Is there a setting for nurse practitioners and supervising physicians

billing

(Sherwin Gaddis) #1

We are trying to get our billing correctly in the x12/837.
The situation is that the program keeps the nurse practitioner (NP) as the rendering provider when there is a supervising in the building. This is cutting the revenue by %15 because the insurance sees the mid-level as the rendering physician, not the doctor that is supervising.
So, when the doctor is set as supervisor his information should be showing on the 837, not the NP. Is there a setting for this in the system now.


(Stephen Waite) #2

hi @juggernautsei, don’t think so, you’d have to add the logic for what believe is called incident-to billing else it’s going to add the supervisor to the X12 but leave the rendering in there

some guidance

another article

probably would need to create a GLOBAL to help with the logic


(Jerry P) #3

This seems fairly important.


(Stephen Waite) #4

easy to just bill with supervising if the conditions are met


(Sherwin Gaddis) #5

It is important from the billers point of view and being audited. I agree with them that the documentation should accurately match what occurred that day. Not just manipulate the system to get the desired results.
The system should have the NP as the rendering provider and the supervisor should be the doctor. That should stay then the billing should place/override the NP as the rendering provider without having to change the fee sheet. If no supervisor is entered then whatever user is set as the rendering provider is place in the x12/837.


(Stephen Waite) #6

it’s also payer specific so in most places it’s only Medicare

since the guidance states “When billing incident to services, the claim should be submitted as if the physician personally performed the service." should be fine by selecting the appropriate “rendering” in the fee sheet


(Sherwin Gaddis) #7

So, you are saying not to use the Supervising box?

UPDATE: @sunsetsystems Rod, I need to loop you into this because you signed your work, thank you.

        // 24i and 24j Top. ID Qualifier and Rendering Provider ID
    if ($claim->supervisorNumber()) {
        // If there is a supervising provider and that person has a
        // payer-specific provider number, then we assume that the SP
        // must be identified on the claim and this is how we do it
        // (but the NPI of the actual rendering provider appears below).
        // BCBS of TN indicated they want it this way.  YMMV.  -- Rod

The party that questioned the way these works are in Knoxville TN. So, the code does not work as originally intended. Susie Lochbihler of Paragon Practice Management would like this to work the other way as intended that the supervisor overrides the rendering provider.

Could you post how to switch this back to that functionality?


(Sherwin Gaddis) #8

There is one thing the biller wanted added to the billing manager and that was to show the facility.
The provider has two offices and she said it would be helpful to know which facility the encounter was serviced.

Should I post a repo for this?


(Rod Roark) #9

Sorry I don’t remember much about this, it was a long time ago. A global setting does seem reasonable.


(Sherwin Gaddis) #10

Thanks Rod, I appreciate your response to this. I understand how time plays a factor.