NP-owned practices and practices that rely on PAs bill under rules most physician practices never have to think about. Medicare pays most NP and PA services at 85% of the physician fee schedule, and incident-to billing changes that only when strict conditions are met. Bring your service mix and Taiga will tell you straight whether it fits.
Book a demoMost NP and PA billing questions come back to three points.
Medicare pays NP and PA services at 80% of the lesser of the actual charge or 85% of the physician fee schedule amount, outside a hospital or SNF. Commercial and Medicaid plans set their own rates, so the same visit can pay differently by payer.
A service can be billed under a supervising physician at 100% of the fee schedule only when that physician performed the initial service, stays actively involved in the course of treatment, and provides direct supervision in the office. If those conditions are not met, the visit belongs under the NP or PA's own NPI.
Since January 1, 2022, PAs can bill Medicare under their own NPI or let an employer bill reassigned services. Each PA's enrollment record decides where Medicare sends payment, so check it before claims move.
Clinical scope stays with your license and your state. Claim work moves to Taiga.
Credentialing choices, any collaboration or supervision agreements your state requires, and the clinical notes. Your rendering clinicians approve every code Taiga drafts before submission.
Coding drafts from notes, eligibility checks, claim scrubbing against each payer's rules, submission, denials, appeals, and patient statements.
Which services, if any, are billed incident to a physician, and how supervision is documented. If a payer credentials only the physician, that has to be known before claims are built.
Bring de-identified examples of claims billed under each clinician. Patient details stay out of the booking form.
Say whether an NP, a PA, or a physician owns it, and which state or states you practice in.
List each NPI, any reassignment to the group, and the payers each clinician is credentialed with.
Describe which visits are billed under a physician and how direct supervision and ongoing involvement are documented.
Worth a call for an NP-owned clinic, or a practice that relies on NPs and PAs, that wants coding drafts, clean claims, and denial follow-up under the right NPI.
Medicare covers NP and PA services only as state law and scope-of-practice rules allow, and Taiga does not decide what a license permits. NP and PA practices are not among Taiga's named specialties, so fit is confirmed on the call.
No. Medicare pays NP and PA services based on 85% of the physician fee schedule amount. Services billed incident to a supervising physician are paid at 100% only when every incident-to condition is met.
Yes, for services on or after January 1, 2022. A PA can bill directly or let an employer or contractor bill reassigned services under the PA's NPI.
Generally no. Incident-to requires that the physician performed the initial service and remains actively involved in the course of treatment, with direct supervision in the office.
It can. Medicare covers NP and PA services only when they follow state law and scope-of-practice rules, including any collaboration or supervision your state requires.
List your NPs, PAs, and physicians with how each one bills today. Taiga will tell you straight whether it fits.
System guides show possible billing handoffs, not proven specialty compatibility.