NP and PA's

[sglamuzina]

Good Morning,

We are looking into getting with a PA or NP to join the practice.
Can someone please help me with the Requirements and and Scope of Practice Requirements.

Also...I know that there are options RE: Billing and would like to pros and cons.
Direct Pay
Incident to
Split / Shared Services

 

[amyjph]

This is a pretty huge question.
Search the forums here for anwers to a lot of these, they have been discussed a lot.
You would need to check the state for scope of practice.
Starting with the CMS site is a good place to learn about NPP requirements.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf

190 - Physician Assistant (PA) Services
200 - Nurse Practitioner (NP) Services

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

 

[jkyles@decisionhealth.com]

Good Morning,

We are looking into getting with a PA or NP to join the practice.
Can someone please help me with the Requirements and and Scope of Practice Requirements.

Also...I know that there are options RE: Billing and would like to pros and cons.
Direct Pay
Incident to
Split / Shared Services

I agree this is a huge question. It will depend on a number of factors including what the practice hires them to do, how much revenue it expects to make and Medicare and private payer rules for NPPs.

Scope of practice varies by state. To read your state's rules you can start with the respective societies for PAs (AAPA) and NPs (AANP). They both have summaries of SSP for each state and links so you can read the details.

I would note that:

• Incident-to is a Medicare-specific rule and also a big area of compliance enforcement. My read is that MACs and the OIG are pretty much out of patience with practices that make mistakes. Everyone will need to understand the rules for it to avoid problems. You should also discuss internally if might be easier and more cost-efficient to have the NPPs bill Medicare under their NPIs.
• There are two kinds of split/shared and both are restricted to certain E/M services. CPT split/shared for coding (applies to office/outpatient this year, will apply to all level-based services except ED next year) and CMS split/shared (applies to critical care and level-based E/M except office/outpatient) for billing. They are similar but not the same.

 

[sglamuzina]

I agree this is a huge question. It will depend on a number of factors including what the practice hires them to do, how much revenue it expects to make and Medicare and private payer rules for NPPs.

Scope of practice varies by state. To read your state's rules you can start with the respective societies for PAs (AAPA) and NPs (AANP). They both have summaries of SSP for each state and links so you can read the details.

I would note that:

• Incident-to is a Medicare-specific rule and also a big area of compliance enforcement. My read is that MACs and the OIG are pretty much out of patience with practices that make mistakes. Everyone will need to understand the rules for it to avoid problems. You should also discuss internally if might be easier and more cost-efficient to have the NPPs bill Medicare under their NPIs.
• There are two kinds of split/shared and both are restricted to certain E/M services. CPT split/shared for coding (applies to office/outpatient this year, will apply to all level-based services except ED next year) and CMS split/shared (applies to critical care and level-based E/M except office/outpatient) for billing. They are similar but not the same.

Thank you so much!!!! I know it’s such a huge question with so many factors!