Online Training Course

Prod ID: 387
Billing for Advanced Practice 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.




176 min



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.


Jan Hailey


Jan Hailey is PMI's Director of Workforce Initiatives. She has more than 20 years of experience in healthcare administration, coding, and billing, and a passion for teaching educational programs nationwide.

Jan is the former Director of Care Management with Select Health Network, an entity of Saint Joseph Physician Network in Mishawaka, IN.  She led a comprehensive interdisciplinary team across the health system and worked closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience.  To improve risk scores for the health system, Jan developed a documentation improvement and education program for the Hierarchical Condition Category (HCC). Prior to joining Saint Joseph, she served as Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana.

She earned a Master's in Healthcare Leadership and holds four professional certifications in medical office management, coding, billing, and compliance, and is an active member of WPS Medicare’s Provider Outreach and Advisory Group, Indiana Association for Healthcare Quality. 

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.

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

This is a comprehensive session 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. Includes additional guidance on unique billing situations.

  • 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

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

Past participant comments:

"Excellent session on proper billing."

"This was very informative."

"Great information on billing for various types of advanced practice professionals." 

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