Medical Billing Services for Non-Physician & Mid-Level Providers
As the demand for team-based, value-driven care continues to grow, non-physician providers have become integral across a wide range of clinical settings. From outpatient practices to hospital departments, these licensed professionals—who operate without MD or DO credentials—bring critical efficiency to patient care delivery. However, billing for non-physician provider services presents unique challenges tied to regulatory guidelines, scope-of-practice rules, and payer-specific billing protocols. At MedsIT Nexus, our tailored RCM solutions are built to address these complexities with precision. For practices seeking compliance and consistent reimbursement, outsourcing non-physician provider billing offers a smarter path to streamlined operations and optimized revenue performance.
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Mid-Level Provider Billing Services (NPs & PAs)
Mid-level providers—Nurse Practitioners (NPs) and Physician Assistants (PAs)—are transforming how care is delivered across outpatient clinics, specialty practices, and hospital-based environments. But as their role in patient management grows, so do the billing complexities surrounding their services. What looks like routine care on the surface often hides deep reimbursement challenges due to payer-specific policies, regulatory frameworks, and compliance-sensitive coding scenarios. At MedsIT Nexus, we specialize in the nuances of billing for mid-level providers, ensuring that your practice stays compliant, properly reimbursed, and optimized for value-based performance.
Ready to simplify mid-level billing and improve your cash flow? Partner with MedsIT Nexus—where compliance meets collections
APP Billing in Hospital Inpatient Units
Advanced Practice Providers (APPs) play a critical role in managing complex care episodes within inpatient hospital settings—rounding on patients, contributing to multidisciplinary teams, and participating in split/shared visits. To ensure compliant billing, proper attribution between the APP and supervising physician is essential, especially under Medicare’s split/shared rules and time-based documentation requirements. For facilities navigating these billing intricacies, our solution aligns directly with the documentation standards and modifier applications required in the hospital setting. We specialize in structuring APP-related billing within the broader framework of inpatient hospital billing services, ensuring clean claims, accurate charge capture, and full regulatory compliance.
APP Billing in Hospital Outpatient Departments (HOPDs)
In hospital outpatient departments, APPs often deliver evaluation and management services, assist in minor surgical procedures, and support follow-up care—all of which come with their own set of billing challenges. Unlike the inpatient setting, incident-to billing does not apply, and documentation must clearly support either direct billing under the APP’s NPI or time-based shared services using modifier FS. Our team ensures that outpatient APP encounters are seamlessly integrated into your facility’s existing charge capture and coding systems. We help outpatient departments meet payer expectations and optimize revenue by aligning APP contributions with compliant billing strategies that reflect the nuances of outpatient hospital unit billing services.
Your Mid-Level Team Deserves More Than Just “Physician-Light” Billing
At MedsIT Nexus, we elevate mid-level provider billing beyond support roles. Our billing solutions for Nurse Practitioners and Physician Assistants are designed to align seamlessly with Physician Billing Services, ensuring accurate attribution in split/shared visits and compliance with Medicare and payer rules. We specialize in bridging documentation, modifier use, and revenue strategies between physicians and APPs—helping you capture every earned dollar. Whether in hospitals or group practices, our approach secures compliant billing and maximizes reimbursement for your entire care team.
Key Differences in APP Billing – Working With Physicians vs Billing Independently
When Advanced Practice Providers (APPs) such as Nurse Practitioners and Physician Assistants operate within hospital inpatient units or outpatient departments, their billing pathway often hinges on how closely they collaborate with supervising physicians. At MedsIT Nexus, we decode this complexity with precision, because how an APP bills isn’t just procedural, it’s a financial strategy.
Impact of APP Billing Decisions
In Hospital Inpatient Units, APPs frequently engage in split/shared visits, where both the physician and APP see the patient on the same day. When documented correctly, this allows the hospital to bill under the physician’s NPI at 100% of the Medicare Physician Fee Schedule. However, when APPs see patients independently without physician collaboration, the billing shifts to direct reimbursement under the APP’s NPI, typically reimbursed at 85%. This distinction affects both revenue integrity and documentation standards.
