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Posted By Lynn Radecky on 02-06-2019, 11:42:39 in Ob-Gyn
We have a Nurse Practitioner in the office and she is credentialed with Medicare. Are NP's allowed to see new patients? I keep getting differing info and I was hoping you would know. Thanks!!
Comments (5)
Posted By Lynn Radecky on 02-07-2019, 13:24:55
Thank You!
Posted By Melanie Witt on 02-07-2019, 13:06:21
Since you are asking about Medicare, the answer is no, the rules do not change from state to state. Commercial payers who credential NPs usually require that they bill under their own number. Remember that "incident to" is a Medicare concept and does not mean it has been adopted by commercial payers.
Posted By Lynn Radecky on 02-07-2019, 09:59:01
One more question does it vary state by state? I am in NJ....... Thanks!
Posted By Lynn Radecky on 02-07-2019, 09:49:47
Thank You Melanie!
Posted By Melanie Witt on 02-06-2019, 15:10:26
Yes, if they bill under their own number. However, Medicare will pay them less than the MD would be reimbursed (they get 85% of the physician allowable). If you bill under the MD number (so that you are paid the MD rate rather than the NP rate) their services are "incident to" and they cannot see new patients, but must wait for the MD to see the patient and set the treatment plan and they can only see the patient for follow-up care to that established plan.
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