At times, the line between physician and non-physician provider services may be fuzzy.  Who gets credit for what services?  What documentation is required?  What kind of reimbursement should be expected?

After researching several carriers, professional organizational stance, and state law, the bottom line is this:  services provided by a nurse practitioner must be in “collaboration” with a physician, and services provided by a physician assistant must be provided under the “supervision” of a physician.  Typically, this relationship can be illustrated by a co-signature on the patient’s chart.  This helps demonstrate the designated professional relationship between the non-physician practitioner and the physician.  In addition, the hospital may have specific policies that require physician signature on NPP charts.

If a NP performs and documents services in the emergency room and a physician provides and documents any face-to-face portion of the evaluation/management encounter that day, the service may be billed under the physician’s number and would be reimbursed at 100%.  If there is no face-to-face encounter between the patient and the physician, (even if the physician reviewed the medical record) then the service must be billed under the NP’s number and reimbursement will be at 85%.