NP billing issue/question

[amandarez]

I am a NP working in a private practice. One part of my job is to go to the hospital and see new Consults. I exam the patient, write up the note, and initiate care. My physician is available as needed for me to discuss with the patient.

I have my own medicare number for billing.

I was recently approached by a NP working for the hospitalist group who told me that per medicare rules, I could not develop a plan nor initiate care for the new consults.

However, I have reviewed the Non-Physician Practitioners Manual and I cannot find anything that indicates that; nor have the billing specialists in our practice. I have sent a note to my state's NP board and the AANP to see if they know.

But I thought I would put a note out and see if anyone knows anything about it.

thanks

[core0]

I am a NP working in a private practice. One part of my job is to go to the hospital and see new Consults. I exam the patient, write up the note, and initiate care. My physician is available as needed for me to discuss with the patient.

I have my own medicare number for billing.

I was recently approached by a NP working for the hospitalist group who told me that per medicare rules, I could not develop a plan nor initiate care for the new consults.

However, I have reviewed the Non-Physician Practitioners Manual and I cannot find anything that indicates that; nor have the billing specialists in our practice. I have sent a note to my state's NP board and the AANP to see if they know.

But I thought I would put a note out and see if anyone knows anything about it.

thanks

The other NP is wrong. The Medicare billing manual clearly states that non-physician providers can provide any physician services that they are qualified for. What you cannot do is co bill for the consult. This is probably a way for the physicians in the other NPs service to maximize (their) reimbursement.

http://www.aapa.org/paf/images/stories/documents/partners/medicare_web_copy.pdf

Specifically (the law is the same for NPs):

Services provided by PAs are reimbursable by Medicare when provided in offices or clinics, nursing facilities, hospitals, and ambulatory surgical centers. Medicare pays PAs for nearly all types of medical and surgical services (as allowed by state law). Covered services include, but are not limited to, high-level evaluation and management services, consultations, initial hospital histories and physicals, mental health services, diagnostic tests, telemedicine services, and ordering durable medical equipment.

David Carpenter, PA-C