Your nurse practitioners (NPs) and certified nurse midwives (CNMs) stand to collect $21,250 each under the Medicaid electronic health record (EHR) incentive program, a little-known fact because no non-physician practitioner (NPP) of any kind can participate in the Medicare EHR program, which pays out $18,000 in the first year. NOTE: Physician assistants working in a federally qualified health center or rural health clinic are also eligible for the Medicaid incentive.

You and your peers have lost over $171 million in denied claims with modifier AS (assistant in surgery) attached, according to a Part B News analysis of CMS’s 2010 claims data. The best way your practice can stave off such losses is to be discretionary when using non-physician practitioners (NPPs) in surgery assists.

These charts show 10 of the fastest-growing codes billed by non-physician practitioners (NPPs) that still have high denial rates; all based on the newest 2010 CMS claims data. NOTE: Lab codes, supply codes, codes that generated less than $1 million in annual reimbursement and codes with low denial rates were excluded from analysis. NOTE: All utilization and denial rates below reflect combined CMS claims data for audiologists, certified nurse midwives, certified registered nurse anesthetists, chiropractors, nurse practitioners, physician assistants and physical therapists.

Can a nurse practitioner see new Medicare patients?  If so, where does CMS specify this?

Your non-physician practitioners (NPPs) aren’t eligible to collect the $18,000 first-round electronic health record (EHR) incentive payment, but they can help your physicians get that cash by boosting workflow and assisting with meaningful use measures.

“NPPs help with many of the list-based measures, they help with managing patients and they help fill the gap … when physicians are learning EHR and getting used to that workflow,” says Christopher Tashjian, MD, a family practitioner in Ellsworth, Wis., who has already earned the federal incentive money.

Using your physician assistants (PA) to assist in surgeries can free up your doctor’s time, but can also be a big reason for claims denials with surgical modifiers. Medicare claims data showed that PAs had a 16% denial rate for using both modifier 78 (return to or for related procedure, post op, same physician) and modifier AS (assistant in surgery) in 2009 and experts don’t believe that is a coincidence.

These charts examine E/M code level selection by nurse practitioners (NPs) and physician assistants (PAs) based on the two biggest place of service (POS) settings. NOTE: The percentage values in parentheses above the bars indicate what share that particular code level had out of all E/Ms billed by NPs or PAs. Because the bars were graphed based on utilization by volume, the percentages don’t always match (e.g. for level 3 E/Ms in the office setting, the NP bar is higher despite the percentage being lower). NOTE: Code levels reflect a combination of new and established patient visits on the office side and a combination of observation and hospital care on the inpatient side. Graphs derived from the latest 2009 CMS claims data.

Non-physician practitioners (NPPs) in imaging and radiology will see the same pay cuts as their specialty providers despite CMS’s projections that nurse practitioners (NPs) and physician assistants (PAs), in general, would see a pay gain during the dataset transition for calculating reimbursement rates, experts say.

Your non-physician practitioners (NPPs) have been billing more and more smoking cessation services, though denials remain surprisingly high. Cutting denials and focusing on this fast-growing service could be even more important in 2012,because smoking cessation would become billable as a telehealth service under the 2012 Medicare Physician Fee Schedule (PFS) proposed rule, an NPP Report analysis shows.

These charts look at how top-billed codes by non-physician practitioners (NPPs) would be impacted by relative value unit (RVU) changes in the proposed 2012 Medicare Physician Fee Schedule (PFS).