs about $93,750. If the additional overhead expenses of employing an NP are $60,000 (additional space, furniture, assistants, supplies, telephone, continuing education, and so on), the full expense of employing an NP would be approximately $187,500.

Medicare Requirement for Collaboration

Federal law defines "collaboration" as "a process in which an NP works with a physician to deliver healthcare services within the scope of the practitioner's professional expertise, with medical direction and appropriate supervision as provided for in jointly developed guidelines or other mechanism as defined by the law of the State in which the services are performed."[6] States vary in their requirements for collaboration between physician and NP. Check your own State Board of Nursing requirements.[7]
In 8 states, there is no requirement that an NP have a formal agreement with a physician or other healthcare provider promising collaboration or supervision. For example, Oregon law states: "The NP is responsible for recognizing limits of knowledge and experience, and for resolving situations beyond his/her NP expertise by consulting with or referring clients to other healthcare providers."[8] However, most states require NPs to have a collaborative agreement with a physician. And, while Medicare generally defers to state law requirements, federal law requires that an NP billing Medicare have a collaborative relationship with a physician. So, even in Oregon, an NP must establish a collaborative connection with a physician.

View CE credit article in its entirety:

Billing For Nurse Practitioner Services -- Update 2007: Guidelines for NPs, Physicians, Employers, and Insurers

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