Incident-To Billing Limits
In Hospital Outpatient Departments (HOPDs), the dynamic changes yet again. APPs may engage in “incident-to” billing—but only under stringent Medicare rules, where the supervising physician must be physically present and actively involved in the patient’s care plan. Failing to meet these conditions means the claim must be submitted under the APP’s NPI, again at the reduced rate. The margin may seem minor, but across volume, it translates to thousands in either lost revenue or compliance penalties.
Turn APP Billing Challenges into Revenue Opportunities
Whether your APPs are rounding on inpatient beds or evaluating patients in an HOPD, the billing rules don’t just depend on where they work, but how they work. At MedsIT Nexus, we specialize in structuring billing models that maximize allowable reimbursement while ensuring full CMS and payer compliance. From incident-to optimization to split/shared strategy, we turn APP billing from a gray area into a revenue-optimized workflow.
Ready to simplify APP billing while boosting compliance and reimbursement?
Partner with MedsIT Nexus to transform complex billing rules into streamlined revenue strategies.
Mid-Level Provider Credentialing
Credentialing & NPI-Level Billing Challenges
Not all payers credential mid-level providers the same way, and not all states recognize them equally. Whether your NP or PA is newly onboarded or expanding services, delays in NPI linkage, state license updates, or commercial payer enrollment can disrupt billing for weeks. Our credentialing team works alongside billing workflows to ensure your mid-levels are billable from day one, without missing a revenue beat.
Explore our Provider Credentialing Services for a full suite of enrollment and CAQH support
Maximize reimbursement accuracy for CRNAs, LCSWs, Therapists & More—No Matter Where They Practice
Healthcare doesn’t stop with physicians and APPs. From licensed clinical social workers in behavioral clinics to CRNAs in surgical teams and physical therapists in SNFs, today’s care landscape relies on a broad spectrum of non-physician providers. But here’s the challenge:
Each facility setting comes with its own billing rules, modifiers,
and compliance standards.
At MedsIT Nexus, we specialize in decoding the complexity of billing for non-physician provider services across hospitals, outpatient departments, skilled nursing facilities, and rehab centers. Whether your providers bill under the UB-04 institutional claim or CMS-1500, we align every detail with payer-specific protocols.
Facility-Sensitive Billing That Adapts to Your Care Environment
Our medical billing company handles a diverse range of facility types, with unique billing rules that can make or break your revenue. Here’s what we optimize:
Inpatient Units
We ensure CRNAs are billed accurately using QX/QZ modifiers with proper attending oversight.
Outpatient Services
LCSWs & psychologists are billed under UB-04 claims, provided that incident-to guidelines & supervision levels are met.
Skilled Nursing Facilities
For therapy services, we manage compliance with MDS reporting, plan-of-care approvals, & timed CPT rules.
Rehab & Mental Health
We navigate hybrid billing (CMS-1500 + UB-04) with a focus on accurate documentation & timed-session tracking.
Why It Matters:
The Reimbursement Risk Is Real
Billing errors for non-physician services often result in denials, delays, or compliance flags. Common traps include:
Using the wrong claim form (CMS-1500 vs. UB-04)
Missing or misused modifiers like GO, GP, QX, QZ
Overlooking supervision requirements and documentation standards
Confusing "incident-to" vs. direct billing in outpatient settings
Whether you're billing for a solo physical therapist or a whole behavioral health team, MedsIT Nexus delivers specialty-focused billing precision with facility-specific compliance.
Book a free consultation & discover how we optimize reimbursement for non physician providers.
MedsIT Nexus Specializes in Medical Billing & Claims Processing for Diverse Non-Physician Provider Groups
Therapy Providers
Licensed professionals specializing in rehabilitation and therapeutic services.
- Physical Therapist
- Occupational Therapist
- Speech-Language Pathologist
- Respiratory Therapist
Mental Wellnesss
Mental and behavioral health professionals are involved in therapy, counseling, & psychiatric evaluation.
- Licensed Clinical Social Worker
- Licensed Professional Counselor
- Psychologist
- Marriage and Family Therapist
- Board Certified Behavior Analyst
Certified Technologists
Providers who deliver technical services in support of diagnosis and monitoring.
