Medicare Compliance & Reimbursement - 2011 Issue 8
Reader Question: Seek RNFA Assistant-at-Surgery Rules
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Article Overview
This article explains a payer-policy question about how registered nurse first assistants may be billed when they assist in surgery, especially in hospital inpatient settings. It is useful for coding, billing, and reimbursement staff who need a high-level understanding of incident-to billing concerns, assistant-at-surgery reporting, and the role of payer- and state-specific rules. The discussion references Medicare, Blue Cross Blue Shield of Michigan, and broader payer compliance considerations without providing detailed coding guidance.
Why This Topic Matters
Facilities and practices that use RNFAs need to know whether billing should be tied to the surgeon, the individual assistant, or a payer-specific workflow. The topic matters because reimbursement and compliance can vary by payer and by state scope-of-practice requirements.
Article Sections
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Question
Introduces the billing scenario involving RNFAs in a surgical setting and the question raised by the subscriber.
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Answer
Addresses the billing and payer-policy issue at a high level, including inpatient setting considerations, payer-specific expectations, and state-related compliance concerns.
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Do this
Provides general guidance to verify requirements with major payers and consider state scope-of-practice and payer-rule differences.
What You Will Learn
- The general billing concerns raised when RNFAs assist in surgery
- Why inpatient settings can create different billing considerations than other settings
- How payer policy and state scope-of-practice requirements affect assistant-at-surgery reporting
- Which organizations or payer types may have their own reporting expectations
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Practice managers
- Compliance staff
- Surgical office staff
Modifiers Discussed
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