These charts show 10 codes billed by non-physician practitioners (NPPs) that have relatively low denial rates, but were responsible for a major chunk of lost reimbursement in 2010. The top chart shows the average dollar amount lost per single denial in 2009 and 2010, while the bottom chart shows the average denial rate. NOTE: For the purpose of this analysis, NPPs include certified nurse midwives, certified registered nurse anesthetists (CRNAs), chiropractors, clinical nurse specialists, nurse practitioners, physician assistants and physical therapists. CMS does not distinguish between physician-billed services and those billed incident-to by NPPs, so this data excludes incident-to services.

Your peers increasingly think of Medicare’s annual wellness visit (AWV) as a patient data-gathering and education visit, especially with the new health risk assessment (HRA) requirement. Because no physical exam is required and much of the AWV is collecting patient health information, your non-physician practitioners (NPPs) play a bigger role than physicians.

You and your peers rake in a lot of extra revenue by billing your non-physician practitioners’ (NPP) services incident-to with Medicare. But you could be taking in even more money by letting your NPPs bill under their national provider identifier despite the 15% lower reimbursement rate, experts say. 

How have inpatient E/M utilization by nurse practitioners (NPs) and physician assistants (PAs) changed from 2009 to 2010 – the first year in which CMS stopped accepting consultation codes (99241-99255)? In 2010, inpatient consults were required to be billed as initial or subsequent hospital care codes (99221-99233) by CMS. All figures are based on the latest Medicare claims data from 2010. NOTE: All billing data for NPs and PAs are based only on services billed under their own individual national provider identifiers (NPIs). CMS does not distinguish between physician-billed services and those billed incident-to by NPPs.

Can a nurse practitioner (NP) perform a joint injection? If so, whose name goes on the documentation if the NP performs the injection while the doctor is performing an E/M visit on the same patient? Also, is this encounter billed under the physician’s or the NP’s national provider identifier (NPI)?

Your non-physician practitioners (NPPs) are raking in more E/M income than any previous year, according to an exclusive NPP Report analysis of the latest Medicare claims data from 2010, the first year CMS stopped taking consultation codes (99241-99255). Remember: NPPs are permitted to bill consults so long as they are not billed incident-to, which would require a physician-initiated plan of care.

Your non-physician practitioners’ (NPPs) incident-to billing practices are a top target on the HHS’ Office of Inspector General (OIG) 2012 WorkPlan, which meansyour NPPs must be extremely careful when billing these services. NPPs are invisible on incident-to claims which is why it is so important to make sure a service musters up to the criteria, says Dianne Wilkinson, RHIT, a compliance auditor at West Tennessee Healthcare in Jackson, Tenn.

Who picks more high-level E/M codes, nurse practitioners (NPs) or physician assistants (PAs)? These charts examine the ratio of new and established patient E/M levels by NPs and Pas, comparing 2009 data to recently released 2010 data. NOTE: Incident-to services billed by non-physician practitioners (NPPs) appear as additional physician utilization in CMS claims data, thus the NPP services in this data do not include those that were billed incident-to.

According to Medicare guidelines for split-share billing, the non-physician practitioner (NPP) and physician must conduct distinct parts of the service. In which scenario is this most appropriate and how do you bill it?