Coding & Billing Updates For Physician Assistants & Nurse Practitioner - Understand Incident To, Shared Visits & Direct Billing!

Session # 1 - Coding and Billing Updates for Physician Assistants

Healthcare provider shortages are being filled in many areas by Physician Assistants. This is especially true for hospital owned practices. Whether in the hospital rounding, performing procedures or seeing patients in the office, these valuable providers are being seen more and more. CMS/Medicare calls them NPP’s.  Other names include Mid-Levels or Physician Extenders.  Whatever the name, these valuable providers have three unique methods of billing available to them, per CMS/Medicare.  Other commercial carriers add a fourth.  Understanding each of these methods, what the patient care model is for it and deciding which will work best for your practice is imperative to avoid non-compliant billing.  The area of billing for NPP’s is one that I have seen where the logic is “because we have always done it that way” and not because of any carrier rules or policies.  This type of logic exposes your practice to audits, and possible sanctions if the “traditions way” of billing is not the current compliant way

CPT for 2024 has seen major changes in their Guidelines for Split or Shared visits. These changes are not surprising but need to be understood to see if your practice is following them in 2024. CMS/Medicare has also made a major change in their definition of Split or Shared visits and this may create compliance issues if the new Guidelines are not incorporated into your policies and procedures for the care your NPP’s give. 

This timely webinar will give you the valuable updates in Guidelines for your Physician Assistant for 2024 but will also review the other methods of billing for their services.  This will ensure that your practice can have compliant documentation, coding and billing of your Physician Assistant’s services.

Session Objective:

The three methods of billing for services that CMS/Medicare allows will be discussed in detail with examples of compliant and non-compliant documentation. 

The fourth method that commercial carriers sometimes utilize will also be discussed.

Session Agenda:

• What is the scope of practice for your Physician Assistant – what does scope mean?
• Billing Methods – This will include Guidelines, Policies and Documentation requirements
  • Incident to
  • Split or Shared
  • Direct Billing
  • Billing under a physician.

Session Highlights:

• Scope of practice – what is it, where to find it and why should I care
• Incident to billing – what is the physician’s role in this methodology, what documentation is needed and how is it billed
• Split or shard – what is new in 2024 for both CPT and CMS/Medicare rules – how does that change your practice’s model for Physician Assistant services
• Direct Billing – is it as simple as it sounds?
• Physician Billing for PA services – what are the requirements and why can this be a compliance nightmare?

Session # 2 - Coding and Billing Updates Nurse Practitioners

The role of Nurse Practitioners (NP) continues to expand in the medical provider community.  Several years ago, they were found mostly in primary care settings, now they are found in surgical and medical specialty practices as well.  They are found with significant roles in both in the inpatient hospital, outpatient hospital and the office. 

Although there are at least three methodologies in billing for NP’s services, these are entirely dependent on the insurance payers’ rules and guidelines for them.  It is imperative that all parties involved understand what each of these methods are and how the guidelines affect how the practice utilizes and bills for the services of NP’s. 

One cannot assume that the rules for CMS/Medicare are the rules for all insurances.  That is far from the truth.  “Because we have always done it that way” is not a logic that is defensible when it comes to billing services and should no longer be even considered as a starting point.  Billing for NP services correctly can be tricky and errors in billing lead to takebacks and sanctions. 

Changes to CPT guidelines matched with CMS/Medicare’s significant changes for split shared visits in 2024 have caused significant changes in practice’s workflow.  If your practice has not seen changes in 2024 in this, you may not be using proper documentation and billing for services may be incorrect.

This timely webinar will give you the valuable updates in Guidelines for your Nurse Practitioner for 2024 but will also review the other methods of billing for their services.  This will ensure that your practice can have compliant documentation, coding, and billing of these provider’s services.

Session Objective:

• Scope of Practice – understanding differences state to state
• Incident To – documentation and billing of this often mis-understood concept
• Split or Shared Visits – who has to do what portion of the service and what documentation is needed – in which location
• Direct Billing – the simplest and more direct method of documentation and billing
• What services can be supervised by a Nurse Practitioner

Session Highlights:

• What are Split Shared guidelines from CPT for 2024?
• What are CMS/Medicare’s guidelines for Split Shared visits in 2024?
• What are the documentation requirements of the supervising physician for incident to services
• What documentation does the NP need to include in the patient’s record when billing incident to services
• What locations can NP’s utilize for split or shared visits or incident to visits
• What can an NP’s role be in surgery and with procedures

Who Should Attend

Coders, Billers, Auditors, Office Managers, Office Administrators, Nurse Practitioners, Physicians