Billing, Coding & Compliance for NPs & Practice Providers

Your NPI is on every claim. Your biller submits it. Your EHR generates it. But YOU are legally responsible for every single one.

As seen through the eyes of a Quality Management nurse by me who reviews provider and NPs documentation and patient complaints, someone who sits on the other side of the desk and reads your notes with a very different set of eyes than your patients do.

This is not a coding textbook. This is what every NP and Provider must know before they write their first claim.

This PDF+ Bonus Audit Checklist- $124 value for $97

📋 What's Inside 35+ Pages, 10 Chapters

Every chapter is written in plain clinical language  no legal jargon, no confusing code tables you need a decoder ring for. Just the real information that protects your license and your income.

📌 Chapter 1: The Billing & Coding Landscape

Who CMS, MACs, OIG, and RACs are  and exactly what they are looking for in your claims data right now.

📌 Chapter 2: E/M Coding Under the 2021 AMA Rules

The MDM table every NP must know, time-based billing traps, and what 'complexity' has to look like in writing to hold up under audit.

📌 Chapter 3: Upcoding  Definition, Patterns & Consequences

The five most common upcoding patterns QM nurses flag, the statistical thresholds that put your billing profile on a payer's radar, and what happens next.

📌 Chapter 4: What Nobody Taught You in School

Incident-to billing violations, why your NPI is your legal signature, the copy-paste compliance crisis, signature authentication rules, and mental health billing nuances most NPs get completely wrong.

📌 Chapter 5: Red Flags That Trigger Audits

Eight sources that initiate real audits  including patient complaints, whistleblower actions, DEA reporting, and the OIG Work Plan targets that directly affect NPs.

📌 Chapter 6: The OIG, RAC & MAC

Who is watching, how they find you, what the Targeted Probe and Educate process looks like from the inside, and how to respond without making things worse.

📌 Chapter 7: Fraud & Abuse Statutes in Plain Language

The False Claims Act, Anti-Kickback Statute, Stark Law, and Civil Monetary Penalties decoded with actual penalty amounts and real examples.

📌 Chapter 8: License Revocation

The seven-stage pathway from statistical outlier to NPDB report  and what the National Practitioner Data Bank means for your career permanently.

📌 Chapter 9: What QM Nurses See in Your Notes Every Day

Five anonymized composite case patterns from real QM reviews  the documentation problems that turn a patient complaint into a federal investigation.

📌 Chapter 10: Building a Culture of Compliance

The OIG's seven elements, the 60-day overpayment rule, and a 13-point self-audit checklist you can run on your own charts starting today.

🎁 FREE BONUS Included  $27 Value

Provider Self-Audit Checklist PDF

A print-ready, single-page compliance checklist covering five critical review areas. Run it on a random sample of your own charts every month  it takes 10 minutes and could save your license.

•   ✔ E/M level & Medical Decision Making accuracy

•   ✔ Documentation integrity  catch cloning before auditors do

•   ✔ Coding accuracy & modifier use

•   ✔ Incident-to billing & supervision requirements

•   ✔ Medical necessity & orders documentation