Abstract
Having a concept and understanding of coding and billing for procedural services is important to the advanced practice provider (APP). Reimbursement for services delivered is important to the financial stability of practices and organizations. Billing and coding also hold legal obligations to the provider of such services and require understanding of concepts of waste, abuse, and fraud. Understanding reimbursement practices to local regions and the nuances of billing and coding is crucial to showing the value of the APP to the practice.
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References
Centers for Medicare and Medicaid Services: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf. Accessed 6 June 2020.
Centers for Medicare and Medicaid Services: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2997CP.pdf. Accessed 6 June 2020.
Centers for Medicare and Medicaid Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM6123.pdf. Accessed 6 June 2020.
Health and Human Services, Office of the Inspector General: http://oig.hhs.gov/compliance/provider-compliance-training/files/Compliance101tips508.pdf. Accessed 6 June 2020.
Centers for Medicare and Medicaid Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-MLN4649244.pdf. Accessed 6 June 2020.
Centers for Medicare and Medicaid Services: https://www.cms.gov/research-statistics-data-and-systems/monitoring-programs/medicare-ffs-compliance-programs/recovery-audit-program/. Accessed 6 June 2020.
Centers for Medicare and Medicaid Services: https://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SMD032207Att2.pdf. Accessed 6 June 2020.
Additional Resources
Centers for Medicare and Medicaid.: https://www.cms.gov
American Association of Physician Assistants: https://www.aapa.org/advocacy-central/reimbursement/
American Academy of Professional Coders.: https://www.aapc.com
Disclaimer
This chapter does not represent any legal advice and was based on current understanding of CMS rules and regulations at the time of its writing. Ultimately, the accuracy and responsibility of the claim submission rest with the provider of the service.
CPT© is copyright of the American Medical Association.
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Sherry, S.P. (2021). Coding and Billing for Procedures. In: Taylor, D.A., Sherry, S.P., Sing, R.F. (eds) Interventional Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-64661-5_4
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DOI: https://doi.org/10.1007/978-3-030-64661-5_4
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