Medical Billing for Nurse Practitioners & PAs
NP and PA billing has its own rules — 85% Medicare rates, incident-to, split/shared visits and state supervision laws. We get them right so you are paid the full amount you are entitled to.
Small Billing Mistakes Cost Advanced Practice Providers the Most
Nurse practitioners and physician assistants deliver a large share of primary and specialty care, but their billing is easy to get wrong. A visit billed incident-to when it does not qualify is a compliance risk. A visit billed under the NP when it could legally be billed incident-to may leave money on the table. Payers that credential NPs differently from physicians can deny claims for the wrong rendering provider.
AccMed RCM reviews how each visit should be billed, keeps your enrollment clean and follows up on every denial.
- Correct rendering and billing NPI on every claim
- Incident-to and split/shared visit review against current rules
- NP and PA enrollment with Medicare, Medicaid and commercial payers
- State supervision and collaboration rules reflected in billing
- Denial follow-up for provider-type and credentialing denials
How We Handle NP & PA Claims
Check enrollment
Confirm each NP or PA is credentialed and linked with every payer you bill.
Review the visit
Decide how each service should be billed based on setting, patient status and payer policy.
Submit clean
Claims are scrubbed for provider type, modifiers and NPI before submission.
Follow up
Denials are corrected, resubmitted or appealed, and patterns reported to you.
Services NPs and PAs Use Most
NP & PA Billing: Common Questions
How does Medicare pay nurse practitioners and PAs?
When an NP or PA bills Medicare under their own NPI, Medicare generally pays 85% of the physician fee schedule amount. Under incident-to rules, some services in an office setting can be billed under the supervising physician at 100%, but only when every incident-to requirement is met. We review which applies to each visit.
What are the incident-to requirements?
In general, the physician must have started the course of treatment, the patient must be established with a plan of care, the service must be in the office (not a hospital), and the physician must provide direct supervision. New patients and new problems usually must be billed under the NP or PA. Rules can vary by payer, so we check each payer policy.
Can an NP practice bill insurance on its own?
Yes, in many states NPs can own a practice and bill Medicare, Medicaid and commercial payers under their own NPI. Scope of practice and supervision rules depend on your state, and some commercial payers credential NPs differently from physicians.
Do PAs need a collaborating physician to bill?
PAs can bill Medicare directly, but state law and payer contracts still set collaboration or supervision requirements. We make sure your enrollment and claims match those requirements.
Do you handle NP and PA credentialing?
Yes. We enroll NPs and PAs with Medicare, Medicaid and commercial plans, keep CAQH up to date and track revalidation dates.
Make Sure Every NP and PA Visit Is Billed Correctly
Our free audit reviews a sample of your APP claims for rendering provider, incident-to and denial issues.