# Billing for physician assistants



## coder25 (Apr 22, 2009)

Hello,

For those of you who bill for PAs, I have a question.  Do any of you know whether a PA can be a scribe for a doctor during a consultation, until her billing numbers come in?  We were told by an auditor that we could do this, however, our PA came in today and said that she heard Medicare is not paying for these consults.  Any ideas?

Also for billing hospital work, if the PA did the work, this all goes under her numbers...is this correct and get reimbursed at 85%   This is what I thought I read under Medicare regulations and PA Medical Society Laws....just wanted to be sure, since we never had a PA working for us before.

Thanks for your help!


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## Chicoine (Apr 22, 2009)

*Non-physicians as scribes*

If the physician is having a PA (or other non-physician practitioner) write in the medical record for them, with the physician merely writing the note, they need to understand the potential compliance issues. 

One of Medicare's contractors, CIGNA recently published an article on their website on this topic and indicated that:

If a mid-level provider, i.e., PA acts as a scribe for the physician, the PA writing the note (or history or discharge summary, or any entry in the record) should note "written by xxxx, acting as scribe for Dr. yyy." 

The physician should co-sign, indicating that the note accurately reflects work and decisions made by him/her (physician). 

In doing so, CIGNA made clear that the scribe is functioning as a real time recorder of the physicians words and actions and cannot be exercising any independent clinical judgment while scribing.  

CIGNA also made clear that Medicare only pays for medically necessary services and expects the physician receiving payment to be the one delivering the services and creating the record.  Specifically, there is no billing for scribe services. 

In summary, "the scribe should be merely that, a person who writes what the physician dictates and does. This individual should not act independently, and there is no payment for this activity" and that "the physician is ultimately accountable for the documentation, and should sign and note after the scribe's entry the affirmation above, that the note accurately reflects work done by the physician."

Hope this helps!


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## coder25 (Apr 22, 2009)

Yes, this helps.  Thanks for the info


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## RebeccaWoodward* (Apr 22, 2009)

I just gotta say...I really don't like NPP being used as scribes.  IMHO, this is not utilizing their skills productively.  I see it as a "walking dictaphone".

Your question:

"Also for billing hospital work, if the PA did the work, this all goes under her numbers...is this correct and get reimbursed at 85% This is what I thought I read under Medicare regulations and PA Medical Society Laws....just wanted to be sure, since we never had a PA working for us before."

If the PA "did the work", you would bill under their name and NPI # since "incident to" does not apply to facility billing.  The reimbusement would be 85% of Medicare's allowable.


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## coder25 (Apr 22, 2009)

Thanks Rebecca for your answer.  Please see PM which I just sent.  Thanks.


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## poyersaug (Apr 30, 2009)

when the physician countersigns, do they have to put a date and time on this.  Is it required?


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