With the current economic landscape, there is more consolidation within the health care industry and physicians are forced to do more with less. Many doctors are employing the use of physician assistants and nurse practitioners to streamline processes. Many private insurers and Medicare and Medicaid allow this and allow for billing of services.
While nurse practitioners and assistants can get their own billing numbers, they pay at a lower reimbursement rate. This is an area of billing under Medicare and now under Florida Medicaid that allows for the ancillary provider (the nonphysician practitioner) to provide the service and bill at the physician’s level of the fee schedule. This can obviously be very lucrative and allow doctors to see more and more patients on a regular basis.
That said, this can present significant confusion as many doctors and billing staff do not often know how to bill or track correctly. They think that because a nurse practitioner can practice under indirect supervision that they can then bill. In actuality, it must be direct supervision.
This opens up significant problems with reimbursement levels. Physicians must be aware of the scope of practice that a nurse practitioner or physician assistant can apply. This raises questions like:
- Can they prescribe?
- What services can be billed?
- What is incident to services?
- What level of supervision is required?
- Do they have to be employed by the practice?
- Must they be licensed in Florida?
If you or your business is facing any of these issues, our Orlando health care attorneys at Lowe & Evander, P.A., are prepared to bring our expertise to help you document and address all processes in the most compliant way. Our health care law attorneys can bring in consultants to draft up collaborative practice agreements covering all needed compliance. Additionally, our lawyers can help define what must be reported to the board of nursing and medicine and address all insurance issues.
To schedule an initial consultation to discuss incident to billing and compliant use of nonphysician practitioners with one of our Florida health care attorneys, call (407) 332-6353 or contact us online.