Billing questions (and other cures for insomnia)

[Alicia777, MSN, NP]

Hello!

I have a couple questions regarding billing especially for you NPs that work in hospitals alongside MDs.

I was surprised to find out that the PA I work with has not been billing for her services of assisting on cases. That's years and years of lost revenue for the hospital as well as a lost opportunity to show our value!The CMO is under the impression that if we have surgeons that are not hospital employees ( most work for a separate practice and have a hospital contract/privileges) that we can not legally bill for them. True? Are we only able to bill for MDs that are employed by the hospital itself?

Also, approximately how much have you billed for your hospital in one year?

Thanks

[Neuro Guy NP, DNP, PhD, APRN]

PAs are not independent providers, so in no state can they bill for their services independently of the physician. APRNs ARE independent providers separately licensedand can independently bill for their services in all 50 states for private insurers and Medicare/Medicaid. This also includes an ability to separately bill for surgical services/first assisting etc. So yes you could bill for surgical first assisting services under your own licensure. Just realize you'll get only like 85%'of the physician reimbursement

[Neuro Guy NP, DNP, PhD, APRN]

Btw your ability to bill holds true even if your state requires a collaborative practice agreement, etc.

[Alicia777, MSN, NP]

PAs are not independent providers, so in no state can they bill for their services independently of the physician. APRNs ARE independent providers separately licensedand can independently bill for their services in all 50 states for private insurers and Medicare/Medicaid. This also includes an ability to separately bill for surgical services/first assisting etc. So yes you could bill for surgical first assisting services under your own licensure. Just realize you'll get only like 85%'of the physician reimbursement

Yes, of course. PAs are not independent billers, but can still also retain 85% of the physician fee while working along side of him or her (as with first assisting in the OR).

My question though pertains to billing for physicians employed by an outside practice. Anyone know the answer?

[core0]

Yes, of course. PAs are not independent billers, but can still also retain 85% of the physician fee while working along side of him or her (as with first assisting in the OR).

My question though pertains to billing for physicians employed by an outside practice. Anyone know the answer?

The issue is the hospital employment. If you were employed by the surgical group then the group could bill for your services. If you were independently employed then you could bill for your services either directly (as an NP) or through a separate corporation (NP or PA). If the surgeons were also employed by the hospital then the hospital could bill for your services. However, when the surgeons are employed by a different entity then you can't bill since the hospital (your employer) doesn't have a relationship to the patient. This would also apply to any other services such as H&P or E/M that you provide to the surgeons patients.

According to American College of Surgeons, the correct way to bill for this is to move all or part of your salaries to hospital cost report of Medicare part A.

Its a pretty sweet deal for the surgeons. The hospital eats the costs and they get free help. Ideally your employment arrangement should be something that allows reimbursement.

Billing for services performed by nonphysician practitioners | The Bulletin

Chapter 15, Section 60.1:

For hospital patients and for [skilled nursing facility, or SNF] patients who are in a Medicare covered stay, there is no Medicare Part B coverage of the services of physician-employed auxiliary personnel as services incident to physicians' services under §1861(s)(2)(A) of the Act. Such services can be covered only under the hospital or SNF benefit and payment for such services can be made to only the hospital or SNF by a Medicare intermediary. (See §80 concerning physician supervision of technicians performing diagnostic x-ray procedures in a physician's office.).

[Jules A, MSN]

One of the beauties of being a hospital employee is I have a minimum of billing duties. In psych there are fewer options and the billing department reviews all my stuff and upticks or downgrades my billing sheets as indicated. At the jobs where I'm on productivity my pay rate is simply based on whether I see a new evaluation, recheck or consult so not complicated. I'm happy to be on the idiot program with regard to the billing crap, lol.