Catalog Number : cca1678
Title : Credentialing Non-Physician Practitioners: Compliance Issues Lurking in the Dark
Speaker : Duane Abbey

Webplay Recording Date : 2-10-2010
Webplay Price : $ 200 for two weeks viewing

Target Audience:

• Coding Personnel
• Billing and Claims Transaction Personnel
• CVIR Personnel
• Chargemaster Coordinators
• Financial Analysts
• Compliance Personnel
• Utilization Review Personnel
• Internal Audit Staff
• Medical Staff Organization Directors
• Nurse Practitioners
• Physician’s Assistants
• Clinical Nurse Specialist
• Speech-Language Pathologists
• Nurse Midwives
• Physicians
• Other Interested Personnel

Webinar Objectives:

• To review the range and type of non-physician practitioners that are utilized by physicians, clinics and hospitals
• To appreciate how important the credentialing and qualification process is for NPPs including clinical and billing credentialing
• To understand compliance concerns surrounding NPPs
• To appreciate the process of gaining billing privileges for NPPs for Medicare and private third-party payers
• To understand the difference between ‘freestanding’ situations and ‘provider-based’ situations relative to NPPs
• To briefly review the payment methodologies for RBRVS (Resource Based Relative Value System) and APCs (Ambulatory Payment Classifications)
• To appreciate the concept of ‘incident-to’ and the differences in interpretation between physician/clinic situations and hospital situations
• To work through several case studies illustrating the credentialing process and the associated billing and reimbursement issues

The following are a few of the topics to be discussed:

• Non-Physician Practitioner Overview
  • Types of NPPs
  • Medicare versus State Law Requirements
  • Utilization of NPPs
  • Qualification and Credentialing Requirements
    • National Level
    • State Level
    • Local Level
  • Reimbursement Issues for NPPs
• Professional versus Technical Component Payment
  • RBRVS Review
    • Relative Values
    • Place of Service Differential
    • Examples - Reduced Payment for NPPs
  • APC Review
  • Freestanding versus Provider-Based Status
  • Private Practice for NPPs
• Compliance Considerations
  • Clinical Credentialing vs. Billing Credentialing
  • Failure to Properly Qualify and Credential
  • Recoupment of Payments
  • Improper Physician Supervision
  • Special Concerns for Critical Access Hospitals
• Examples and Case Studies
  • Nurse Practitioner in Medical Practice
  • Physician’s Assistant in Provider-Based Clinic
  • Clinical Nurse Specialist in Hospital Setting
  • Nurse Practitioner at Urgent Care Center
  • Other NPP Utilization
• Sources for Further Information

Webinar Level: Intermediate/Advanced

Contact Hours:

Upon attending this course you will receive a 1.8 Nursing Contact Hour Certificate or a 1.5 Contact Hour Attendance Certificate. There is usually a reciprocal agreement between state associations to allow these to count for each state. If you have any questions, please ask your state association.

Full tuition is refunded immediately on request if the participant has not been sent the program materials and instructions. Once the instructions (including access codes) have been sent, a full refund will be issued only after the program runs and it is verified that the participant did not access the program.