title: Scope of physician procedures independently billed by mid-level providers in the office setting.
abstract: OBJECTIVE
  Mid-level providers (nurse practitioners and physician assistants) were originally envisioned to provide primary care services in underserved areas. This study details the current scope of independent procedural billing to Medicare of difficult, invasive, and surgical procedures by medical mid-level providers.
  
  
  OBJECTIVE
  To understand the scope of independent billing to Medicare for procedures performed by mid-level providers in an outpatient office setting for a calendar year.
  
  
  METHODS
  Analyses of the 2012 Medicare Physician/Supplier Procedure Summary Master File, which reflects fee-for-service claims that were paid by Medicare, for Current Procedural Terminology procedures independently billed by mid-level providers.
  
  
  METHODS
  Outpatient office setting among health care providers.
  
  
  METHODS
  The scope of independent billing to Medicare for procedures performed by mid-level providers.
  
  
  RESULTS
  In 2012, nurse practitioners and physician assistants billed independently for more than 4 million procedures at our cutoff of 5000 paid claims per procedure. Most (54.8%) of these procedures were performed in the specialty area of dermatology.
  
  
  CONCLUSIONS
  The findings of this study are relevant to safety and quality of care. Recently, the shortage of primary care clinicians has prompted discussion of widening the scope of practice for mid-level providers. It would be prudent to temper widening the scope of practice of mid-level providers by recognizing that mid-level providers are not solely limited to primary care, and may involve procedures for which they may not have formal training.
authors.affiliation: Department of Dermatology, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Brett
authors.initials: B
authors.lastname: Coldiron
authors.affiliation: Procedural Dermatology Fellow, TriHealth Good Samaritan Hospital, Cincinnati, Ohio.
authors.forename: Mondhipa
authors.initials: M
authors.lastname: Ratnarathorn
mesh_terms: D000553:Ambulatory Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration / Q000592:standards; D003880:Dermatology / Q000191:economics / Q000458:organization & administration; D006801:Humans; D006278:Medicare / Q000191:economics*; D009722:Nurse Practitioners / Q000191:economics / Q000458:organization & administration*; D010823:Physician Assistants / Q000191:economics / Q000458:organization & administration*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D024382:Professional Role; D011787:Quality of Health Care; D012051:Reimbursement Mechanisms / Q000191:economics; D014481:United States