Effective Utilization of Non-Physician Practitioners for Hospitals and Physicians

Event Information
Product Format
Prerecorded Event
90 Minutes
Product Description

Identify Non-Physician Practitioners and how Hospitals and Physicians can effectively utilize them.

Join expert speaker Duane C. Abbey, Ph.D., in this 90-minute conference to get answers to questions such as:

  • Who are all these non-physician practitioners (NPPs)?
  • Is it possible for non-physician practitioners to bill separately to Medicare programs?
  • Do non-physician practitioners have to work incident-to physicians?
  • What are these joint/shared visits?
  • Where do I find out about state scope-of-practice laws?
  • How much payment do practitioners get paid under the Medicare Physician Fee Schedule?
  • What requirements do NPPs have and how do they relate to physicians?
  • NPPs involvement in provider-based clinics and Rural Health Centers (RHCs)?
  • Can special compliance issues affect NPPs?
  • How can NPPs relate to Medicare physician supervision rules?
  • Is it possible for NPPs to start their own independent practices?   

The objectives of the session are:

  • To review the range and type of non-physician practitioners that are utilized by clinics, physicians and hospitals.
  • To appreciate how non-physician practitioners are reimbursed for services under Medicare and other private third-party payers.
  • To understand proper coding conventions and utilization of modifiers for non-physician practitioners.
  • To understand the difference between ‘freestanding’ situations and ‘provider-based’ situations.
  • To review the interplay between the MPFS and APCs for non-physician reimbursement in different settings.
  • To appreciate the concept of ‘incident-to’ and the differences in interpretation between physician/clinic situations and hospital situations.
  • To review the physician supervision requirements under Medicare for NPPs.
  • To understand the proper use of shared/joint visits.
  • To work through several case studies that illustrate the coding, billing and claims process and differences during payment.
  • To review various compliance issues which are important, that includes the Place of Service (POS) and surround the use of NPPs.

Session Highlights:

  • Non-Physician Practitioner Overview
    • Types of NPPs
    • Medicare versus State Law Requirements
    • Utilization of NPPs
    • Reimbursement Issues for NPPs
    • Compliance Issues for NPPs
  • Professional versus Technical Component Payment
    • RBRVS Review
      • Relative Values
      • Place of Service Differential
      • Examples – Reduced Payment for NPPs
    • APC Review
    • Freestanding versus Provider-Based Status
    • Private Practice for NPPs
    • Medicare Enrollment
  • Non-Physician Practitioners – Compliance
    • The ‘Incident-To’ Concept
      • Freestanding Situation
      • Provider-Based Situation
    • Place of Service (POS) Considerations
    • Collaborative Agreements and Other Requirements
    • Shared/Joint E/M Services with Physicians
    • Physician Supervision Requirements
    • Medicare Physician Fee Schedule
    • Medicare Physician Payment
  • Examples and Case Studies
    • Nurse Practitioner in Medical Practice
    • Physician Assistant in Provider-Based Clinic
    • Clinical Nurse Specialist in Hospital Setting
    • Nurse Practitioner at Urgent Care Center
  • Sources for Further Information

Who should attend?

Coding Personnel, Billing and Claims Transaction Personnel, Chargemaster Coordinators, Clinic Managers, Financial Analysts, Compliance Personnel, Nurse Practitioners, Physician’s Assistants, Clinical Nurse Specialist, Speech-Language Pathologists, Nurse Midwives, Physicians and Other Interested Personnel



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About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

 Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrolment and other financially related concerns of organizations....   More Info
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