Nonphysician Providers Could Enhance Your Practice
In these volatile economic times, adding staff to your medical practice may not be feasible. However, if it is, hiring new staff could help grow the practice by improving patient satisfaction.
Although you may not want to bring in new physicians, you might want to consider hiring one or more nonphysician providers (NPPs) to round out your staff. Doing so may assist you in responding effectively to changing needs.
What do they do?
There are two primary categories of NPPs: physician assistants and nurse practitioners. Which category is best for your practice depends on which is licensed in your state and the range of activities that the NPP in question is licensed to perform.
An NPP may be able to function independently or work under a doctor’s supervision — again, depending on relevant state law. Typical services that an NPP of either type may provide include coordinating health education, patient counseling and patient care. They also can order and/or perform diagnostic and therapeutic procedures, arrange patient referrals, deliver on-call care, perform physical exams, take patient histories, and contribute to clinical decision making.
Discuss with your physicians which services they’d be willing to accept from an NPP. Also, calculate the appropriate number of NPPs to meet the practice’s needs, and establish benchmarks to evaluate their performance.
How can you find them?
The most direct way to find good NPP candidates is through job listings on the websites of local and national associations for physician assistants and nurse practitioners. Another source of candidates may be local schools that train NPPs.
Once you’ve found and hired your NPPs, you’ll need to introduce them to two critical constituencies: physicians and patients. When introducing them to doctors, clarify how the NPPs will improve patient care. Then define the roles for physicians and NPPs and document applicable standing orders, protocols, collaborative agreements and supervision agreements. Also send letters to patients explaining the hire of NPPs and the role they’ll play.
What about billing?
An NPP can bill Medicare for services in two ways:
1) “incident to” a physician’s care, using the doctor’s National Provider Identifier (NPI)
2) directly after being credentialed by Medicare, using the NPP’s own NPI
Under the first option, after an initial visit by a doctor, the NPP can provide services under the physician’s direct supervision or while the doctor is available in the office to give immediate assistance. To continue billing subsequent visits with the NPP as “incident to,” the physician must actively participate in and manage the patient’s treatment, with commensurate documentation in the patient’s medical record.
Unless all of an NPP’s services fall within the “incident to” definition, the NPP must use the second option — that is, to enroll in Medicare, obtain an NPI and bill directly. NPPs who bill directly receive lower reimbursements (85% of the full physician fee schedule rate) than when they bill “incident to” (100%).
Private commercial payers have their own rules about reimbursing NPP services. They usually apply separate criteria for credentialing NPPs, sometimes not allowing them to bill directly.
Plus, they typically reimburse NPPs at lower rates than for supervising physicians. Your practice must bill under the doctor’s NPI and follow the billing guidelines in the payer’s provider manual. And you may need to append certain modifiers to the bill to correctly identify the NPP and supervising physician providing the care together.
Is it the right move?
NPPs can fill a niche in your practice, helping provide high-quality services to patients while relieving pressure on the physicians. It’s a possibility worth considering as you seek to maintain (or increase) patient volume and meet the demands of today’s health care marketplace in an uncertain economic environment.
If you have any questions, please contact Deirdre Hartmann, CPA or Harlene Stevens, CPA at (973) 298-8500.
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