Billing Issue

Trauma Columnist · Nov 2, 2008

Nope - have never heard of this. Does he have a reference or URL? Would be interested.

core0 · Nov 3, 2008

I talked to a NP last night who's going back to school for his DNP. He SWORE that we can bill at 100% of the doctor rate through several insurance companies and Medicare with a DNP. I had never heard of this before. Does anyone know if this is true? If so, then I'm going to consider going back to school myself.

There have been no Medicare changes for DNPs. You could bill at 100% if you do incident-to. Or you could commit Medicare fraud which will also net you 100%. Looking at the upcoming MEDPAC it isn't even on the horizon. Realistically since the 85% for NPs is written into law its going to take an act of Congress to change it.

As far as insurance companies, most insurance companies pay 100% if you bill under the physician (most don't credential NPPs). For those that do credential NPPs they generally pay 100% of the physician fee. Those few that don't pay some percent (Bluecross being the big one here). The issue with insurance companies, is that unlike Medicare you can negotiate with them over the rate. There is no physician rate as such. Instead you usually negotiate some percentage of the Medicare rate. FP in a very crowded market may make only a percentage of the Medicare rate. In demand specialists in a shortage market may negotiate a percentage above Medicare. I know a PA that is a solo provider in a rural county. His contract with the insurance provider with the local town pays 150% of Medicare rate.

So basically the NP you were talking to is full of it.

David Carpenter, PA-C

ANPFNPGNP · Nov 3, 2008

There have been no Medicare changes for DNPs. You could bill at 100% if you do incident-to. Or you could commit Medicare fraud which will also net you 100%. Looking at the upcoming MEDPAC it isn't even on the horizon. Realistically since the 85% for NPs is written into law its going to take an act of Congress to change it.
As far as insurance companies, most insurance companies pay 100% if you bill under the physician (most don't credential NPPs). For those that do credential NPPs they generally pay 100% of the physician fee. Those few that don't pay some percent (Bluecross being the big one here). The issue with insurance companies, is that unlike Medicare you can negotiate with them over the rate. There is no physician rate as such. Instead you usually negotiate some percentage of the Medicare rate. FP in a very crowded market may make only a percentage of the Medicare rate. In demand specialists in a shortage market may negotiate a percentage above Medicare. I know a PA that is a solo provider in a rural county. His contract with the insurance provider with the local town pays 150% of Medicare rate.
So basically the NP you were talking to is full of it.
David Carpenter, PA-C

Thanks for the information. Something else, one of the docs I work for keeps saying that if Obama becomes president, then that will be very bad for doctors, but good for NP's. I don't know where he's getting his information. Why would this be good for NP's??