NP Billing Services | RCM for Endocrinologists

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Serving More Than 60 Specialties

Billing and Coding Experts

Nurse Practitioner Billing and Credentialing Services That Protect Every Dollar You Earn

Nurse practitioner billing services are specialized revenue cycle workflows that handle coding, claim submission, payer enrollment, and denial recovery for NP practices under the specific reimbursement rules that apply to nurse practitioners under Medicare, Medicaid, and commercial payers. ANR Medical Billing manages this work for solo NPs, group practices, telehealth providers, and specialty clinics across all 50 states, with billing teams trained in the 85% Medicare rule, incident to compliance, shared visit guidance, state scope of practice laws, and the modifier patterns that quietly cost most NP practices thousands of dollars every month. Whether you run a solo PMHNP practice in Texas, an FNP clinic in Florida, or a multi-state telehealth group, our team manages your billing, credentialing, coding, and payer enrollment with state-aware compliance strategies built around NP regulations.

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Why Generic Billing Companies Cost Nurse Practitioners More Than They Save

Nurse practitioner billing operates under a separate set of CMS rules from physician billing, and most generalist billing companies don't know them well enough to protect your revenue. Medicare, Medicaid, and commercial insurance payers apply different reimbursement rules, credentialing requirements, modifiers, and documentation standards to NP claims. A single mis-coded incident-to claim during a CMS audit can trigger a recoupment demand covering the past three years.

The 85 Percent Medicare Rule

Under Medicare Part B, nurse practitioners receive 85 percent of the physician fee schedule when billing services under their own NPI. Many practices assume there is no way around this number. There is, but only when documentation, supervision, and payer policy align under incident to or shared visit rules. We know exactly where those lines sit, and we bill accordingly.

Incident To Compliance at 100 Percent Reimbursement

Incident to billing can lift NP reimbursement from 85 percent to 100 percent of the physician fee schedule, but the rules are unforgiving. The supervising physician must initiate the plan of care, remain actively involved, and provide direct supervision according to current CMS standards. One documentation gap turns a routine claim into an audit risk. We review every incident to claim against payer policy and CMS guidance before submission.

Shared and Split Visit Rules

CMS has updated shared and split-visit guidance in recent years, especially for facility-based care. Determining whether the physician or nurse practitioner performed the substantive portion of the visit directly affects billing eligibility and reimbursement.

State Scope of Practice and Collaborative Agreements

Twenty seven states and the District of Columbia grant nurse practitioners full practice authority. The remaining states require reduced or restricted practice arrangements with collaborative physician agreements on file. Payers in those states will not credential NPs without compliant documentation, and they will deny claims when the agreement lapses. We track these requirements during enrollment and during ongoing billing operations.

Collaborative Practice Agreement Requirements

Reduced- and restricted-practice states often require formal collaborative physician documentation before payers will approve enrollment or reimbursement. Missing agreements can delay credentialing for months.

Modifier Accuracy for NP Claims

Modifier 25, modifier 59, modifier AS, modifier SA, and modifier 95 appear constantly on NP claims, and each one has a precise use case. Modifier 25 separates a significant E/M service from a same day procedure. Modifier SA identifies NP services billed incident to a physician in some states. Modifier 95 confirms synchronous telehealth. Used incorrectly, any of these can trigger a denial, a recoupment, or a payer audit. Our certified coders apply modifiers based on documentation and payer rules, not assumption.

Credentialing Bottlenecks That Stall Revenue Before It Starts

Most commercial payers take 90 to 180 days to credential a nurse practitioner, and the longest delays come from Aetna, regional Blue Cross plans, and Medicaid managed care contracts. Every day of delay is a day of out of network claims, suspended reimbursement, or rejected submissions. Our credentialing team manages CAQH, PECOS, NPPES, and commercial applications in parallel to shorten enrollment timelines.

