Billing for Non-Physician Practitioners
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.
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.
- 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
Not able to attend a live session?
Check out our self-paced version!