HealthCare News

Reimbursement of Professionals in Training

Issue: #407 MAR2019

Topic: Reimbursement

Professionals in training must be working towards and participating in a supervision plan to become a recognized, payable provider by Blue Cross Blue Shield of North Dakota (BCBSND). These professionals must practice under direct supervision of a provider, as approved by the individual’s board, who is licensed, registered, or certified by the appropriate state agency and meets the credentialing criteria set forth by BCBSND. Direct supervision means the supervising provider must be present in the office suite and immediately available to provide assistance or direction to the professional in training. Services must be billed using the supervising provider’s NPI and appropriate modifier when applicable.

Professionals in training who have not yet achieved the level of licensure just below the payable level of licensure may not bill for services.

  • Licensed Associate Professional Counselor (LAPC) would first need to become a Licensed Professional Counselor (LPC) in order to bill for services supervised by a Licensed Professional Clinical Counselor (LPCC).

Professionals in training who are eligible and must bill under the supervising provider’s NPI:

  • Graduate Registered Nurse Anesthetists (GRNA)
  • Licensed Professional Counselor (LPC)
  • Licensed Clinical Social Worker (LCSW)
  • Post-doctoral Psychology Resident
  • Psychiatry Resident in psychotherapy training under the direct supervision of a Psychologist.

Professionals in training who are not eligible to bill:

  • Resident Physicians
    • The attending/supervising physician must either be present while the substantial elements of the history and examination are performed by the resident, or the attending/supervising physician must independently perform them. Billing occurs under the attending/supervising physician’s NPI.
    • The attending/supervising physician participates in the clinical decision making and formulation of the treatment plan.
    • Documentation by the attending/supervising physician needs to support this information.