TMA Ask the Expert: Delegate to Nonphysician Practitioners
By Emma Freer

Delegating prescriptive authority to nonphysician practitioners (NPPs), such as nurse practitioners and physician assistants, can help physicians manage their workloads and budgets. But doing so requires vigilance to comply with state scope-of-practice laws and avoid costly billing mistakes.

Now you can take advantage of guidance the Texas Medical Association shared on this topic during TMA’s latest Ask the Expert event, Delegation of Nonphysician Practitioners and Scope of Practice. The recording of the event is free to TMA members as a CME to Go program, and you can earn 0.5 AMA PRA Category 1 Credits™ (enduring), 0.5 Ethics.

TMA’s advocacy is guided by the principle that independent diagnosing and prescribing is the practice of medicine – and the purview of physicians alone, Vice President for Advocacy Dan Finch said at the virtual event. “Physicians can delegate, but must supervise, because ultimately they’re accountable for the delegated act,” he added.

This accountability extends to billing. Under certain circumstances, supervising physicians can bill NPP visits under their own National Provider Identifier (NPI) number for full payment, explained Carra Benson, TMA’s manager of practice management and reimbursement.

Under Medicare, these visits are known as “incident to” services because they are incidental to the physician’s diagnosis and treatment of an injury or illness.

To qualify, an NPP must see a patient for an existing problem and use a treatment plan developed by the physician in advance and under direct supervision, where a physician is present in the same office suite and available to intervene if needed. Should a new issue arise during such a visit, the physician must get involved; otherwise, the visit cannot be billed under the physician’s NPI number.

Similarly, if an NPP sees a patient under general supervision, where a physician is only available by phone, the visit must be billed under the NPP’s NPI number – not the physician’s.

A less common scenario is known as “shared splits,” Ms. Benson said. When a physician and an NPP each see a patient face-to-face in an inpatient, outpatient, or emergency department setting, the two visits may be billed together under the physician’s NPI number, with certain exceptions.

In all cases, NPPs must be employed by the supervising physician and registered with the Texas Medical Board as having delegated prescriptive authority.

Although not required, Ms. Benson encouraged supervising physicians to have their NPPs credentialed by individual payers. Doing so provides a safety net against lost revenue if an NPP visit billed under the physician’s NPI number is disqualified for any reason, she says.

These nuances can be tricky to navigate. “This is a complex thing, and there are going to be mistakes,” Austin attorney Julian Rivera said during the event.

Mr. Rivera encouraged physicians to document any mistakes as well as any corrective actions enacted to address them. “When something like this happens, there is only one solution and there is only one opportunity – but it’s a big opportunity – and that is to prove compliance,” he said.

If a mistake is substantial, Mr. Rivera recommends hiring a lawyer who can help analyze the situation confidentially.

Check out TMA’s Ask the Expert webpage to find more resources on this topic and register for upcoming events, including a Sept. 17 session on TMA’s updated Policies and Procedures Manual.

Last Updated On

September 01, 2021

Originally Published On

September 01, 2021

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Emma Freer


(512) 370-1383

Emma Freer is a reporter for Texas Medicine. She previously worked in local news, covering city politics, economic development, and public health. A native Clevelander, she graduated from Columbia Journalism School and the University of St. Andrews.

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