Understanding Participating and Non-participating provider status for NPs

On the surface, it sounds like having non-participating provider status with Medicare is a good thing. But for NPs, is it really?

Medicare requires NPs enrolled with Medicare as a provider to accept assignment. That the rule had always taught me that NPs could not opt for “non-participating” provider status. Recently though, I’ve heard from several who are enrolled with a “non-participating” status. But is this a good thing for NPs?

That’s why I sat down with Don Self to review the whole issue and discover what advantages there are for Nurse Practitioners who opt for non-participating status.

In this video podcast, Don talks about just what it is and what, if any advantage there is for NPs. Take a list, as this may not be what you think.

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  1. I have questions regarding billing for a non-par provider prior to her becoming a par-provider with Medicare, can she still bill the dates prior to her effective date of becoming a par-provider with Medicare?

  2. I just answered your question on YouTube. I’m not a biller (disclaimer), but I don’t see why not. She has a PTAN I assume and has been billing MCR. In general, CMS allows 1 year of back billing from the time you apply.

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