- Radiologic Technologist (RT(R))
- Sonographer / Diagnostic Medical Sonographer
- EEG / EKG Technicians
Audiology Experts
Diagnose and treat hearing loss and balance-related disorders
- Audiologist
- Hearing Aid Dispenser
Alternative Medicine
May be billable under specific plans with credentialing
- Chiropractor
- Acupuncturist
- Naturopathic Doctor
Clinical Laboratory
Usually do not render direct patient care but are credentialed under a facility or group.
- Clinical Laboratory Technician
- Phlebotomist
- Pathology Assistant
Transport Providers
Deliver urgent medical care and patient transport in critical situations
- Emergency Medical Technician
- Paramedic
Eye Specialists
Provide routine eye exams, vision correction, and optical health services
- Optometrist
- Ophthalmic Technician
Nurse Practitioners & Physician Assistants work closely with the Physicians' specialties
I covered a section of “ Advanced Practice Providers ” in the Hospital Inpatient facility setting
Mid-Level Providers practice in the Outpatient facility settings, with physicians
These medical providers work with the “private practices,” free-standing facilities && “small practices” hospital-affiliated facilities
How MedsIT Nex Helped Renowned Hospitals In the USA Cut Costs, Speed Up Reimbursements, & Build Resilient RCM
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Our services are trusted by 2000+ providers
Dr. Ndidi Uka
A-plus Dentistry
"I want to thank MedsIT Nexus for their impeccable service. They are incredibly knowledgeable and work to make sure you receive the maximum reimbursement. Sam, my dedicated Practice Manager, is always available to answer my questions and keep my abreast on the status of my submitted claims. Being able to bill medical services has allowed me to offer the best care."
M. Techeira
Family Medicine
"We are an outpatient family medicine/ primary care practice. Have offices in NYC and Nassau County. MedsIT Nexus handles all our medical billing and insurance claims. We switched from another company and the process was hassle free, no fees and FAST which was important since we operate 6/7 days. They are always available to answer any questions. We definitely recommend!"
Memoona Waheed
Family Medicine & Pain Management
"After reviewing different medical billing companies, I came across MedsIT Nexus. Not only do they offer billing and coding services, but specialize in credentialing and unpaid claims. Their staff is knowledgeable, professional and are easily accessible- inquiries are answered quickly. Thank you MedsIT Nexus for helping us improve our healthcare practice at a competitive rate!"
S. Dhillon
Physical Medicine & Rehabilitation
"I am the manager at a private physical medicine & rehabilitation practice. We operate in 2 different boroughs in NYC through multiple clinics. MedsIT Nexus handles all our medical billing, coding, denials and prior authorizations for all procedures. We are pleased with their same day approvals as well. Their staff is easily accessible, fast & pleasant to work with."
Dr. Ndidi Uka
A-plus Dentistry
"I want to thank MedsIT Nexus for their impeccable service. They are incredibly knowledgeable and work to make sure you receive the maximum reimbursement. Sam, my dedicated Practice Manager, is always available to answer my questions and keep my abreast on the status of my submitted claims. Being able to bill medical services has allowed me to offer the best care."
M. Techeira
Family Medicine
"We are an outpatient family medicine/ primary care practice. Have offices in NYC and Nassau County. MedsIT Nexus handles all our medical billing and insurance claims. We switched from another company and the process was hassle free, no fees and FAST which was important since we operate 6/7 days. They are always available to answer any questions. We definitely recommend!"
Memoona Waheed
Family Medicine & Pain
" After reviewing different medical billing companies, I came across MedsIT Nexus. Not only do they offer billing and coding services, but specialize in credentialing and unpaid claims. Their staff is knowledgeable, professional and are easily accessible- inquiries are answered quickly. Thank you MedsIT Nexus for helping us improve our healthcare practice at a competitive rate!"
S. Dhillon
Rehabilitation
" I am the manager at a private physical medicine & rehabilitation practice. We operate in 2 different boroughs in NYC through multiple clinics. MedsIT Nexus handles all our medical billing, coding, denials and prior authorizations for all procedures. We are pleased with their same day approvals as well. Their staff is easily accessible, fast & pleasant to work with."
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