Billing For Mid-Level Providers


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Course Description

Earn 3 CEUs from Practice Management Institute

The correct documentation and billing for Mid-Level Providers is always been a tricky area. The Center for Medicare’s Rules for billing for Mid-Level Providers is very clear, but you must know where to find these rules. Mid-level provider claims are a common audit risk area. This session will review tough billing situations with examples and guidance on documentation needed to support claims. Participant will be able to learn when it is appropriate to bill under the provider initializing care or under the supervising providers and improve aptitude for cross-checking and code selection.

Areas Covered In The Session:

  • Incident to billing criteria, requirements and reimbursement considerations
  • Direct vs. indirect supervision by the physician/NPP
  • Level of education, scope of practice and other protocols of the NPP
  • State definition of scope of practice for mid-level providers
  • Differentiating between scope of practice and scope of license
  • Examples of non-physician practitioners and auxiliary personnel
  • Explanation of service settings such as unsupervised or off-site
  • Difference between Nurse Practitioner and Physician Assistant
  • Guidance on which national provider identifier (NPI) to bill claims under
  • Review documentation guidelines
  • Why CMS recovery auditors are scrutinizing practices that employ mid-level providers
  • Working with NPPs under independent contract agreement
  • Question and answer period to address participant questions

Target Audience:

  • Coders
  • Auditors
  • Billers
  • Physicians
  • Mid-Level Providers
  • CDI Specialists
  • Consultants
  • Office Managers
  • Administrators

Meet The Presenter:

Rhonda Granja, BS, CMC, CMIS, CMOM, CPC, CPM, MCS, has been in the medical office profession since 1990. She works as an independent medical consultant with several medical groups and has been involved extensively in medical advocacy projects. She enjoys sharing her experience and knowledge with others. Her vast experience has been achieved by actively working in all areas of a medical practice – everything from the front desk to the clinical side. Rhonda is an active member of the American Academy of Professional Coders (AAPC); Medical Group Manager’s Association(MGMA), and the Consumer Family Advisory Committee. She has extensive knowledge of billing and reimbursement related to managed care and commercial carriers as well as Medicare and state funded products. Rhonda has a wealth of experience and her passion for speaking tends to get attendees excited about what they do.

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