Practice Management Alert

Question: A patient received services from a physician assistant (PA) at our practice. The patient's primary insurance credentials PAs, but his secondary insurance does not. How should I bill the services? Maine Subscriber Answer: Many secondary insurers, especially Medigaps, will pay for PA services even if they do not credential PAs. If they deny the claim, appeal it with a letter that explains the situation, including the supervising physician's information.

Most plans that do not credential PAs want the services billed under the supervising physician's number. Ask the carrier if that's the way they want PA services billed. Don't ask a general question like, "Do you pay for PA services?" If they don't credential PAs, then they're going to say "no." Instead, ask how to bill for them. If Medicare is the secondary payer, the charges must be assigned to the PA's employer. According to the Balanced Budget Act, PAs who treat Medicare patients must have a provider identification number (PIN). Remember, state law determines what services a PA can do and what type of physician supervision is required. Make sure your practice is providing PA services within those limits. You Be the Expert and Reader Questions were answered by consulting editor Catherine Brink, CMM, CPC, president of Healthcare Resource Management Inc., Spring Lake, N.J.; Robert Ramsey, JD, an attorney with Buchanan Ingersoll in Pittsburgh; Robert Mazer, JD, principal with Ober Kaler, Baltimore; and Karen Jehgers, PA-C, CPC, manager of Compliant Billing Services in Carver, Mass. The template letter was provided by Joey Hilario, a biller with the Jurani Clinic in Las Vegas. $ $ $