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End to End Revenue Cycle Management Built
Around NP Workflows

Eligibility and Benefits Verification

We verify active insurance coverage, deductible status, copays, referral requirements, telehealth eligibility, authorization rules, and payer-specific limitations before appointments occur.

Medical Coding Review and E/M Audit

Our AAPC certified coders review CPT, ICD 10 CM, HCPCS, and modifier accuracy on every claim. We audit E/M codes 99202 through 99215 to catch both overcoding risk and undercoding loss, and we support specialty coding for behavioral health, chronic care management, transitional care, preventive medicine, telehealth, women's health, and aesthetic services. We also bill G2211 correctly on qualifying primary care visits, an add on code most practices either miss entirely or apply incorrectly.

Charge Entry and Electronic Claims Submission

We submit claims electronically within 24 to 48 hours after charge entry. Our billing workflows include claim scrubbing, payer edits, demographic verification, and modifier validation before transmission.

Denial Management and Appeals

We work denial codes that hit NP practices hardest, including CO 16, CO 197, CO 109, and CO 50, along with payer specific denials around incident to billing, supervising physician mismatches, telehealth modifiers, and authorization issues. Appeals go out with documentation, citation of payer policy, and clinical justification when needed.

AR Follow-Up and Aging Recovery

AR over 60, 90, and 120 days is where most billing companies stop trying. We work aged claims through timely filing windows, payer escalation, corrected claim submission, and second level appeals. Practices we onboard typically see AR over 120 days drop from 18 to 22 percent down to under 8 percent within the first quarter.

Payment Posting and Reconciliation

ERAs, EFTs, paper checks, and patient payments post accurately and reconcile against contracted rates. Underpayments get flagged and appealed. Most practices lose 3 to 7 percent of revenue to silent underpayments that never show up on a denial report.

Patient Statements and Soft Collections

Statements go out on a clear schedule with itemized balances and accessible support. Patients call our team with billing questions, not your front desk. Collections improve, and your patient relationships stay intact.

Incident To and Shared Visit Billing

Our billing specialists review documentation, physician involvement, supervision requirements, and payer policies before submitting these claims.

Telehealth Billing for NPs

Place of service 02 and 10, modifier 95, audio only requirements, and state by state parity rules change frequently. We track payer policy updates and apply them in real time so telehealth claims do not bounce.

Custom KPI Reporting and Dashboards

Every practice gets a custom dashboard showing clean claim rate, denial percentage, days in AR, first pass resolution rate, collections by payer, and reimbursement trends. Monthly performance reviews translate those numbers into decisions you can act on.

Medical Credentialing and Payer Enrollment for Nurse Practitioners

NPI Registration

Type 1 NPI for individual nurse practitioners and Type 2 NPI for group entities, registered through NPPES with accurate taxonomy codes and practice information.

CAQH ProView Setup and Maintenance

Incomplete CAQH profiles are one of the most common causes of enrollment delays. We create, maintain, attest, and update CAQH ProView profiles to keep payer applications moving.

Medicare PECOS Enrollment and Revalidation

Our team handles Medicare enrollment, reassignment applications, PECOS updates, and revalidation requirements for nurse practitioners and group practices.

State Medicaid Enrollment

Every state Medicaid program operates differently, and the managed care plans inside each state operate differently again. We manage state applications, supporting documentation, provider agreements, and tracking through approval.

Commercial Payer Enrollment

We credential nurse practitioners with major commercial insurance plans, including BCBS, Aetna, Cigna, UnitedHealthcare, Humana, and Tricare, as well as regional payer networks.

Re Credentialing and Roster Management

Credentialing does not end after approval. We track expiration dates, renewals, roster changes, and recredentialing deadlines to help practices avoid network termination.

Hospital Privileging Support

Hospital and facility privileging applications often require extensive documentation. We coordinate application packets, training records, board certification details, and supporting documents.

Collaborative Agreement Documentation

For states requiring collaborative physician agreements, we help organize and submit compliant documentation during payer enrollment.

