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Billing for Advanced Practice Providers
Medicare reimburses advanced practice providers (APP) for services that are ‘incident to’ a physician’s service with defined guidelines. When billed correctly, these services are reimbursable at 100 percent of the physician’s fee schedule. This course will help reduce audit risk when your team understands Medicare and third-party guidelines for APP service billing.
This is a comprehensive course with expert guidance that covers the documentation requirements needed to support claims, cross-checking and code selection, how to avoid under-coding, and work through grey areas. Learn the differences in APPs, NPs, PAs, RNs, CNMs, CRNAs, scope of practice and protocols. The instructor will explain how to handle tough billing situations like split/shared billing, utilization of APPs in alternate healthcare settings, and collaborative agreement arrangements.
Additional guidance on unique billing situations will include:
- Services provided by non-physician practitioners, physician assistants, and auxiliary personnel
- When to bill under the provider initializing care or under the supervising providers. Improve aptitude for cross-checking and code selection.
- Billing requirements for shared/split visits in outpatient, emergent, and hospital settings
- Reimbursement for provider-based vs. office-based facilities
- Incident-to billing requirements for Medicare, Medicaid, and private carrier reimbursement
- A detailed explanation of AMA/CMS documentation guidelines for E/M services
- Review of the False Claims Act, Anti-kickback Statute, Stark Law, overpayments, fraudulent claims submissions, mandates, and legal actions that may result in exclusion from participation in Federal health care programs.
- Frequently-asked questions for Incident-to reimbursement, working with NPs and APPs
Full Schedule
Program times are Central unless otherwise noted.
| Session | Date | Time | Instructor | |
| 1 | May 20, 2025 | 11:00-02:00 | Jan Hailey | |
| Fee: $239.00 | Register | |||
Can't attend a live session? Register anyway and you'll receive a link to the recording by the next business day.
Online Learning Format Includes: Clear video/audio, secure encrypted web access (no downloads), in-session chats, and access to session recordings anywhere in US and 190 countries.
Target Audience
This is an intermediate-level training designed to benefit medical office coders, billers, auditors, practice managers, compliance officers, and non-physician providers.
CEUs:
| PMI | 3 |
About the Presenter
Jan Hailey MHL, CMC, CMCO, CMIS, CMOM, CMCA E/M
Jan Hailey has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles, and teaches medical office professionals around the country how to excel in their careers. Jan has also been instrumental in the development of PMI's Workforce Initiatives program.
Jan's affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has served as Director of Quality for Saint Joseph Physician Network located in Mishawaka, IN, and Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. As Care Management Director, Jan led the physician network and comprehensive interdisciplinary team across the health system working closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience. She developed a documentation improvement program and a Hierarchical Condition Category (HCC) coding education program to predict future healthcare utilization by accurately reporting patient complexity.
Prior to joining Saint Joseph, Jan was the Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana. She has a Master of Health Leadership and four professional certifications in office management, coding, insurance processing, and compliance. She is a member of WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group.