July 12, 2018
We have multiple practice locations and have therapy departments at several of the locations. Our question has to do with whether or not we should obtain NPI numbers and credential all of the therapists?
KZA recommends that the practice obtain NPI numbers and credential the therapists for “direct billing”, especially if Medicare is a large part of the payor mix. Medicare allows licensed physical therapists to bill Incident-to but this means a supervising physician must be in the same suite as the therapist. In our experience, this is not typically the case. Direct billing does not require the same degree of supervision, and for Medicare there is no payment differential between direct and incident-to billing. If the therapist is credentialed and bills directly to Medicare, the need to ensure a physician is in the suite during therapy encounters is eliminated.
*This response is based on the best information available as of 07/12/18.