Crack the Codes: Practice Management & Coding Virtual Course-Recording: PA & NP Billing Strategies

Video Transcription

Video Summary

In this video, Jennifer Cabrera and Jennifer Bell discuss billing strategies for physician assistants (PAs) and nurse practitioners (NPs) in both office and hospital settings. They cover three different billing options: incident-to billing, direct billing, and split-shared billing. Incident-to billing involves a non-physician provider (NPP) providing a service that is billed by the physician using the physician's NPI number. This method has higher reimbursement but comes with restrictions and can only be used in an office setting (place of service 11). Direct billing involves the NPP billing under their own NPI number, with lower reimbursement but fewer restrictions. Direct billing can be used in all settings. Split-shared billing is a new method that involves the physician and NPP jointly providing a service. The billing is determined based on either the provider who performs the majority of the time or the provider who performs the history, exam, or medical decision-making in its entirety. Split-shared billing is used in facility settings (outpatient hospitals, provider-based clinics, inpatient hospitals, and ERs), while incident-to billing is used in office settings (place of service 11). The presenters also discuss upcoming changes to split-shared billing in 2024, where the substantial portion of the visit will be determined based on greater than 50% of total time. The video includes examples and scenarios to illustrate the different billing methods and their requirements. The presenters note that it's important to stay updated on state-specific regulations and guidelines for PAs and NPs, as commercial insurances may have different guidelines for incident-to and split-shared billing. The video concludes with a Q&A session.

Keywords

billing strategies

physician assistants

nurse practitioners

incident-to billing

direct billing

split-shared billing

reimbursement