Maximize Advanced Practice Provider Reimbursement and Stay Compliant with Payer Guidelines

$251.00 – $255.00

 Original price was: $399.00.Current price is: $251.00.
 Original price was: $349.00.Current price is: $254.00.
 Original price was: $349.00.Current price is: $255.00.

The landscape of healthcare is evolving, with advanced practice providers (APPs) playing an increasingly significant role. The share of U.S. healthcare visits delivered by nurse practitioners (NPs) and physician assistants (PAs) has grown significantly in recent years and this trend is expected to continue, driven by a growing demand for healthcare services and a relative shortage of physicians. Advanced practice providers are increasingly delivering care in primary care and specialty settings. Advanced practice providers play a vital role in the current and future healthcare system.

Advanced practice providers (APPs) are trained to perform a variety of tasks including diagnosing and treating illnesses, managing chronic conditions, and prescribing medications. This expansion of roles helps to alleviate the pressure on the healthcare system by providing patients with more accessible care options. By working collaboratively with physicians, these practitioners contribute to a more efficient and responsive healthcare system, ensuring that patient care continues to be delivered effectively despite the challenges posed by physician shortages.

Advanced practice providers (APP) face several billing challenges, particularly when it comes to reimbursement rates and the complexity of billing regulations. APPs are typically reimbursed at 85% of the Medicare Physician Fee Schedule, which can impact financial planning for medical practices. Additionally, billing for services provided by APPs can be complex due to the “incident to” and split/shared billing rules. These rules require careful documentation to ensure that services are billed correctly, whether they are provided independently by the APP or as part of a team with a physician.

Private health plans have their own policies for credentialing APPs and providing reimbursement, which may differ from Medicare’s guidelines. This necessitates that APPs understand the policies of each health plan they contract with, adding an additional layer of complexity to their billing process. The need for constant vigilance and updates to billing practices in response to changing regulations and payer policies is a continuous challenge for APPs, requiring them to stay informed and adaptable to ensure proper reimbursement for their services.

Furthermore, the scope of practice for APPs varies by state, affecting the types of services they can provide and bill for. Practices must stay informed about the specific laws and regulations in their state to avoid billing errors and ensure compliance.

This exclusive webinar will delve into strategies for proper billing for advanced practice providers to optimize reimbursement. In this session, you will gain insight into regulatory guidelines and compliance standards, ensuring you are equipped with the knowledge to navigate confidently in the complex maze of provider billing. Understanding regulatory guidelines will help you stay ahead of the curve and ensure compliance to avoid costly penalties.

Advanced practice providers are integral to a variety of healthcare settings, reflecting the versatility and broad scope of their roles. Their footprint will continue to grow and fulfill needs across all specialties. Proper billing and optimal reimbursement for APPs are essential for the financial health of medical practices.

Learning Outcomes:
  • Learn when it is appropriate to bill incident to
  • Gain an understanding of the different supervision requirements
  • Learn Medicare guidelines regarding APP billing and why some Payers follow these guidelines while other have their own unique guidelines
  • Split and shared visit guidelines have been updated for 2024
  • Learn the latest guidelines and how to apply them with your providers
  • Discuss utilizing APPs in different healthcare settings to maximize their effectiveness
  • Discuss what is required in a collaborative agreement
  • Identify the APP’s scope of practice by state
Areas Covered in the Session:
  • Progression of Terms
  • Who are advanced practice providers
  • How are Advanced practice providers utilized?
  • Nurse practitioner and physician assistant
  • Types of billing
    • Incident to billing
    • Split / shared billing
    • Direct billing
  • Incident to billing
    • MEDPAC Recommendations to Congress
    • Incident to requirements
    • Coding tip
    • Incident to – initial visit
    • Incident to Scenario
  • Direct Supervision
  • Supervision
  • Supervision and Medical Record Documentation
  • Supervision of Diagnostic tests by Certain Nonphysician Practitioners (NPPs)
  • Pharmacists Providing Services Incident to Physician’s Services
  • Difference in Medicare and other payer requirements
  • Split or Shared visit
  • Correct Billing Requirement
    • Medical necessity
    • Documentation to support level of care
    • Approved location
    • Group practice
    • Substantive portion identified
    • Documentation to support billing provider
    • Modifier FS
    • Substantive Portion
    • Time
    • Medical Decision Making
  • Direct billing
  • Collaborative agreements
Recommended participants:
  • Advanced Practice Providers
  • Practice Managers
  • Clinical staff
  • Healthcare Administrators
  • Physicians
  • Non-Physician Practitioners
  • Medical Office Managers
  • Billers and Coders
  • Medical Assistants
  • Nurses
  • Agency Owners
  • Clinical Supervisors
  • Directors of Nursing
  • Quality Improvement/ Quality Assurance Managers
  • Compliance Officers
  • Clinicians
  • Administrative Staff
Presenter Biography:

Jan Hailey, MHL, CMC, CMCO, CMIS, CMOM, CMCA-E/M, 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’s affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has led comprehensive interdisciplinary teams working closely with providers, management, staff, communities, and payers to develop strategies for process improvement, quality gap closures, and patient experience. Jan has a Master of Health Leadership degree and five professional certifications in office management, coding, insurance processing, auditing, and compliance. She is a WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group member and has also been instrumental in developing Practice Management Institute’s Workforce Initiatives program.

Additional Information:
System Requirement:
  • Internet Speed: Preferably above 1 MBPS
  • Headset: Any decent headset and microphone which can be used to hear clearly

For more information, you can reach out to the below contact:
Toll-Free No: +1 800-757-9502
Email: cs@waymoreeducation.com