Enhanced Care and Optimal Billing
A Strategic Guide for Healthcare Practices
Physicians often ask me how to best utilize advanced practice providers for optimal patient satisfaction, clinic efficiency, and maximizing revenue.
In the rapidly evolving healthcare landscape, the integration of Advanced Practice Providers (APPs) such as nurse practitioners (NPs) and physician assistants (PAs) into our medical teams has become a game-changer.
APPs play a pivotal role in healthcare delivery, providing a range of patient care services that, when utilized strategically, can transform both patient outcomes and practice efficiency.
Strategic scheduling is crucial in optimizing the full potential of APPs and physicians' clinical time.
Postoperative Care
Utilizing APPs in postoperative care is one of the best strategies for surgical providers. Postoperative visits are typically unpaid during the global period. Allowing the APP to manage these patients is a win-win. The physician can utilize this time for revenue-generating activities like seeing new patients, and postoperative patients will enjoy having a comprehensive post-op visit with the APP.
Concurrent Visits
Having APPs manage follow-up appointments while physicians simultaneously see new patients can significantly increase operational efficiency and maximize revenue. During these concurrent sessions, the practice can utilize incident-to-billing if the APP's service is under the "direct supervision of a physician"—who must be present in the office suite and immediately available.
Concurrent visits allow the practice to bill for the APP's service at 100% of the physician's fee schedule.
Solo Follow-ups
Incident-to-billing no longer applies when APPs see follow-up patients without a physician directly supervising them, resulting in reimbursements dropping to 85% of the physician's fee schedule.
Credentialing management can complicate things further. It can be time-consuming and costly to credential APPs under all the health plans, leading to potential network and payor issues.
New Patient Intakes
While APPs are qualified to handle new patients, you should not do this for a few reasons.
The new patient visit is an interview. If they don't meet you, or you are running in and out, distracted and rushed, this could create doubt in the patient's mind. I promise patients are not impressed by how busy you are. They want your full attention. Utilize the APP to allow you to spend maximum time with new patients. It will pay off in multiple ways.
Increased Patient Satisfaction
This may not be a popular position, but new patients want to see a doctor. The new patient visit allows the doctor to establish a rapport with the patient and build the patient-physician relationship.
Higher Surgical Conversion Rates
Patients are getting more savvy and shopping for doctors based on reviews and outcomes.
More time = More Trust
Lower Reimbursement
A few private payors will not reimburse for APP's new E&M codes; when they do, it is 85% of the physician fee schedule.
Ensuring Compliance and Maximizing Reimbursement
Understanding and adhering to billing regulations is essential for compliance and maximizing reimbursement.
Being aware of state laws and insurer-specific rules that affect how APP services are billed. Ensuring proper documentation and supervision to qualify for incident-to-billing where applicable.
Conclusion
Advanced Practice Providers are indispensable in modern healthcare, enhancing patient care and practice efficiency. By strategically deploying APPs, particularly in postoperative care and structured patient visit schedules, healthcare practices can improve patient satisfaction and ensure robust financial performance.
By integrating these practices, healthcare providers can achieve a balance between high-quality patient care and optimal billing outcomes, propelling their practices toward greater success.
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