Advanced practice providers—specifically nurse practitioners, physician assistants and radiologists assistants—are playing a bigger part in modern healthcare overall, and their impact on the practice of radiology in particular continues to grow.

One recent study found that the amount of imaging-related Medicare payments to nonradiologists has surpassed the amount of payments made to radiologists. This high rate of growth for non-physicians’ roles within radiology merits additional scrutiny and evaluation, according to an article published online May 23 in the Journal of the American College of Radiology authored by C. Matthew Hawkins, MD, and his colleagues at Emory University School of Medicine.

“Referred to by some as advanced practice providers, advanced practice clinicians, midlevel providers, or physician extenders, their scope of practice, prescription privileges, and ability to practice independently have increased but continue to vary widely among practices and states,” wrote Hawkins et al. “[T]he full impact of the increasing prevalence of nurse practitioners and physician assistants in radiology departments remains unclear, and their impact on patient safety, practice revenue, and radiology education thus warrants review and critique.”

One area of concern is billing for radiology services, the authors noted, especially with regard to nurse practitioners and physician assistants. “Billing for services provided for nurse practitioners and physician assistants can be complex and has recently been targeted by the government as an area meriting heightened fraud and abuse scrutiny,” wrote Hawkins and colleagues. “A firm grasp of what is (and is not) allowable is thus essential when contemplating nurse practitioners or physician assistants employment so as to simultaneously optimize legitimate revenue and minimize compliance risk.”

Despite being subject to licensing and government regulations, it’s important for these advanced practice providers to ensure the safety of their patients and the compliance of their employers by staying abreast of changes in local and state laws. “Nurse practitioners and physician assistants are state licensed and must maintain national certification to remain eligible for credentialing at most institutions,” the authors wrote. “A thorough understanding of local and state regulations and rules is necessary, as the scope of practice for nurse practitioners and physician assistants varies widely and is constantly changing.”

Radiologist assistants, on the other hand, represent another challenge to radiology practice compliance. “Although highly trained specifically in radiology and certified by national accrediting organizations, these radiologist extenders are not recognized as providers by Medicare and most other payers as billable providers,” wrote Hawkins and colleagues. “Because supervision requirements and billing compliance rules for radiology assistants are substantially different from those for nurse practitioners and physician assistants, practices considering hiring such professionals are advised to exercise careful due diligence.”