Non-Physician Practitioners Billing Issues Reviewed

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AudioEducator is conducting a 60-minute audio session on Medicare's Rules for Non Physician Practitioners, Incident to, and Direct Services on Tuesday, April 14. Participants will learn how to structure office (or hospital) use of NPP's to be efficient and compliant.

You will be surprised to know the number of limitations and independence rules that are overlooked every day in NPP billing. -- Jill M. Young

The roles and responsibilities of non physician practitioners have expanded tremendously with the implementation of the Patient Protection and Affordable Care Act. As non physician practitioners (NPPs) are increasingly being used by healthcare organizations to enhance patient satisfaction, there are certain issues one must be aware of, for instance, each state has different regulations regarding the scope of practice and level of supervision required for each type of practitioner.
Compliance Issues with NPPs

The risk for noncompliance with NPPs is higher, as every health plan, including Medicare, has its own set of rules regarding NPP billing. Health plans can set up their own policies credentialing NPPs and providing reimbursement for services provided without a cost. However, there are some plans which do not instruct practices to bill for services provided by NPPs as if the physician had provided them, using the physician name and provider number on the claim. Medicare calls this arrangement “incident-to” billing. Health plans that allow this type of billing may do so with fewer restrictions than Medicare. According to CMS, the service provided needs to be an essential part of a Medicare patient’s normal course of treatment, where the physician personally performed the initial service and remained involved in the course of treatment.

In another arrangement, NPPs are required to complete Medicare enrollment forms (CMS-855I application) to be paid for providing care to Medicare beneficiaries, until and unless all services fall under the “incident to” definition. Credentialing NPPs independently requires less administrative work—though the reimbursement received will be lower, because NPP services are reimbursed at a lower rate as compared to physician fee schedule rates.

The Medicare’s rules for Non Physician Practitioners, incident-to and direct services are confusing. Expert speaker Jill M. Young, who has over 30 years of medical experience working in all areas of the medical practice including clinical, billing and rounding with physicians, will shed light on the various compliance issues relating to NPP billing in an informative audio session on Tuesday, April 14, 2015 at This 60-minute session will review the supervision rules for diagnostic procedures and how to apply them. Additionally, participants will get valuable tips and tools on how to structure their office’s or hospital’s use of NPPs to be efficient and compliant.

Here’s a sneak peek of the topics covered in the session:

  • Diagnostic tests – Find out when can NPPs supervise and when can't they
  • Hospital Services vs Office Services – Learn how independent can a NPP be
  • Provider based billing – Find out rules that apply
  • New patients and new problems—Find out what all options NPPs have for billing
  • Learn why the physician component of documentation for NPP services is not the same as for physicians supervising residents

For more information,

About AudioEducator

AudioEducator, the country’s leading source of business-enhancing information, has been providing knowledge and training to healthcare professionals on trending industry topics for more than a decade. With an esteemed panel of industry experts, it helps professionals get information directly from the veterans and get their queries answered directly. AudioEducator specializes in audio conferences, training webinars, transcripts and DVDs on a wide array of healthcare topics such as medical coding, billing, HIPAA compliance, food safety, rehab, pharma & biotech, and more.

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