# New patient visit with physician assistant



## pjdrugge (Aug 17, 2016)

I need the guidelines for a PA seeing a new patient.  This is a ortho office


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## Orthocoderpgu (Aug 20, 2016)

First of all, you are not going to like this answer. I too work in ortho and have multiple PA's. Basically, you live by the Golden Rule: the one with the gold makes the rule: the insurance, and they are different. It will also depend on if the insurance can credential them to work independently or not. You cannot bill a new patient to Medicare, after that, you live by the golden rule. The best thing you can do for your office is to get the PA's to FOLLOW the physicians. Let the doc diagnose and treat, and then let the PA do the follow up care. That is your best bet. When the PA starts seeing new patients and not working "incident to", that's when you will run into issues. Also, BX makes you bill a PA as "incident to" when they assist at surgery. Very dumb, but that's what they require. Keep in mind, if the PA is not working "incident to", you will need to write off visits every now and then. A lot of payers will credential them to work independently, but not all.


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## mhstrauss (Aug 22, 2016)

Orthocoderpgu said:


> First of all, you are not going to like this answer. I too work in ortho and have multiple PA's. Basically, you live by the Golden Rule: the one with the gold makes the rule: the insurance, and they are different. It will also depend on if the insurance can credential them to work independently or not. You cannot bill a new patient to Medicare, after that, you live by the golden rule. The best thing you can do for your office is to get the PA's to FOLLOW the physicians. Let the doc diagnose and treat, and then let the PA do the follow up care. That is your best bet. When the PA starts seeing new patients and not working "incident to", that's when you will run into issues. Also, BX makes you bill a PA as "incident to" when they assist at surgery. Very dumb, but that's what they require. Keep in mind, if the PA is not working "incident to", you will need to write off visits every now and then. A lot of payers will credential them to work independently, but not all.



I agree with most of this, in that each payer will differ. However, Medicare does pay new patient visits by a PA here in Louisiana--this may vary by state though. You really need to check with each payer to see who will credential PA's directly, and check your state's scope of practice for them.


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