Can NPP Services Be Reimbursed?

Absolutely, as long as the services meet the minimum criteria and you’re medical billing documentation is ironclad. If you aren’t getting a reimbursement for the services rendered to patients by a nonphysician practitioner (NPP) affiliate with your practice, you’re leaving money on the table for the insurance company that rightfully belongs to your practice.

Learn the rules of the carrier and take the time to bill under the NPP provider number and statistics how that over three-fourths of the health plans billed would reimburse at an average rate of 85%. While this isn’t a full reimbursement, it is far better than not receiving anything in return for your services rendered. There are two main rules for using this type of billing. The patient’s physician or another affiliated physician must be available in the office during the time the services were rendered. Also, shared visits apply where the patient sees both the physician and the NPP.

Each individual carrier has their own policies in place for the credentialing and reimbursement to NPPs. Find out what the patient’s insurance plan covers up front before you compile your medical billing.

When you combine calling the carrier and getting the hard-line of what exactly is covered and what is not along with medical necessity of services rendered, you will have an air tight medical billing claim, that should result in at least a partial reimbursement for services rendered by an NPP.

View all Articles by: Kathryn Etienne, CCS-P