Part B Insider - 2002 Issue 6
Five Pointers on How to Optimize Reporting Nonphysician Practitioner Services
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Article Overview
This article explains how reporting of emergency department services changes when nurse practitioners and physician assistants are involved. It covers Medicare and other payer policy considerations, state practice and supervision rules, billing under the practitioner versus physician, and the general handling of split or shared services. The piece is intended for coders, billing staff, and revenue cycle professionals who need a broad understanding of nonphysician practitioner reporting in hospital settings.
Why This Topic Matters
Correct reporting for nonphysician practitioner services affects compliance, reimbursement, and documentation integrity. The article highlights why payer rules, institutional policies, and Medicare distinctions matter when NPPs participate in emergency care and observation services.
Article Sections
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Which services can NPs and PAs provide in the ED?
Discusses the broad scope of emergency department services performed by nonphysician practitioners and the role of state law, supervising physicians, and institutional policy.
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What supervision requirements govern NPPs?
Reviews general supervision and collaboration considerations for nurse practitioners and physician assistants, including payer and facility policy differences.
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Should an NPP's services be reported as 'incident to' the physician's?
Addresses hospital billing concepts for nonphysician practitioner services, including claim submission under the practitioner and the relationship to physician billing.
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Do other commercial payers reimburse for NPP services?
Summarizes how private payer and Medicaid policies may differ regarding recognition of nonphysician practitioner services and related billing practices.
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Is it appropriate to submit split bills if a physician and an NPP see a patient in the ED?
Covers shared emergency department encounters, partial service situations, and CMS policy developments affecting how combined physician and nonphysician practitioner work is reported.
What You Will Learn
- How payer and state rules affect services provided by nonphysician practitioners in the emergency department
- How supervision and collaboration requirements may differ for nurse practitioners and physician assistants
- How hospital settings affect reporting relationships between physicians and nonphysician practitioners
- How commercial payer recognition of nonphysician practitioners can affect reimbursement
- How shared or split emergency department encounters are addressed at a high level
- How CMS policy developments have influenced reporting of partial services
Who Should Read This
- Medical coders
- Emergency department billing staff
- Revenue cycle professionals
- Compliance staff
- Practice managers
Codes Discussed
Code Ranges Discussed
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