Demonstrating advanced practice provider value: Implementing a new advanced practice provider billing algorithm

Abstract

Background: Rapid changes in health care are driving the adjustment of work flow by which providers serve patients in team-based care. Specifically, there is a need to develop more effective and efficient utilization with accurate attribution of advanced practice providers' (APPs) productivity. Local Problem: The Directors of the APP-Best Practice Center conducted assessments of each clinical area at MUSC Health, a large academic medical center. A knowledge gap was identified, not only regarding billing practices of the APPs (nurse practitioners/physician assistants) but also in the utilization of APPs to practice to the fullest extent of their license, education, and experience. Methods: By substantiating APPs' contribution margin through the process of implementing a new standardized APP billing algorithm, a change in practice was accepted by senior leadership and a new APP billing algorithm was built while following updated practice laws, compliance/legal standards, and hospital bylaws/regulations. Interventions: A new billing algorithm was implemented on July 1, 2017, and outcomes were evaluated 12 months after implementation. Results: This project uncovered the work already performed by APPs while increasing relative value units, collections, and overall patient encounters by the APP/physician team. Findings suggest improved utilization and appropriate attribution of productivity. Conclusions: With the APP work force growing, the implementation of electronic medical record systems, and today's health care financial constraints, it is imperative that health care systems standardize their billing practices. The APP billing algorithm is a critical tool that will help to meet this demand.

Surgical Faculty Perception of Service-Based Advanced Practice Provider Impact: A Southwestern Surgical Congress Multicenter Survey

“…APPs are reimbursed an average of 85% of the physician fee schedule rate by Medicare, Medicaid, and many private payors resulting in substantial loss of potential revenue. 9,32 Clarifying and cataloging APP impact, therefore, may have a direct influence on nationallevel recognition of APP function and thus influence billing standards.…”

“…Decreased length of stay (LOS), improved continuity of care, reduced costs, promotion of standardized care, and enhancing patient satisfaction have been cited as established benefits of APPs. 6,[9][10][11][12] While the contributions of the APP have been well documented, much of the research has centered around their role in the critical care or unit-based setting or in comparison between physician and APP outcomes. 6,13,14 Trauma and surgical subspecialty services are increasing their utilization of service-based (SB) APPs 14 and their integration has demonstrated a positive impact on resident education and increased resident operating room (OR) opportunities.…”

Advanced Practice Provider Onboarding

“…The 2nd day of APP Onboarding is abbreviated to 2 hours and is focused primarily on billing and compliance (SDC #1, http://links.lww.com/JONA/B14), at which point APP general documentation, coding, and billing guidelines and regulations are reviewed in detail. Brooks and Fulton speak to the importance of APPs being knowledgeable in the financial aspect of care provision and needing accurate billing and coding skills 11 . The billing and compliance department updates relevant content based on changes in billing guidelines and recommended practices.…”

“…Brooks and Fulton speak to the importance of APPs being knowledgeable in the financial aspect of care provision and needing accurate billing and coding skills. 11 The billing and compliance department updates relevant content based on changes in billing guidelines and recommended practices.…”

An Effective Model for Unit-Based Advanced Practice Provider/Physician Collaboration on a Complex Medicine Hospital Unit

“…Advanced practice providers who practice at the top of their license, education, and scope positively impact healthcare delivery to patients. Numerous studies demonstrate that APP care in the acute care setting has outcomes equivalent to that of physicians [1][2][3][4][5][6] and are associated with decreased complications, length of stay (LOS), and cost of care. 3,7 Advanced practice providers are available to other members of the healthcare team to discuss and provide direction for patient care, and contribute to improvements in continuity of care, access, patient safety/quality, physician productivity, nursing engagement, and patient throughput.…”