Online Training Course

Billing for Mid-Level Providers

Reduce your audit risk and ensure that billing procedures are compliant. Instructor will review documentation guidelines and provide examples and guidance on tough billing situations.




180 min



Mid-level provider claims are a common audit risk area. Review tough billing situations with examples and guidance on documentation needed to support claims. Learn when it is appropriate to bill under the provider initializing care or under the supervising providers and improve aptitude for cross-checking and code selection.

  • Incident to billing criteria, requirements and reimbursement considerations
  • Direct vs. indirect supervision by the physician/NPP
  • Level of education, scope of practice and other protocols of the NPP
  • State definition of scope of practice for mid-level providers
  • Differentiating between scope of practice and scope of license
  • Examples of non-physician practitioners and auxiliary personnel
  • Explanation of service settings such as unsupervised or off-site
  • Difference between Nurse Practitioner and Physician Assistant
  • Guidance on which national provider identifier (NPI) to bill claims under
  • Review documentation guidelines
  • Why CMS recovery auditors are scrutinizing practices that employ mid-level providers
  • Working with NPPs under independent contract agreement
  • Question and answer period to address participant questions

Rhonda Granja

Rhonda has been in the medical office profession since 1990 and works as an independent medical consultant. Rhonda has done the necessary follow-up work and has a proven track record for winning insurance appeals. She works with several medical groups and has also been involved extensively in medical advocacy. Rhonda enjoys sharing her experience and knowledge with others in this profession. Her vast experience has been achieved by actively working in all areas of a medical practice - everything from the front desk to the clinical side. She has developed staff motivation techniques and also has extensive knowledge of billing and reimbursement related to managed care and commercial carriers as well as Medicare and state funded products. Rhonda’s experience and passion for speaking tends to get attendees excited about what they do.Aside from her professional relationships, she makes time to advocate with the non-profit organization, Autism Speaks.

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