On Demand: Essential Coding and Documentation Guidelines for APPs-Webinar Recording

Video Transcription

Video Summary

In this webcast, Nicole Knight, the leader of the Revenue Cycle Division and Care Transformation team, provides a comprehensive overview of coding and documentation guidelines for advanced practitioners. The session covers independent billing, incident-to billing, and split-shared service guidelines, with a focus on Medicare requirements, though acknowledging the variations with commercial payers.<br /><br />Nicole clarifies that incident-to services are applicable only in office settings (Place of Service 11) and require employment by the physician or clinic, direct physician supervision in the office during the service, and a pre-established treatment plan initiated by the physician. Any new problems or treatment changes disqualify a service from incident-to billing, requiring APPs to bill independently at 85% reimbursement unless the supervising physician takes over the visit.<br /><br />The session also discusses split-shared services applicable in hospital settings, where the billing is determined by who performs the substantive portion of medical decision-making or spends more than half the total time. This allows for 100% reimbursement when appropriately billed with an FS modifier.<br /><br />Additionally, Nicole highlights the importance of proper documentation, emphasizing that advanced practitioners can independently interpret diagnostic tests based on state scope of practice. Furthermore, telehealth guidelines are reviewed, reaffirming the need for secure platforms and documenting patient consent and the method (audio/video) used, especially considering potential legislative extensions.<br /><br />Key takeaways include the necessity for consistent documentation, cautious use of copy-paste functionalities, and ensuring that all diagnosis codes are supported by documented medical necessity. Nicole concludes by encouraging questions and feedback from participants to enhance shared learning across the MedAxiom community.

Keywords

Revenue Cycle

Care Transformation

Coding Guidelines

Documentation

Incident-to Billing

Split-shared Services

Medicare Requirements

Advanced Practitioners

Telehealth Guidelines

Medical Necessity

MedAxiom