Practice Management Alert

If your PA doesn't have a UPIN, chances are you forfeit billable services

Although carriers reimburse less for physician assistant (PA) services than for physician services, a PA still provides tremendous financial value to your practice. Whether your PA assists at surgery, provides pre- and postoperative care, or performs hospital services, make sure you recoup every penny you deserve by knowing exactly how your payers want you to bill for PAservices.

The following three tips can help you improve your PA billing:

1. Ask how the carrier wants you to bill for PAsurgical assisting. Medicare will reimburse for a PA surgical assistant, but other carriers may have different policies that confuse you, says Ron L. Nelson, PA-C, president of Health Services Associates in Freemont, Mich.

Many carriers want you to use modifier -AS (Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery), but others may want modifier -81 (Minimum assistant surgeon) or modifier -80 (Assistant surgeon).

Problem: Billers often call a carrier and ask the customer service representative whether the insurance company covers PA services, but that's the wrong way to collect the information you need, Nelson says. When asked in this way, many carrier reps will simply say "no."

Solution: Call the carrier and specifically ask, "How do you want us to bill for PA services involved with surgery?" You're guaranteed to get a more helpful answer.

2. Know which of your PA's hospital services are billable. You should check with your Medicare carrier to determine coverage for PAs who perform hospital procedures and services. For example, if a PA performs a consult on an inpatient, Medicare will reimburse the claim under the PA's ID number at 85 percent of the physician's fee.

Ask first: Coverage for PA hospital services varies among private payers, so be sure to check with all of your carriers about coverage before you bill. A good way to phrase the question is, "Which PA hospital services will you cover and under what circumstances?"

3. Obtain a Medicare PIN and UPIN for your PA. Without these ID numbers, you can report PA services only under incident-to rules, and this means you may forfeit payment on some PA services, Nelson says. Incident-to billing can be tricky, and your risk of not complying with the rules increases if you're trying to make all of your PA services fit incident-to billing criteria, he says. (For a review of incident-to rules, see "Physician or Nonphysician Practitioner ID Number: Do You Know How to Choose?" in our June 2004 issue.)

What are these ID numbers? For a provider to be able to bill Medicare, he needs a Medicare provider identification number (PIN). When you apply, Medicare will issue a PIN to your practice that identifies your particular PA. Then when you bill under that PIN, Medicare will pay you based on the provider information registered under that number.

In addition to the PIN, Medicare will also issue your PA a unique provider identification number (UPIN), which is a "nationally recognized number required by many insurance companies" for billing purposes, Nelson says.

What if your practice doesn't see Medicare patients? Your PA will still benefit by having his own UPIN to use on other carrier's claims. After you're assigned a UPIN, you can simply ask Medicare to deactivate your PA's PIN, Nelson says. Your PA's UPIN will remain valid and active. If you ever begin billing Medicare in the future, you can simply reactivate the PIN and start billing.