AP’s—Not to Be Confused with PA’s—Present Legal and Coding Challenges for Urgent Care Operators

The challenges of staffing rural urgent care centers has spurred some operators to get creative in order to meet patient demand. The question is, are some getting a little too creative in billing for their services? These murky waters have led to two individuals—an urgent care physician-owner and his office manager—being charged with healthcare fraud in Missouri. The United States Attorney’s Office, Eastern District of Missouri alleges that the pair “conspired to make false statements to Medicare and Medicaid by billing for services performed by multiple assistant physicians (APs) as if [the physician] had provided those services, even if he was out of town or abroad.” Missouri law requires APs to be supervised by physicians under a collaborative practice arrangement. The indictment charges that the physician-operator promoted his urgent care operations as a “steppingstone” for med school grads who weren’t able to land a residency and were therefore unable to practice medicine. According to the document, at least 39 APs have done so since January 2018. Whether the accused in this case are guilty or not, the discussion of APs underscores that it is essential to both know and comply with applicable regulations regarding how your operation bills for the clinicians who see patients. A challenge inherent in employing APs, according to at least one coding expert, is that there is no clear way to legally seek reimbursement for the time they spend with patients.