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Area of Science:

  • Health Services Research
  • Medical Economics
  • Clinical Practice Management

Background:

  • Advance practice clinicians (APCs), including physician assistants and nurse practitioners, can bill Medicare directly or indirectly.
  • Indirect billing, often termed 'incident to' billing, involves submitting claims under a physician's name, potentially leading to higher reimbursement.
  • Understanding the volume and financial implications of indirect APC billing is crucial for healthcare policy and practice.

Purpose of the Study:

  • To quantify the volume and spending associated with office-based encounters billed indirectly by APCs within the Medicare program.
  • To differentiate between direct and indirect billing practices for services rendered by APCs.

Main Methods:

  • A cohort study utilizing Medicare fee-for-service and Medicare Advantage claims data from 2022.
  • Linking Medicare Part B (physician/clinician services) claims with Part D (prescription drug) claims to identify the prescribing clinician's unique identifier.
  • Distinguishing indirectly billed APC services by analyzing prescription drug fill data associated with clinician identifiers.

Main Results:

  • In 2022, 38.9% of all office encounters provided by APCs were billed indirectly.
  • For the median physician, indirect billing for APC services constituted 11.1% of their total billed encounters.
  • Indirect billing for APC services was most prevalent among surgical specialists (29.7%) and least common in primary care (3.9%).
  • Potential Medicare savings of $270 million in 2022 if all indirectly billed APC care were billed directly.

Conclusions:

  • APCs deliver a significant proportion of office-based care to Medicare beneficiaries.
  • Accurate identification of indirectly billed APC services is essential for a comprehensive understanding of healthcare delivery to Medicare patients.
  • Shifting to direct APC billing could yield substantial financial savings for Medicare.