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

Paula B Brooks1, Megan E Fulton

  • 1Medical University of South Carolina, Charleston, South Carolina.

Journal of the American Association of Nurse Practitioners
|February 13, 2019
PubMed
Summary
This summary is machine-generated.

Implementing a standardized advanced practice provider (APP) billing algorithm improved APP productivity attribution and utilization. This initiative enhanced relative value units, collections, and patient encounters within a team-based care model.

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Area of Science:

  • Healthcare Management
  • Health Services Research
  • Medical Economics

Background:

  • Healthcare systems face rapid changes necessitating workflow adjustments for team-based care delivery.
  • There is a critical need for efficient and accurate methods to track and attribute the productivity of advanced practice providers (APPs).
  • A knowledge gap existed at MUSC Health regarding APP billing practices and full scope of practice utilization.

Purpose of the Study:

  • To assess and improve the utilization and accurate productivity attribution of APPs within an academic medical center.
  • To implement a standardized billing algorithm for APPs to optimize their contribution margin.

Main Methods:

  • A new, standardized APP billing algorithm was developed and implemented, adhering to legal and regulatory standards.
  • The algorithm was designed to substantiate the contribution margin of APPs.
  • Outcomes were evaluated 12 months post-implementation.

Main Results:

  • The project revealed previously undocumented APP work, leading to increased relative value units (RVUs) and collections.
  • Overall patient encounters by APP/physician teams saw an increase.
  • Findings indicated improved APP utilization and more appropriate productivity attribution.

Conclusions:

  • Standardizing billing practices is crucial for healthcare systems, especially with a growing APP workforce and financial constraints.
  • The developed APP billing algorithm serves as a vital tool for optimizing APP productivity and financial performance.
  • This approach supports practicing APPs to the fullest extent of their licensure, education, and experience.