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

Paula B Brooks1, Megan E Fulton

  • 1At the Medical University of South Carolina in Charleston, Paula B. Brooks is director of advanced practice nurses and Megan E. Fulton is director of physician assistant practice. The authors have disclosed no potential conflicts of interest, financial or otherwise.

JAAPA : Official Journal of the American Academy of Physician Assistants
|January 30, 2019
PubMed
Summary
This summary is machine-generated.

Implementing a standardized billing algorithm for advanced practice providers (APPs) improved their productivity attribution and financial contribution. This initiative enhanced the utilization of APPs within a team-based care model.

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Area of Science:

  • Healthcare Management
  • Health Services Research
  • Medical Economics

Background:

  • Healthcare systems face workflow adjustments due to rapid changes and the need for efficient team-based care.
  • Accurate attribution of advanced practice providers' (APPs) productivity is crucial for optimizing healthcare delivery.
  • A knowledge gap existed regarding APP billing practices and their full scope of practice utilization.

Purpose of the Study:

  • To assess and improve the utilization and productivity attribution of APPs within an academic medical center.
  • To develop and implement a standardized APP billing algorithm to align with updated practice laws and regulations.
  • To enhance the financial contribution and efficiency of APPs in a team-based care setting.

Main Methods:

  • Conducted assessments of clinical areas to identify knowledge gaps in APP billing and practice scope.
  • Developed and implemented a new, standardized APP billing algorithm compliant with legal and institutional standards.
  • Evaluated outcomes 12 months post-implementation of the new billing algorithm.

Main Results:

  • The project revealed existing APP contributions, increasing relative value units, collections, and patient encounters.
  • Findings indicated improved utilization and more accurate attribution of APP productivity.
  • The new algorithm facilitated better integration of APPs into the physician/APP team.

Conclusions:

  • Standardizing APP billing practices is essential given the growing APP workforce, EMR implementation, and financial constraints.
  • The developed APP billing algorithm serves as a critical tool for healthcare systems to meet current demands.
  • This approach supports efficient APP utilization and accurate financial attribution in evolving healthcare environments.