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NP Specialty Billing Expertise

1

Family Nurse Practitioner (FNP)

We do FNP billing for preventive medicine, chronic disease management, G2211 add on coding, and primary care E/M optimization.

2

Psychiatric Mental Health Nurse Practitioner (PMHNP)

We offer Psychiatric Mental Health Nurse Practitioner billing for medication management codes 90792, 99202 through 99215

3

Adult Gerontology Nurse Practitioner (AGNP and AGACNP)

We offer Adult Gerontology Nurse Practitioner billing for transitional care management, chronic care management, advanced care planning, and Medicare Annual Wellness Visits.

4

Pediatric Nurse Practitioner (PNP)

ANR offers PNP billing for well-child visits, developmental screening, vaccine administration coding, and Medicaid pediatric panels.

5

Women's Health Nurse Practitioner (WHNP)

We offer best WHNP billing for preventive gynecology, prenatal care, contraceptive management, and global obstetric packages.

6

Acute Care and Emergency Nurse Practitioners

Acute care and ENP billing for hospital and facility E/M codes, critical care services, and shared visit documentation in inpatient settings.

7

Neonatal Nurse Practitioner (NNP) Billing

NNP billing for NICU services, neonatal critical care, and complex facility based reimbursement.

8

Aesthetic and Med Spa Nurse Practitioners

Aesthetic and Med Spa NP billing for covered medical services alongside cash pay aesthetic procedures, with clean separation that protects both revenue streams.

9

Telehealth Only Nurse Practitioners

Nurse Practitioner Telehealth billing services are ideal for across multi-state licensure compacts, place of service codes, modifier 95, audio only policies, and payer specific telehealth rules.

10

Solo and Independent NPs

Our Solo and Independent billing and coding services are ideal for billing under full practice authority arrangements with simplified workflows designed for single provider practices.

A Frictionless Onboarding Built Around Your Practice

Free Discovery and Practice Audit

We review your current billing performance, denial trends, credentialing status, payer mix, AR aging, and workflow gaps.

EHR and Practice Management Integration

Our team integrates with your existing EHR, EMR, and practice management software while completing HIPAA business associate agreements.

Credentialing Cleanup

If enrollment gaps or inactive payer contracts exist, we correct credentialing issues before billing operations begin.

Daily Billing Operations Begin

Our billing specialists begin charge review, claim submission, denial follow-up, payment posting, and payer communication immediately.

Monthly Performance Reviews and Optimization

Each month, we review KPIs, denial patterns, payer trends, and reimbursement performance with your practice.

Software We Already Work In

We integrate with the EHR and practice management platforms NPs use most, including Athenahealth, Kareo, Tebra, AdvancedMD, eClinicalWorks, DrChrono, NextGen, SimplePractice, TheraNest, Practice Fusion, and NueMD. If your platform is not on this list, our onboarding team almost certainly supports it. Ask during your audit call.

We regularly work with:

Athenahealth

NextGen

Kareo and Tebra

SimplePractice

AdvancedMD

Theranest

eClinicalWorks

Practice Fusion

DrChrono

NueMD

If your practice uses another platform, our onboarding specialists can usually support custom workflows and integrations.

HIPAA Compliant, Audit Ready, Built on Trust

Healthcare billing requires a strong compliance infrastructure, especially for nurse practitioners operating across multiple states and payer networks.ANR Medical Billing complies with HIPAA and HITECH standards through encrypted workflows, secure data handling, restricted-access controls, and signed business associate agreements.

Our coding and billing teams include AAPC-certified professionals with CPC, CPB, and CPMA credentials. We maintain audit-ready documentation practices aligned with CMS and OIG expectations. We also help practices prepare for payer audits involving incident-to billing, modifier usage, telehealth documentation, and E/M coding compliance.

