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Demonstrating advanced practice provider value

Implementing a new advanced practice provider billing algorithm

Brooks, Paula B. DNP, FNP-BC, MBA, RNFA (Director of Advanced Practice Nurses); Fulton, Megan E. MSPAS, PA-C (Director of Physician Assistant Practice)

Journal of the American Association of Nurse Practitioners: February 2019 - Volume 31 - Issue 2 - p 93–103
doi: 10.1097/JXX.0000000000000155
Quality Improvement Report

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.

Medical University of South Carolina, Charleston, South Carolina

Correspondence: Paula B. Brooks, DNP, FNP-BC, MBA, RNFA, Medical University of South Carolina, 169 Ashley Avenue, 245 A North Tower MSC 301, Charleston, SC 29425; E-mail:

Author contributions: Both authors developed the project, collected data, and revised the manuscript for final submission.

Competing interests: The authors report no conflicts of interest.

Received April 24, 2018

Accepted September 17, 2018

© 2019 American Association of Nurse Practitioners
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