You bill under a physician's NPI at 100% reimbursement, thinking you've won. But Medicare requires the physician to establish the care plan first, be in the office suite during your visit, and only offer follow-up — not new problems.
You and the physician both saw the patient. You documented everything. But Medicare now requires the physician to perform a "substantive portion" — more than half the total time when time-based coding applies.
You practice in a full-authority state. You bill under your own NPI. But commercial payers still apply physician rules, reimburse at lower rates, or deny without explanation.
| What Generic Billers Do | What ANR Does for FNPs |
|---|---|
| Treat, you like a physician → denials | Treat, you like an FNP → clean claims |
| Ignore incident-to rules → audit risk | Audit every incident-to claim → compliance guaranteed |
| Miss split-shared documentation → 60-day delays | Flag missing elements before submission → 22% fewer denials |
| Commercial payers underpay FNP rates | Map state authority to each payer's FNP fee schedule |
| No FNP-specific reporting | Monthly report: own NPI vs incident-to revenue, denial reasons by payer |
| 12-month lock-in | 60-day opt-out. Month-to-month after. |
We audit every incident-to claim against Medicare's four requirements: physician-established care plan, follow-up only, physician in suite, and typical office service.
We review every split-shared note for physician face-to-face time, time breakdowns, and practitioner identification. Missing elements flagged before submission.
We map your state's practice authority to every commercial payer's FNP-specific fee schedule. No more default physician rates.
We add smart documentation fields to your EHR: "Physician in suite? Yes/No" — "Care plan established by physician? Date" — "Split time breakdown."
We categorize FNP denials by root cause: incident-to failures, split-shared gaps, payer non-recognition, and underpayment. Each denial receives appeal within 48 hours.
Real-time metrics: clean claim rate by billing type (incident-to vs own NPI), denial trends by payer, revenue split between supervision models, and days in A/R.
We report MIPS quality measures for FNPs: diabetes control, blood pressure management, preventive screenings, and medication reconciliation.
We confirm whether the visit bills under your NPI (independent) or incident-to a supervising physician. We also check prior authorization requirements for specialty services.
We code and document the procedures for physician-established care plan, follow-up only, and physician in suite.
Every claim runs through our 12-point compliance check before submission. We verify NPI selection (yours vs supervising physician), modifier accuracy, diagnosis linkage, and incident-to conditions.
We submit clean claims directly to Medicare, Medicaid, and 50+ commercial payers via our clearinghouse. Claims route to the correct payer address with proper FNP taxonomy codes.
Denials trigger our 48-hour fire drill. We identify root cause, correct the issue, and resubmit or file a written appeal. We track every denial by payer, reason, and resolution.
Payments post to your system within 24 hours of receipt. We reconcile EOBs, identify underpayments, and flag claims paid at incorrect FNP rates. Unpaid claims receive follow-up every 7 days.
Clean claim rate this month (98.1%). Incident-to compliance score (96%). Split-shared documentation pass rate (94%).
Missing physician face-to-face time (42% of denials). Incident-to care plan not documented (31%). Split time breakdown missing (27%).
Under your own NPI: 12,400(5312,400(539,800 (42%). Split-shared: $1,200 (5%).
UnitedHealthcare FNP claims average 38 days (warning). Aetna 24 days (good). Cigna 19 days (excellent).
If we don't achieve 98% first-pass acceptance on your FNP claims within 90 days, we credit three months of service fees.
We provide quarterly incident-to compliance audits. If a Medicare audit finds incident-to errors caused by our process, we cover recoupment costs up to $10,000 per audit.
No long-term contract. Month-to-month after first 60 days.
Percentage of collections (4-7% depending on FNP claim volume) or fixed monthly pricing. Start with $0.
Our most advanced medical billing solutions are offered to all medical specialties across the state and include famous cities like:
