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

$239.00

This product is not for purchase at this time.


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, CMCO, CMIS, CMOM, CMCA E/M

Jan Hailey has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles, and teaches medical office professionals around the country how to excel in their careers. Jan has also been instrumental in the development of PMI's Workforce Initiatives program. 

Jan's affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has served as Director of Quality for Saint Joseph Physician Network located in Mishawaka, IN, and Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. As Care Management Director, Jan led the physician network and comprehensive interdisciplinary team across the health system working closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience. She developed a documentation improvement program and a Hierarchical Condition Category (HCC) coding education program to predict future healthcare utilization by accurately reporting patient complexity.

Prior to joining Saint Joseph, Jan was the Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana. She has a Master of Health Leadership and four professional certifications in office management, coding, insurance processing, and compliance. She is a member of WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group.

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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