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The entire practice, any medical provider who works there (nurse practioner, physician's assistant, MD) all bill under the tax ID for the practice as one business. So for instance, DR X. from ABC Surgical Group is going to bill under the same tax ID to the insurance company as his/her mid-level NP or PA in the practice who sees patients for more routine visits like suture removal or pre-ops. And, the mid-levels must be "supervised" by an MD by law. Supervision does not require the doctor to even be in the building at the time the patient is seen. It just means that the supervising MD oversees and acknowleges the work of the mid-level. Our docs do a few chart reviews from each mid-level every week. If there is something that the MD would have done differently they sit down to discuss it.
Where I feel the ause of this occurs is when some offices bill insurance and collect co-pays for things like a blood pressure check. The doctor starts a patient on a new med, wants them to check in for a BP check just to be sure things are moving in the right direction. The patient signs in with the receptionist, is called back to the medical assistant's desk, sits in a chair right there for the BP check, never sees anyone except the medical assistant, and some doctors will bill insurance and collect a co-pay for an office visit. I see this also happens with vaccinations or other procedures that do not require a doctor to adminster. When I go for a BP check or anything else, I don't mind if the assist does the work but I expect at the very least, that the doctor will poke his head in to acknowledge the results and just check in with me for a minute.
Billing is done by a tax ID and a list of CPT codes for the procedure. Who did it at the practice of the tax ID submitted is of no concern to the insurance company.
Well it appears to me most of you accept how the current billing system works. Could get very lucrative for docs, if they can build up their practice and employ 3 or 4 NP's that he is able to bill out at full cost. Even a reduced rate for less qualified people would render additional profit for the doctor. I say, if we all agree on how it is currently done, then stop complaining about our very high health care costs.
My son saw the Nurse Practitioner at the Pediatrician's office. We were charged for a "specialist" visit which is more than the Doctor visit. The Doctor co-pay is $25.00. The Specialist co-pay is $35.00. We have to pay $35.00 because we saw the Nurse Practitioner instead of the Doctor. How can a NP cost more than the pediatrician? And, how does Highmark allow this to happen?
My son saw the Nurse Practitioner at the Pediatrician's office. We were charged for a "specialist" visit which is more than the Doctor visit. The Doctor co-pay is $25.00. The Specialist co-pay is $35.00. We have to pay $35.00 because we saw the Nurse Practitioner instead of the Doctor. How can a NP cost more than the pediatrician? And, how does Highmark allow this to happen?
That is something you need to raise with your insurance company. Every EOB I have ever received has had a notation to contact the insurance company if services billed were not provided. Now a quick question, did you pay the co-pay at the providers office when you saw the NP?
My son saw the Nurse Practitioner at the Pediatrician's office. We were charged for a "specialist" visit which is more than the Doctor visit. The Doctor co-pay is $25.00. The Specialist co-pay is $35.00. We have to pay $35.00 because we saw the Nurse Practitioner instead of the Doctor. How can a NP cost more than the pediatrician? And, how does Highmark allow this to happen?
Is this the office of a general pediatrician, or a pediatric specialist such as a gastroenterologist, cardiologist, endocrinologist etc? The only time I've had to pay the slightly more expensive co-pay is when the physician is not a general practitioner. But, if it's your general peds practice, then yes, like Rabritta points out above, you might want an explanation from your insurer.
If I'm paying to see the Brain Surgeon I dont want to be billed the same rate when Greg the Nurse comes in to tell me what he thinks the Dr might say.
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