Online Training Course

Prod ID: 176
Billing for Non-Physician Practitioners

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.

CEUs

3

Length

134 min

Price

$119.40

Medicare provides reimbursement for non-physician provider services that are ‘incident to’ a physician’s service. ‘Incident to’ services are specific to Medicare billing and have defined guidelines that must be followed. When billing ‘incident to’ services, a practice can be reimbursed 100% of the physician’s fee schedule. Failing to bill or billing incorrectly for ‘incident to’ services could cost a practice thousands of dollars each year.

 

Jan Hailey

MHL, CMC, CMIS, CMOM, CMCO

Jan Hailey has more than 20 years of experience in healthcare with proficiency in administration, coding, and billing roles. She joined Saint Joseph Physician Network located in Mishawaka, IN as the Director of Quality in November 2015. In 2019, her role transitioned into Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. This transition allowed for her expertise to expand beyond the physician network to lead a comprehensive interdisciplinary team across the health system and work closely with providers, management, staff, community and payers to develop strategies on process improvement, gap closures and patient experience.  

Jan also developed a documentation improvement program and is currently implementing an education program for Hierarchical Condition Category (HCC) coding in order to improve risk scores. She holds four professional certifications in office management, coding, and compliance. She is a member of WPS Medicare’s Provider Outreach and Advisory Group, Indiana Association for Healthcare Quality.

Jan has a passion for teaching and facilitates educational programs nationwide. Prior to joining Saint Joseph, Jan was the Director of Quality, Coding and Compliance for one of the largest health systems in Northern Indiana.

This class will explain tough billing situations and provide guidance on documentation needed to support claims. Learn when it is appropriate to bill under the provider initializing care or under the supervising providers. Improve aptitude for cross-checking and code selection.

This is an intermediate-level training designed to benefit medical office coders, billers, auditors, practice managers, compliance officers, and non-physician providers. Program materials will be provided for use beyond this session.

Review tough billing situations and receive 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.

Highlights:

  • Review of requirements for “Incident To” billing for initial visits and E/M service guidelines and coverage criteria for a variety of situations
  • Services provided by non-physician practitioners, physician assistants, and auxiliary personnel
  • Billing requirements for shared/split visits in outpatient, emergent, and hospital settings
  • Differences in NPPs, NPs, PAs, RNs, CNMs, CRNAs, scope of practice and protocols
  • Reimbursement for provider-based vs. office-based facilities
  • Incident-to billing requirements for Medicare, Medicaid, and private carrier reimbursement
  • 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

Self-paced online program includes unlimited review of previously recorded instructional lecture and downloadable digital materials for 6 months.

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