Q. Our practice is looking into hiring an NPP, and can’t decide whether to hire an advanced registered nurse practitioner (ARNP) or a physician assistant (PA). Any advice you can offer?

It could be a little harder for your non-physician practitioners (NPPs) to meet their quota and avoid the 1% cut to Medicare payments in 2012 if your practice is not set-up for e-prescribing due to a combination of some practices lack of preparedness and providers being numbed with information. “This stuff is painful, so people tend to ignore it until it’s too late,” she says of the hoards of providers fretting about meeting their e-script quota in just days. 

You and your peers lost $88.9 million to denials on chiropractic manipulation services in 2009, down from $115 million in 2007. While the average denial rate for codes 98940-98942 has fallen from 13.3% to 10.8%, chiropractic manipulative treatment (CMT) remains a stubborn trouble spot for a specialty that earns a sizeable chunk of Medicare revenue among non-physician practitioners (NPPs).

Not all providers are required to e-prescribe but knowing  your NPPs’ prescribing responsibilities can help your practice avoid the 1% payment hit in 2012.

Both nurse practitioners (NPs) and physician assistants (PAs) bill the majority of their Medicare services in the office setting, though NPs split the rest of their utilization between nursing facilities and skilled nursing facilities (SNFs). PAs split the rest of their utilization on the emergency room, and inpatient hospital. Neither spend much time in ambulatory surgical centers or end-stage renal disease (ESRD) facilities.

We have a PA-C working in our office. Claims for this NPP are billed incident to our physician. On a recent audit of these, the auditor stated the services rendered did not meet the criteria for incident to billing, as the PA-C was dealing with "new" problems, not outlined in the physician’s plan of care. When I look at the PA-C's note, I see a routine follow-up for chronic conditions. Are we missing something these auditors are looking for? 

You have less than two months to make sure that each of your providers – including non-physicians with prescribing privileges – e-prescribes to at least 10 unique Medicare patients. Every provider who fails to meet this requirement will be penalized with a 1% pay cut in 2012.

Your specialty practice can earn a little extra cash by relying more heavily on its non-physician practitioners (NPPs) to interact with patients and bill primary care codes outside the practice walls with home and nursing home visits. The Primary Care Incentive Payment (PCIP) bonus that was intended to reward primary care providers, extends to NPPs regardless of specialty, Part B News learned (PBN 04/21/11).

These charts look at the most financially damaging codes billed by nurse practitioners (NPs) and physician assistants (PAs), based on the latest available CMS claims data from 2009.

Can an NPP provide direct supervision for imaging services, or does that have to be done by the physician?