# Is there a setting for nurse practitioners and supervising physicians

**URL:** <https://community.open-emr.org/t/is-there-a-setting-for-nurse-practitioners-and-supervising-physicians/12356>\
**Category:** Day-to-Day Users\
**Tags:** billing\
**Created:** [June 28, 2019, 8:06pm UTC](https://community.open-emr.org/t/is-there-a-setting-for-nurse-practitioners-and-supervising-physicians/12356 "2019-06-28T20:06:02Z")\
**Posts on this page:** 10\
**Page:** 1

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**Author:** ![juggernautsei](https://community.open-emr.org/user_avatar/community.open-emr.org/juggernautsei/32/10764_2.png) [@juggernautsei](https://community.open-emr.org/u/juggernautsei)\
**Post date:** [June 28, 2019, 8:06pm UTC](https://community.open-emr.org/t/is-there-a-setting-for-nurse-practitioners-and-supervising-physicians/12356/1 "2019-06-28T20:06:02Z")

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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.

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**Author:** ![stephenwaite](https://community.open-emr.org/user_avatar/community.open-emr.org/stephenwaite/32/15754_2.png) [@stephenwaite](https://community.open-emr.org/u/stephenwaite)\
**Post date:** [June 28, 2019, 8:13pm UTC](https://community.open-emr.org/t/is-there-a-setting-for-nurse-practitioners-and-supervising-physicians/12356/2 "2019-06-28T20:13:21Z")

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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](https://www.medicaleconomics.com/modern-medicine-feature-articles/incident-billing-clearing-confusion)

[another article](https://www.aapc.com/blog/44912-seven-incident-to-billing-requirements/)

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

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**Author:** ![sjpadgett](https://community.open-emr.org/user_avatar/community.open-emr.org/sjpadgett/32/21623_2.png) [@sjpadgett](https://community.open-emr.org/u/sjpadgett)\
**Post date:** [June 28, 2019, 8:23pm UTC](https://community.open-emr.org/t/is-there-a-setting-for-nurse-practitioners-and-supervising-physicians/12356/3 "2019-06-28T20:23:52Z")

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This seems fairly important.

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**Author:** ![stephenwaite](https://community.open-emr.org/user_avatar/community.open-emr.org/stephenwaite/32/15754_2.png) [@stephenwaite](https://community.open-emr.org/u/stephenwaite)\
**Post date:** [June 28, 2019, 8:42pm UTC](https://community.open-emr.org/t/is-there-a-setting-for-nurse-practitioners-and-supervising-physicians/12356/4 "2019-06-28T20:42:31Z")

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easy to just bill with supervising if the conditions are met

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**Author:** ![juggernautsei](https://community.open-emr.org/user_avatar/community.open-emr.org/juggernautsei/32/10764_2.png) [@juggernautsei](https://community.open-emr.org/u/juggernautsei)\
**Post date:** [June 28, 2019, 8:51pm UTC](https://community.open-emr.org/t/is-there-a-setting-for-nurse-practitioners-and-supervising-physicians/12356/5 "2019-06-28T20:51:33Z")

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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.

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**Author:** ![stephenwaite](https://community.open-emr.org/user_avatar/community.open-emr.org/stephenwaite/32/15754_2.png) [@stephenwaite](https://community.open-emr.org/u/stephenwaite)\
**Post date:** [June 28, 2019, 8:57pm UTC](https://community.open-emr.org/t/is-there-a-setting-for-nurse-practitioners-and-supervising-physicians/12356/6 "2019-06-28T20:57:33Z")

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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

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**Author:** ![juggernautsei](https://community.open-emr.org/user_avatar/community.open-emr.org/juggernautsei/32/10764_2.png) [@juggernautsei](https://community.open-emr.org/u/juggernautsei)\
**Post date:** [June 28, 2019, 9:51pm UTC](https://community.open-emr.org/t/is-there-a-setting-for-nurse-practitioners-and-supervising-physicians/12356/7 "2019-06-28T21:51:02Z")

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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?

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**Author:** ![juggernautsei](https://community.open-emr.org/user_avatar/community.open-emr.org/juggernautsei/32/10764_2.png) [@juggernautsei](https://community.open-emr.org/u/juggernautsei)\
**Post date:** [June 28, 2019, 9:58pm UTC](https://community.open-emr.org/t/is-there-a-setting-for-nurse-practitioners-and-supervising-physicians/12356/8 "2019-06-28T21:58:39Z")

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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.

 ![image](https://discourse-uploads-openemr.s3.dualstack.us-east-1.amazonaws.com/original/2X/c/c4f04aa2eed5e58c175a2b718fb7dee2581406c9.png)

Should I post a repo for this?

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<div class="post-metadata">

**Author:** ![sunsetsystems](https://community.open-emr.org/user_avatar/community.open-emr.org/sunsetsystems/32/11906_2.png) [@sunsetsystems](https://community.open-emr.org/u/sunsetsystems)\
**Post date:** [July 6, 2019, 9:02pm UTC](https://community.open-emr.org/t/is-there-a-setting-for-nurse-practitioners-and-supervising-physicians/12356/9 "2019-07-06T21:02:47Z")

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

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<div class="post-metadata">

**Author:** ![juggernautsei](https://community.open-emr.org/user_avatar/community.open-emr.org/juggernautsei/32/10764_2.png) [@juggernautsei](https://community.open-emr.org/u/juggernautsei)\
**Post date:** [July 6, 2019, 10:47pm UTC](https://community.open-emr.org/t/is-there-a-setting-for-nurse-practitioners-and-supervising-physicians/12356/10 "2019-07-06T22:47:52Z")

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