A non-physician practitioner (NPP) can be a better hire than a physician when you need flexibility and your state laws don't limit their scope of practice, experts say. Once you pass this test, the benefits of picking an NPP over a physician become more obvious, she says. Here are four reasons to go the mid-level route. 

Non-physician practitioners (NPPs) billed far fewer high-level E/M visits than physicians did from 2006 to 2008. The trend affected both new and established patient visits, according to an NPP Report analysis of CMS claims data. Not surprisingly, utilization for established visits is consistently higher than for new visits, which pay better but have more demanding documentation requirements.

This week's question is answered by Margie Scalley Vaught, CPC, coding content specialist for DecisionHealth.  

Q. My doctors want to know when our nurse practitioner can bill a consult. We know Medicare no longer covers consults (99241-99245), but we'd like to know how to bill her consults to our private payers. 

Several physicians of the same specialty work under an "umbrella." All of the physicians in the practice do their own billing and have separate tax ID numbers (TINs). One physician sees a patient in the office. Four months later a different physician sees the same patient and creates a new chart for the patient. In such a scenario, should the second physician bill a new patient visit (99201-99205) or an established patient visit (99211-99215)?

A broad range of specialties are billing more high-level new patient E/M codes, similar to a trend toward greater billing of high-level established E/M codes, according a Part B News analysis of CMS claims data (PBN 2/8/10). NOTE: The percentages above the bars show how much utilization growth codes 99204 and 99205 have seen over the three-year window.

This tool, developed by DecisionHealth Professional Services, will help you select the overall complexity of medical decision-making for a service by looking at the diagnosis (and/or management options), amount and complexity, and risk of complications or morbidity. You'll see it's as easy as 1-2-3!

The AMA issued a 10-page report to clarify how you use consultation codes 99241-99245 and 99251-99255 when billing the non-Medicare payers still accepting the codes. The guidance is too little, too late as far as CMS is concerned. The agency had complained that the rules for billing these codes were too confusing when it eliminated consults Jan. 1 (PBN 11/9/09).  But some private payers and Medicaid plans still pay for and want you to use consult codes.

You need to have a physician recruitment plan in place so you can quickly and efficiently bring a physician on board, whether you're looking to replace a retiring physician or hoping to open a satellite office in a neighboring town, experts say.

$44,000 in Medicare incentives (and thousands more in Medicaid and private payer incentives) available to your practice are riding on whidh electronic health record (EHR) system you select (see main story). Remember these four guidelines when you shop for an EHR system.

Electronic health records (EHRs) can be fully certified, but still lack the features needed to demonstrate meaningful use - costing you your share of $44,000 in Medicare incentive payments, as well as thousands more from Medicaid and private payers. Instead of making an EHR purchase based on its certification, base your decision on the vendor who's selling and maintaining it, experts say.