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In perhaps another sign of the growth in services furnished by non-physician practitioners, the SSA is being asked to give equal weight to the medical findings of NPPs when determining whether a person is eligible for Social Security disability payments.

Don’t risk a denial when your non-physician providers bill an annual wellness visit (AWV) and E/M service for the same patient on the same day. Maintain separate documentation of the two components of the visit – one that fulfills the AWV and one that addressed the patient’s unrelated complaint.
Expect the same scrutiny of your non-physician practitioners’ (NPPs’) billing and payments from HHS’ Office of Inspector General (OIG) can as their physician counterparts. Review all six audit targets for NPP services on the OIG's 2013 Work Plan.
These charts represent the E/M utilization for established patient codes (99211-99215) in 2009, 2010 and 2011 for both physician assistants (PAs) and nurse practitioners (NPs). The utilization for each code is presented from left to right in order of 2009-2011. All numbers come from a Part B News analysis of Medicare claims data.

Don’t rush the non-physician practitioner (NPP) hiring process if you want to see the intended workflow efficiencies and financial results. Thorough research of state laws and NPP credentials, complete physician buy-in and clearly delegated tasks are all necessary before you bring on these new providers.


Instruct non-physician practitioners (NPPs) to justify orders for portable X-ray services with written statements about the patient’s need to avoid denials and survive audits. CMS has proposed to expand its policy on who can order mobile X-ray services from just physicians to include podiatrists, dentists and NPPs, according to the proposed 2013 Medicare physician fee schedule.


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.


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