tci ED Coding & Reimbursement Alert - 2002 Issue 12

Medicare News You Can Use: Changes in NPP Rules Increase Reimbursement

Your ED physicians no longer sacrifice full reimbursement when they recruit nonphysician practitioners (NPPs) to help with E/M services.Effective Oct. 25, 2002, changes to Medicare's NPP rules have increased reimbursement for E/M services.You can now bill an E/M service shared by a physician and an NPP under the physician's UPIN/PIN number, as long as the physician provides "any face-to-face portion" of the E/M encounter. In the past, you billed under the physician's full fee schedule only if the physician directly provided and documented the care. Otherwise, the ED had to bill under the NPP's reduced fee schedule...

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