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Clinical Staff vs. Healthcare Professional

By:  Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Published:  February 5th, 2019

State scope of practice laws and regulations will help determine who is considered clinical staff and who is considered an other qualified healthcare professional.

Physician or other qualified healthcare professionals must have a State license, education/training showing qualifications, as well as facility privileges. 

Examples of other qualified healthcare professionals:

  • Nurse Practitioner (NP)
  • Certified Nurse Specialist (CNS)
  • Physician Assistant (PA)
  • Certified Nurse Midwife (CNM)
  • Certified Registered Nurse Anesthetist (CRNA)
  • Licensed Clinical Social Worker (LCSW)
  • Physical Therapist (PT)

(NOTE: this list is not all-inclusive, please refer to your payer with more specific questions) 

Clinical staff are staff members who would generally work under the supervision of a physician or perhaps another qualified health care professional. Clinical staff must be allowed, by regulation, law, and the policy of the facility, to perform or assist and will not report their service. (This is not all inclusive.)

CMS clarifies Clinical Staff in their FAQs. Read the entire article here

AAPC also has an article that defines a Qualified Healthcare Professional.

Read AMA's Physician Assistant scope of practice at the state level. 


References:

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