Physicians should examine insurer contracts, provider policy and procedure manuals to ensure compliance
If you employ nurse practitioners or physician assistants, you should make sure you’re complying with each payer’s protocols when billing for services provided by nonphysicians. TAFP has recently heard from members who thought they were billing properly but have found themselves under investigation by payers. If these practices are found to be out of compliance, they may owe payers substantial refunds.
Many payers pay reduced fees for services provided by NPs and PAs but the rules and billing procedures doctors should follow when filing claims differ from payer to payer. For instance, Blue Cross Blue Shield of Texas pays 15 percent less for services provided by NPs or PAs than they would for services provided by the supervising physician. The insurer requires that practices include a “Modifier SA” when filing claims to indicate that a service was performed by an NP or a PA.more