tci Medicare Compliance & Reimbursement - 2018 Issue 15
Revenue Booster: Report APPs' Services Correctly to Maximize Reimbursement
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Article Overview
This article covers billing and reporting considerations for advanced practice providers (APPs) in medical practices. It compares general approaches to reporting APP services, highlights the influence of federal and state regulations, and discusses how commercial payer policies can affect whether services are billed under the APP or another billing arrangement. The piece is aimed at practices, coders, billers, and administrators who need a broad understanding of APP-related reimbursement and operational issues.
Why This Topic Matters
APP services can affect both reimbursement and clinic capacity, so understanding the general regulatory and payer landscape helps practices report services more consistently and evaluate staffing models.
What You Will Learn
- What types of clinicians may be considered advanced practice providers
- How federal, state, and payer rules can influence APP service reporting
- Why different billing arrangements can affect reimbursement and workflow
- Which broad payer-policy issues practices may need to review when reporting APP services
Who Should Read This
- Medical coders
- Billers and revenue cycle staff
- Practice administrators
- Physicians and clinical supervisors
- Healthcare compliance staff
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