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Course Description

Reduce your audit risk and ensure that billing procedures are compliant. Instructor will review documentation guidelines and provide examples and guidance on tough billing situations.

Mid-level provider claims are a common audit risk area.

Area 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

Learning Objectives:

  • Participants will be able to understand tough billing situations with examples and guidance on documentation needed to support claims.
  • 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.

Target Audience:

  • Coders
  • Auditors
  • Providers
  • Clinical and Practice Staff involved in medical coding.
  • Consultants
  • Compliance Officers
  • Office Manager

Our Speaker:

Rhonda Granja 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.

Rhonda has worked in all roles of the medical office: from the front desk to the clinical side. She has extensive knowledge of billing and reimbursement related to managed care and commercial carriers as well as Medicare and state funded products.

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