How can physician extenders benefit a radiology practice?
In some cases, the practice may bill and be reimbursed separately for the services of an NPP. Understanding the differences is key to getting started with physician extenders. A registered radiologist practitioner assistant, abbreviated RPA or RRA, is trained initially as a radiologic technologist and then achieves additional training and credentialing. The American Registry of Radiologic Technologists (ARRT) certifies RRAs, who work under the supervision of a radiologist and serve as an assistant to perform patient assessment, patient management, and selected clinical imaging procedures.
RRAs are not qualified to perform any level of imaging interpretation, but they may make observations in communication with the supervising radiologist. The ARRT maintains an Entry Level Clinical Activities list that describes the procedures an RRA might perform, subject to any limitations imposed by state licensing and/or the individual practice’s desires. The capabilities of a PA (physician assistant) or NP (nurse practitioner) are similar to each other, and both are governed by state licensing as to their scope of practice. Both PAs and NPs may obtain National Provider Identification (NPI) numbers that allow their services to be reimbursed by Medicare. In some states an NP may practice independently, but generally both NPs and PAs work in collaboration with a physician practice. In our experience PAs are the most common physician extenders in radiology practices, usually providing services along with interventional radiologists (IR).
Services in radiology practices
The services that may be provided by nonphysician providers (NPPs) are governed by state law as well as by hospital credentialing rules. It is most important to be aware of the scope of practice available through the licensure in the state where your practice operates, and also to check with the hospital before having NPPs provide services in your practice. The ability to bill and be reimbursed for the services of NPPs varies depending on the site of service. PAs and NPs, as providers with NPI numbers, may perform services and the practice may be reimbursed for those services. However, reimbursement for the services of RRAs who are not considered to be providers is included in the technical component (TC); in the hospital, the TC is paid to the hospital facility while in the office the TC is included in the global payment to the practice.
In the interventional radiologists setting, PAs and NPs may assist the radiologist in the pre- and post-procedure evaluation and management services. Initial patient visits require that the physician be present to discuss the procedure with the patient and develop a treatment plan, but the NPP can obtain the patient’s medical history and other preliminary information that will lessen the radiologist’s time. In addition, since the majority of interventional radiology procedures are assigned 0-day global codes, post procedure visits can be handled by the NPP.