Why are nurse practitioners reimbursed at 85% of physician fees?—KATHLEEN OUZTS, PHD, CRNP, Orange Beach, Ala.
This reimbursement rate is determined by Medicare and applies to bills that are submitted under the NP’s National Provider Identifier (NPI). For the most part, Medicare requires the service provider to submit a bill under his or her NPI. The clinician may use “incident to” billing in certain situations. When this type of billing is used, the bill is submitted using the physician’s NPI, and the reimbursement rate is 100%. However, the rules governing this type of billing are very detailed and complex and need to be reviewed carefully before they are applied. Visit www.cms.gov for more detailed information regarding Medicare reimbursement for NPs.—Eileen F. Campbell, MSN, CRNP, associate program director, family health nurse practitioner program, University of Pennsylvania School of Nursing, Philadelphia (149-11)
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