Why NPs Across the U.S. Trust Us With Their Revenue

Nurse practitioners need more than a generic billing vendor. They need specialists who understand how NP regulations affect reimbursement.

NP Dedicated Billing Teams

20 Plus Years of Healthcare RCM Experience

Transparent Pricing

Dedicated Account Management

Real Time KPI Visibility

State Aware Billing Knowledge

Real Numbers, Real NP Practices

Our credentialing team completed enrollment with seven commercial payers within 60 days.

98%+ clean claim rate

Average days in AR below industry benchmarks

Reduced denial percentages across specialty practices

Higher first pass claim acceptance rates

Presence Throughout the
State of USA

Our most advanced medical billing solutions are offered to all medical specialties across the state and include famous cities like:

New York (NY)

Massachusetts (MA)

New Jersey (NJ)

Georgia (GA)

Michigan (MI)

Rhode Island (RI)

West Virginia (WV)

Connecticut (CT)

North Carolina (NC)

Illinois (IL)

Mississippi (MS)

California (CA)

Oregon (OR)

Colorado (CO)

South Carolina (SC)

Oklahoma (OK)

Virginia (VA)

Maryland (MD)

Washington (WA)

Louisiana (LA)

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Simple, Transparent Pricing for NP Practices

Percentage of Collections Model
Flat Rate Per Claim Model
Credentialing Flat Fee Pricing
Solo NP Friendly Options

(860) 500-1471

Frequently Asked Questions (FAQs)

Nurse practitioner billing services manage the financial side of healthcare reimbursement for NP practices. Services usually include medical coding, claim submission, denial management, AR follow-up, payment posting, credentialing, insurance verification, and compliance support. Specialized NP billing companies also understand Medicare reimbursement rules, incident-to billing requirements, telehealth policies, and state-specific scope-of-practice regulations.

Yes. Nurse practitioners can enroll with Medicare and bill directly under their own NPI. Medicare typically reimburses nurse practitioner services at 85% of the physician fee schedule when billed directly. Some services may qualify for full reimbursement under compliant incident-to billing arrangements.

The 85% rule refers to Medicare reimbursement rates for nurse practitioner services billed under the NP's own provider number. Medicare pays nurse practitioners 85% of the physician fee schedule amount for covered services under Medicare Part B, unless the claim qualifies for incident-to billing.

Incident to billing allows certain services performed by a nurse practitioner to be billed under a supervising physician's provider number at 100% reimbursement. The physician must initiate the treatment plan, remain involved in care, and provide direct supervision in accordance with CMS rules.

Incident to billing usually applies in outpatient office settings where the physician supervises the NP's ongoing care plan. Shared and split visits generally apply in facility settings where both the physician and NP participate in patient care during the same encounter.

Credentialing timelines vary by payer and state. Medicare enrollment may take several weeks, while commercial insurance credentialing often takes 60 to 180 days. Delays commonly occur because of incomplete applications, missing CAQH data, or missing collaborative agreements.

Yes. Each nurse practitioner needs a Type 1 NPI for billing and provider identification. Group practices may also require a Type 2 organizational NPI.

Many commercial insurance companies allow nurse practitioners to bill independently, especially in full practice authority states. Requirements vary by payer, specialty, and state regulations.

Common NP billing codes include office visit E/M codes 99202 through 99215, preventive medicine visits, behavioral health codes, chronic care management services, telehealth services, and specialty-specific procedure codes.

Most billing companies charge either a percentage of collections or a flat fee per claim. Credentialing services may use separate per-application pricing. Costs depend on specialty complexity, claim volume, payer mix, and service scope.

Yes. ANR Medical Billing works with solo nurse practitioners, startup clinics, telehealth providers, and growing multi-provider practices.

Yes. We support multi-state nurse practitioner practices with payer enrollment, telehealth compliance, credentialing coordination, and state-aware billing workflows.

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SERVING ALL OVER THE USA

Nurse Practitioner Billing and Credentialing Services