Incident-to not supported
Visits billed under the physician where the NP addressed a new problem or the physician was off site. We check the schedule and note before choosing incident-to and bill under the NP otherwise.
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Nurse practitioner medical billing services
Nurse practitioner billing is decided before the claim is coded: whether the NP bills under their own NPI, incident-to a physician, or as a split/shared visit changes the payment and the documentation required. Independent practices, collaborative arrangements and hospital-employed NPs each follow different rules, and payers audit the choice.
What makes nurse practitioner billing different
The same visit can be billed three ways for a nurse practitioner, and payers check that the way chosen matches the record.
- Medicare pays nurse practitioners under their own NPI at a reduced non-physician rate, while incident-to billing under the physician requires an established plan of care, direct supervision in the office and no new problems addressed by the NP.
- Split/shared visits in facility settings bill under whichever practitioner performed the substantive portion, carry modifier FS, and must be documented so the billing practitioner's contribution is clear in the record.
- Office E/M codes 99202 to 99215 are leveled by medical decision making or total time, and annual wellness visits G0438 and G0439, transitional care 99495 and 99496 and add-on G2211 are all billable by an NP.
- Some commercial and Medicaid plans require modifier SA when an NP renders a service in collaboration with a physician, and state scope of practice determines whether a collaborative agreement must be on file before enrollment is approved.
Denials we see most in nurse practitioner
Every denial gets a root cause, a fix and a feedback loop, so the same denial stops coming back.
Provider not credentialed
Claims denied because the plan has no record of the NP. We run enrollment with each payer before the start date and track effective dates so claims are held and released, not written off.
Missing collaboration modifier
Plans that require SA or a supervising physician on the claim reject it without one. We keep a payer profile for each NP and populate the modifier and supervising fields automatically.
How Core MB bills for nurse practitioner
Core MB bills nurse practitioner practices with a team that knows incident-to, split/shared and direct billing rules, keeps each payer's NP policy current and reviews the schedule before the claim goes out. Credentialing for new NPs and collaborating physicians runs in the same client portal. Credentialing for new providers runs in the same system, tracked live in your client portal.
- Billing method, direct, incident-to or split/shared, chosen per visit from the schedule and the note.
- Payer profiles track which plans enroll NPs, which require SA and which need a supervising physician.
- Enrollment effective dates monitored so claims are held and released rather than denied.
Everything in the service
A complete revenue cycle for NP-led and NP-staffed practices, from eligibility and coding review through scrubbing, follow-up, denials, posting, statements, reporting and credentialing.
- Insurance verification and eligibility checks
- Charge entry and specialty-specific coding review
- Claim scrubbing and electronic submission
- Payer follow-up on every open claim
- Denial management and appeals
- Payment posting and reconciliation
- Accounts receivable recovery
- Patient statements and balance support
- Monthly reporting you can read in five minutes
- Provider credentialing and payer enrollment
Nurse practitioner billing questions
When can we bill an NP visit incident-to the physician?
Only for an established patient with an established problem, following a plan of care the physician set, with the physician physically present in the office suite. A new problem or a physician out of the building means the visit bills under the NP's own NPI.
Why does one commercial plan deny our NP claims that Medicare pays?
Some plans do not credential nurse practitioners directly and expect claims under a supervising physician, while others require modifier SA. We confirm each plan's NP policy during enrollment and set up the billing profile so the claim is built the way that payer expects.
How is a split/shared visit documented in the hospital?
Both practitioners document their work, and the one who performed the substantive portion of the visit bills it with modifier FS. The note needs to make clear who did what, and the billing practitioner must have seen the patient face to face that day.
How do we get started with Core MB for nurse practitioner billing?
Send your NP count, practice setting and monthly visit volume through the quote form and we will reply with a written proposal. Transitions run alongside your current billing so no visit is dropped, and credentialing for new NPs can start at the same time.
NP claims billed the right way, every visit
Core MB handles direct, incident-to and split/shared billing with the documentation to support it, so nurse practitioners are paid for the care they deliver.