Advanced Practice Providers


In this course, coders learn the documentation requirements to bill for advanced practice providers. With more and more insurance companies credentialing advanced practice providers - Nurse Practitioners (NP), Physician Assistants (PA), Certified Nurse Midwives (CNM), Clinical Social Workers (CSW), Clinical Psychologists (CP), Clinical Nurse Specialists (CNS) - it is becoming increasingly important to stay on top of documentation requirements and to know what is required under your insurance company contracts. There are several ways to bill based on documentation and services provided.

Included Lessons:

  • Advanced Practice Provider Definitions
  • Scope of Practice
  • APP Billing Scenarios
  • Organizational Impact

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.
  • 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.

  • 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.

  • 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 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


How does coding for Advanced Practice Providers (APPs) differ from physicians?

Coding for APPs can differ from physicians in aspects such as "incident-to" billing, usage of specific modifiers, and adherence to various payer policies regarding APP services. Understanding the nuances, such as which services can be directly billed by APPs and which need to be billed under a supervising physician, is crucial to accurate and compliant coding.

What are some common challenges faced in coding and billing for APP services, and how does the course address them?

Common challenges in APP coding may include accurately applying modifiers, navigating "incident-to" billing, and ensuring all documentation supports the billed services. The course provides in-depth insights into these challenges through practical examples, case studies, and offers strategies to effectively navigate through them, ensuring compliant and optimized billing.

Will the course address updates and changes in coding guidelines relevant to APPs?

Yes, the course will tackle current coding guidelines and provide strategies for staying updated with future changes in coding and billing related to APPs. Continuous adaptation to evolving guidelines and policies is crucial in maintaining accurate and compliant coding practices, and the course will offer tools and resources to aid in this ongoing learning process.

About our Medical Coding Courses

HIAlearn courses are developed to educate the coder in specific coding topics that have proven to be problematic. They are designed to focus on one area in detail, providing the coder with a thorough clinical knowledge of the diagnosis or procedure utilizing videos, photos, and valid websites to aid the coder in fully understanding the topic. Official coding advice and scenarios are utilized to integrate the clinical knowledge provided. Upon completion, the coder will have a thorough knowledge of clinical concepts and coding guidelines of the particular topic. Participants have the option to submit their completion certificates to AHIMA, with a selection also available for AAPC CEU(s). Learn more about us »

Price : $35.99
Courses : 1
Language : English
Code Type