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NPP Report

This chart presents the denial rates of all E/M office visits appended with modifier 25 (separately identifiable E/M service), organized by both place of service (POS) code and non-physician practitioner (NPP) specialty. Data represent all 99201-99215 codes appended with modifier 25 that were billed to Medicare in 2010, the latest year available.


Non-physician practitioners (NPPs) are included in a major component of the proposed 2013 Medicare physician fee schedule that would create a new G-code for primary care practices to receive additional payment for post-discharge transitional care management.

This G-code, which would pay a work RVU of 1.28 on top of the E/M office visit, would cover non-face-to-face services provided by community physicians and NPPs in the 30 days following a facility discharge.


A provision in the proposed 2013 physician fee schedule would end denials of pain management services provided by certified registered nurse anesthetists (CRNAs), but don’t assume this portion of the rule is a done deal. Anesthesia practices should take advantage of the comment period to submit their support for this portion of the rule.

by: Lauren C. Williams

Encourage your hospitals to expand services provided by non-physician practitioners (NPPs) using a recent CMS rule that endorsed NPP hospital privileges as leverage. But make sure your NPPs abide by the hospital’s bylaws, experts say.

The hospital and critical access hospital reform final rule, published in the May 16 Federal Register, counts NPPs, such as advanced practice registered nurses (APRNs) and physician assistants (PAs), as part of hospital medical staff giving them the power to use their licensed skills in hospitals.


This chart shows the denial rates for five nurse physician practitioner (NPP) specialties for E/M office visits, based on 2010 Medicare claims data. For each specialty, the denial rates of level 3, level 4 and level 5 E/M office visits is depicted, based on a combination of E/M codes billed for initial patient visits and subsequent patient visits (99203-99205 and 99213-99215).


Your doctors may get a break from hospital rounds, thanks to a CMS rule that grants non-physician practitioners (NPPs) the same hospital privileges. The hospital and critical access hospital reform final rule, released May 9, counts NPPs such as advanced practice registered nurses (APRNs) and physician assistants (PAs) as part of medical staff giving them the power to use their licensed skills in hospitals.


A recent report from the HHS Office of the Inspector General (OIG) showing a rise in higher-level E/M coding selection over the past decade includes nurse physician practitioners (NPPs) among the possibly suspicious physicians who consistently bill a level 4 or level 5.


This chart shows the breakdown of specialties among the nearly 1,700 physicians who billed either a level 4 or level 5 for at least 95% of all their E/M codes in 2010. The 1,700 consistently high-billing doctors were chronicled in an HHS Office of the Inspector General (OIG) report released this month.


A change to the therapy cap calculation means more work for practices starting Oct. 1.

CMS will count therapy a patient received in a hospital outpatient department toward the cap, set in 2012 at $1,880 for occupational therapy and $1,880 for physical and speech therapies, said Stewart Streimer, director of CMS’s provider billing group during an April 17 call. CMS will not reprocess claims, but, starting Oct. 1 it will recalculate a patient’s services toward the therapy cap amount retroactive to Jan. 1, he said.


Keep an eye on reimbursement policies for physician assistants and nurse practitioners and be ready to work with physician hospital organizations to prevent improper payments and compliance errors.

A private payer that doesn’t credential non-physician practitioners may allow you to bill your NPPs’ services under the physician’s national provider identifier (NPI). The payer might not require a supervising physician to be in the office suite during the service or visit. In this case the practice is able to receive the full fee schedule amount for the NPP’s work and the physician is free to provide other services.


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