decisionhealth Newsletters, Part B News - 2011 Issue 7 (July)
NPPs to suffer same losses as physicians due to changing RVUs
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Article Overview
This article explains how CMS’s transition in practice expense RVU methodology is expected to affect non-physician practitioners alongside physicians, especially in imaging and radiology. It is aimed at coding, billing, reimbursement, and practice management audiences who need to understand how fee schedule changes, specialty impacts, and incident-to billing may influence payment projections. The discussion also places the issue in the context of CMS policy updates, office visit reimbursement trends, and the practical difficulty of separating NPP services from physician services in records review.
Why This Topic Matters
Payment methodology changes can affect multiple staff categories and specialties at once, shaping reimbursement forecasts, staffing decisions, and coding workflows. Understanding the policy context helps practices anticipate financial impact and evaluate how billed services are represented in documentation and claims.
Article Sections
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Reimbursement impact on non-physician practitioners
Discusses how NPs and PAs in imaging, radiology, and related specialties may be affected by the same reimbursement shifts as physicians. It also notes the broader financial and operational implications for practices.
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CMS transition to PPIS-based RVU calculations
Summarizes the shift from older survey data to Physician Practice Expense Information Survey data in the fee schedule transition. The section places the article in the context of CMS projections and the staged implementation timeline.
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Coding and billing considerations
Addresses documentation and billing issues that make it difficult to distinguish services performed by non-physician practitioners from those performed by physicians. It also references office-based evaluation and management billing in the broader reimbursement discussion.
What You Will Learn
- How RVU methodology changes can affect non-physician practitioners in specialty settings
- Why CMS transition policy matters for reimbursement forecasts
- What billing and documentation issues complicate separating practitioner services
- How practice management concerns intersect with reimbursement shifts
Who Should Read This
- Medical coders
- Billing staff
- Reimbursement specialists
- Practice managers
- Physician assistants
- Nurse practitioners
- Radiology and imaging practices
Codes Discussed
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