Navigating the Complex World of Nurse Practitioners and Physician Assistants Billing

Navigating the complexities of billing rules for Nurse Practitioners (NPs) and Physician Assistants (PAs) can be a daunting task, with each payer presenting its own set of definitions for both direct and indirect billing of services. The divergent rules create a landscape of compliance that is often intricate and perplexing, particularly when it comes to billing for the indirect services of these healthcare providers.

Over the past few years, the Centers for Medicare & Medicaid Services (CMS) has undergone a transition in its definition of split/shared visits, emphasizing the need for a substantive portion of the work to be performed by the billing provider. While this transition has been extended until the end of 2024, the new definition introduced by the Current Procedural Terminology (CPT®) code book has sparked considerable debate regarding its alignment with CMS' regulations.

The disparity between CMS/Medicare and CPT in their interpretation of a "substantive portion" for split shared visits has been apparent. Anticipations for 2024 suggested that CMS/Medicare would again diverge in their approach to determining which provider can bill for joint services in a facility setting. However, the surprise came with the Final Rule from the Physician Fee Schedule (PFS), where CMS/Medicare announced their alignment with CPT's clarified policy in the 2024 code book.

This webinar aims to dissect the new definitions of a "substantive portion" outlined by CPT and explore their implications for NPs and PAs operating in hospital and other facility-based settings. Join us to gain insights into the evolving landscape of billing regulations, and feel free to bring your questions for a comprehensive discussion on these critical topics.

Webinar Objectives

By the end of this webinar, participants will acquire a thorough understanding of the complexities surrounding compliant billing for Non-physician Practitioners (NPPs), particularly Nurse Practitioners (NPs) and Physician Assistants (PAs). The session aims to:

• Navigate NPP Billing Challenges:
  • Comprehend the intricacies and challenges associated with billing rules for NPs and PAs, considering the diverse definitions presented by various payers.
• Decode CPT® 2024 Updates:
  • Gain a comprehensive understanding of the new guidelines for split shared billing introduced in the CPT® 2024 updates.
  • Explore the AMA's perspective on these guidelines and understand the necessary day-to-day documentation changes for compliance.
• Unpack CMS' Perspective on Split Shared Billing:
  • Analyze CMS' evolving definition of split/shared visits, particularly the emphasis on a "substantive portion" and its implications for billing providers.
  • Address challenges arising from the differing terminology used by CMS and CPT.
• Navigate CMS Guidelines for Incident To Billing
  • Gain insights into CMS' guidelines for split shared visits in 2024, including the nuanced requirements for "incident to" billing.
  • Ensure a clear understanding of compliance standards set forth by CMS.
• Master Other Payers' Rules for NPP Billing:
  • Explore rules and regulations established by various payers for the billing of NPP services.
  • Understand how these rules interact with and influence the broader landscape of billing compliance for NPs and PAs.

Webinar Highlights

• The new guidelines for split shared visit found in CPT 2024
• CMS’ guidelines for split shared in 2024
• CMS’ guidelines for incident to
• Other payers’ rules and regulations for Non-Physician Practitioner billing

Who Should Attend

Coders, billers, office managers, office administrators, Nurse Practitioners, Physician Assistants