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Hiring a physician assistant (PA) or nurse practitioner (NP) to provide services to patients is a good way to lower costs and increase patient satisfaction. However, in the southern states especially, there are several rules that govern how these services can be billed. In order to maximize billing profits, it’s important for doctors and billing staff alike to understand the ins and outs of non physician practice (NPP).
The Role of PAs and NPs in Each State
Each state has slightly different laws that regulate how PAs and NPs can work. Here’s a few of the rules that govern some of the southern states.
Georgia
All PAs must be licensed and can work with their supervising doctor to establish their supervision requirements.
NPs can be a primary care provider, order physical therapy, and sign handicap parking permits. They must also be within a specific distance of their sponsoring doctor when practicing.
Tennessee
All PAs must be licensed, have full prescriptive authority, and can sign their own written agreement with their doctor to determine their scope of practice. Additionally, there are no limits on the number of PAs a doctor can supervise at once.
NPs can be a primary care provider, order physical therapy, and sign handicap parking permits.
Alabama
All PAs must be licensed and have full prescriptive authority.
There is no law on whether or not NPs can be a primary care provider, but they can order physical therapy. The doctor must also be present at the NP’s practice site for at least 10 percent of the NP’s working time.
Florida
All PAs must be licensed, have full prescriptive authority, and can determine co-signature requirements at the practice level.
NPs can be a primary care provider, order physical therapy, sign handicap parking permits, and sign workers’ compensation claims. However, they can’t prescribe controlled substances.
North Carolina
All PAs must be licensed, have full prescriptive authority, can sign their own written agreement with their doctor to determine their scope of practice. Additionally, the supervision requirements and co-signature requirements are flexible at the practice level. Finally, doctors can supervise as many PAs as they wish.
NPs can be a primary care provider, order physical therapy, and sign death certificates.
South Carolina
All PAs must be licensed and have full prescriptive authority.
There is no law on whether or not NPs can be a primary care provider, but they can order physical therapy and sign workers’ compensation claims.
Billing Guidelines for NPP in These States
With a better understanding of the role of PAs and NPs, doctors can know what will and what legally won’t be covered by insurance in their state. For example, in Tennessee, they should not try to bill insurance companies for a workers’ compensation visit, as NPs cannot legally perform this service in that state.
The actual billing process itself is not complicated. Doctors can choose to bill NPP visits as incident to or with the NPP’s Nation Provider Identifier (NPI). In incident to billing, the physician must monitor or be in the same suite as the NPP. The services must also be part of the patient’s normal treatment that was initiated by the physician. Because this is billed under the physician, practices can earn more this way.
The other method is NPI billing, where the visit is billed through the NPP. While this billing process is easier, Medicare can pay 15 percent less for these visits.
Because each state has strict requirements, it can be hard to know exactly the right method for an individual practice. Offices which need more help can contact M-Scribe Technologies, LLC for assistance. Simply call me directly at 770-666-0470 or email me at patrick.dougherty@m-scribe.com to learn more about our medical billing services.
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