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Billing for Advanced Practice Providers


Medicare reimburses advanced practice providers (APP) for services that are ‘incident to’ a physician’s service with defined guidelines. When billed correctly, these services are reimbursable at 100 percent of the physician’s fee schedule. This course will help reduce audit risk when your team understands Medicare and third-party guidelines for APP service billing.

This is a comprehensive course with expert guidance that covers the documentation requirements needed to support claims, cross-checking and code selection, how to avoid under-coding, and work through grey areas. Learn the differences in APPs, NPs, PAs, RNs, CNMs, CRNAs, scope of practice and protocols. The instructor will explain how to handle tough billing situations like split/shared billing, utilization of APPs in alternate healthcare settings, and collaborative agreement arrangements.

Additional guidance on unique billing situations will include:

  • Services provided by non-physician practitioners, physician assistants, and auxiliary personnel
  • When to bill under the provider initializing care or under the supervising providers. Improve aptitude for cross-checking and code selection.
  • Billing requirements for shared/split visits in outpatient, emergent, and hospital settings
  • Reimbursement for provider-based vs. office-based facilities
  • Incident-to billing requirements for Medicare, Medicaid, and private carrier reimbursement
  • A detailed explanation of AMA/CMS documentation guidelines for E/M services
  • Review of the False Claims Act, Anti-kickback Statute, Stark Law, overpayments, fraudulent claims submissions, mandates, and legal actions that may result in exclusion from participation in Federal health care programs.
  • Frequently-asked questions for Incident-to reimbursement, working with NPs and APPs

Target Audience

This is an intermediate-level training designed to benefit medical office coders, billers, auditors, practice managers, compliance officers, and non-physician providers.

Full Schedule


There are no programs scheduled at this time


CEUs:

PMI 3