decisionhealth Newsletters, Part B News - 2009 Issue 4 (April)
Know your NPPs' scope of practice rights to fight denials
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Article Overview
This article explains a reimbursement and compliance issue affecting nurse practitioners and physician assistants: denials tied to scope of practice. It is aimed at coding, billing, and reimbursement professionals who need to understand how provider scope is shaped by state law, facility policy, education and experience, and physician delegation, and how carrier or contractor policy mismatches can affect claims outcomes. The discussion centers on general denial management and reference resources rather than specific coding instructions.
Why This Topic Matters
Scope-of-practice denials can interrupt payment for services rendered by non-physician practitioners, so understanding the factors that define scope and where to seek clarification can help organizations respond appropriately to denials and policy mismatches.
What You Will Learn
- What scope-of-practice denials are in the context of non-physician practitioner reimbursement
- Which broad factors influence a physician assistant's scope of practice
- Why carrier policy, state law, and Medicare policy may not always align
- How organizations may respond when a denial appears to be based on outdated or incorrect policy
- Why changes in Medicare Administrative Contractors can affect denial management
Who Should Read This
- Medical coders
- Billing staff
- Reimbursement specialists
- Compliance professionals
- Practice managers
- Providers working with nurse practitioners and physician assistants
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