Advanced Practice Providers
Description
Advanced Practice Providers is an online, self-paced E/M coding course for outpatient and professional fee coders who work with claims for nurse practitioners, physician assistants, certified nurse midwives, clinical social workers, clinical psychologists, clinical nurse specialists, and other APPs. Coders will review documentation requirements and billing options for APP services, including when to bill incident-to versus directly under the APP, and how payer contract rules and scope-of-practice impact code selection and modifier use. This focused course offers 1 AHIMA CEU and 1 AAPC CEU and is designed to help you code APP encounters more confidently while reducing denials tied to documentation and billing requirements.
Included Lessons:
- Advanced Practice Provider Definitions
- Scope of Practice
- APP Billing Scenarios
- Organizational Impact
CEUs available for the following credentials:
AAPC
COC, CPC, CPC-P, CANPC, CCC, CCPC, CCVTC, CDEI, CDEO, CEDC, CEMC, CENTC, CFPC, CGIC, CGSC, CHONC, CIC, CIMC, COBGC, COPC, COSC, CPB, CPCD, CPCO, CPEDC, CPMA, CPMS, CPPM, CPRC, CRC, CRHC, CSFAC, CUC
AHIMA
CCA, CCS, CCS-P, RHIT, RHIA, CDIP, CHDA, CHPS
Key Takeaways
This course focuses on medical coding for APPs and aims to build a foundational understanding and practical application of coding principles, ensuring accuracy, compliance, and optimization of reimbursement processes for services rendered by APPs. This expertise is vital to navigate the complex billing landscape, manage financial health, and mitigate legal risks within healthcare settings.
- Understanding APPs and Their Roles: Gain knowledge about the different types of APPs (e.g., NP, PA, CNM, etc.) and their specific roles and responsibilities within healthcare settings.
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Exploring Specific Codes for APP Services: Explore the unique coding requirements related to services provided by APPs and understand how they differ from physician service codes.
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Incident-To Billing Concepts: Understand "incident-to" billing, where services provided by APPs might be billed under a supervising physician and learn the regulatory requirements for this billing modality.
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Modifiers and Their Usage: Grasp how to use modifiers appropriately in coding to ensure that the services provided by APPs are accurately represented and billed.
Benefits of Taking this Course
- APP Coding Expertise
- Enhanced Compliance Understanding
- Efficient Incident-To Billing
- Advanced Modifier Application
- Reduced APP-Related Denials
- Improved Reimbursement Rates
- Effective Payer Communication
- Optimized APP Utilization
- Telehealth Coding Competency
- Adaptability to Guidelines
- Preparedness for Audits
FAQs
How does coding for Advanced Practice Providers (APPs) differ from physicians?
Coding for APPs follows the same clinical coding guidelines as physicians, but the billing rules can differ based on supervision, scope of practice, and whether the service is billed under the APP or a physician. This course explains how these factors affect code assignment, split/shared visits, incident-to billing, and documentation requirements so you can apply the correct rules in each setting.
What are some common challenges faced in coding and billing for APP services, and how does the course address them?
Coders often struggle with determining when services qualify for split/shared billing, how to handle incident-to rules, and what documentation is required for APP-provided services. The course walks through these situations with examples, showing you how to interpret documentation, apply supervision rules, and avoid common coding and billing errors.
Will the course address updates and changes in coding guidelines relevant to APPs?
Yes. The course highlights current coding and billing requirements for APPs and notes where recent guideline changes may affect documentation or code selection. While the course reflects the guidelines in effect at the time of development, coders are encouraged to stay aware of annual updates, which may impact how APP services are reported.
About Our Medical Coding Courses
HIAlearn, powered by Health Information Associates (HIA)—a leader in medical coding and auditing for more than three decades—offers a flexible, online education platform designed for today’s coders. With a growing catalog of AHIMA and AAPC-approved coding courses, HIAlearn supports both beginners and experienced coders looking to build confidence, accuracy, and CEU credits.
Courses are available across various coding types including CPT, E/M, ICD-10-CM, and ICD-10-PCS, and are designed for multiple specialties including inpatient, outpatient, profee, and CDI.
To stay up to date, coders can explore our Coding Updates hub for the latest ICD-10-CM, ICD-10-PCS, CPT, and IPPS changes. HIAlearn also supports organizations with group discounts and scalable team access, promoting accuracy, compliance, and continuous professional development across departments.
Overview
Code Type
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