Does Your Midlevel Need to Get Credentialed ASAP?

A new policy some health plans have adopted regarding services of nonphysician practitioners (NPPs) not only cuts payments for practices but also could raise costs for patients. 

UnitedHealthcare (UHC) and Blue Cross and Blue Shield of Texas (BCBSTX) are no longer paying for services provided by an NPP when billed under the supervising physician’s National Provider Identifier (NPI). Practices contracted with these plans must bill these services under the nonphysician practitioner’s own NPI, which pays at a lesser rate. In addition, if the NPP is not credentialed with the health plan, the claims for those services will process as out-of-network, saddling the patient with greater out-of-pocket costs. 

“Nonphysician practitioners in practices contracted with UHC and BCBSTX plans should get credentialed as soon as possible,” TMA reimbursement specialist Mary Fox said. See BCBSTX’s network participation instructions and UHC’s Join Our Network page.

TMA’s medical economics and payment staff have met with both insurance companies and urged the payers to instead conduct further educational outreach to physicians and nonphysician providers on proper billing for “incident-to” services. TMA called for the payers to make it clear that physicians can continue to utilize advanced practice nurses and physician assistants under proper incident-to billing arrangements, even if the advanced practice nurse or physician assistant has his or her own NPI. 

Concerned about recent moves by health plans to curtail the longstanding ability for practices to bill incident-to for services provided by nonphysician practitioners, TMA also surveyed Texas physicians to better understand the implications of a payer ending incident-to payments. 

Responding physicians, on average, said they employ two nurse practitioners and one physician assistant, and nearly two-thirds said they bill incident-to when clinically appropriate. Most respondents contract with up to seven different payers, the survey found, and a billing change by one payer “unnecessarily complicates the practice of medicine and places additional administrative burdens on practices’ billing staff,” TMA recently told UHC. 

Also, the TMA survey found, physicians report the ability to treat an additional median count of 50 patients a week as a direct function of working collaboratively with nonphysician practitioners under incident-to arrangements. TMA officials warn that “ending incident-to billing arrangements threatens these patients’ access to physician-led, team-based care.”

Last Updated On

May 03, 2021

Originally Published On

May 03, 2021

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