Industry Notes: MAC Sees Uptick in ‘Scope of Practice’ Quandaries

Why This Topic Matters

Scope-of-practice questions can affect whether claims are supported during review and whether denials are avoided. Understanding where to look for applicable guidance helps practices align Medicare billing with provider-type and state-licensing requirements.

Article Sections

1. MAC alert and scope-of-practice questions

   Overview of the Medicare Administrative Contractor notice and the general increase in provider questions. The section identifies the provider groups and service review context involved.

2. State licensure and coverage considerations

   Discussion of how state licensing authority relates to a clinician’s ability to provide care and how those limits can affect Medicare review. The section references broader professional and regulatory perspectives on scope of practice.

3. Guidance to review before submitting claims

   Summary of the types of Medicare resources and supporting materials practices should consult when evaluating services for coverage review. The section also notes that state practice guidelines may be requested during medical review.