On Demand: Essential Coding and Documentation Guidelines for APPs-Presentation Slides

Presentation Slides

Pdf Summary

The document "Essential Coding and Documentation Guidelines for APPs" by Nicole Knight, EVP at MedAxiom, provides comprehensive guidance for coding, billing, and documentation practices related to Advanced Practice Providers (APPs) in healthcare. It underscores the importance of accurate documentation to support medical billing claims and emphasizes that services should only be billed according to what is documented, as outlined in the CMS Internet Only Manual (IOM). <br /><br />Key components include the distinction between "incident to" services, which occur under the direct supervision of a physician and must meet specific criteria for billing at 100%, and independent APP services, which are reimbursed at 85%. There's also an explanation of "split/shared services," where both a physician and an APP may share patient care tasks, impacting how services are billed. Substantive portions must be performed by the billing practitioner, and documentation needs to clearly outline this division of labor to ensure compliance.<br /><br />APPs include Nurse Practitioners, Clinical Nurse Specialists, Certified Nurse Midwives, Physician Assistants, and other registered healthcare staff, while roles such as registered nurses and medical assistants fall outside this scope according to CPT. <br /><br />The document emphasizes accurate and patient-specific documentation, warning against "cloned" or copy-pasted records, which are seen as a misrepresentation of medical necessity. The information also includes criteria for claiming Continuing Education Units (CEUs) and guidelines around the use of electronic health records and telehealth services.<br /><br />Overall, this document stresses precision in the coding process and mandates understanding state licensure and scope of practice to ensure legal compliance and optimal reimbursement from payers. It is tailored for healthcare providers tasked with maintaining rigorous documentation standards to align with CMS guidelines and maximize reimbursement accuracy.

Keywords

Advanced Practice Providers

medical billing

CMS guidelines

incident to services

split/shared services

documentation compliance

telehealth services

coding accuracy

Continuing Education Units

scope of practice