Wiki Billing and rendering provider

[NMURPHY8366]

Hello. I'm trying to find out if this legal or not. Patient is seen by PA but the insurance does not pay for PA or NPI is not registered with insurance company. Can you use the Provider as the billing and rendering Dr even though the PA rendered the care?

 

[mitchellde]

Only if the encounter meets the criteria as incident -to. Meaning the patient is established and the physician has previously examined the patient for the exact same diagnosis and wrote a plan of care in the chart to include this visit as a follow up, and the physician is physicially in the office at the time of the encounter. If the encounter does not meet these requirements then it you will need to use the PA NPI as the rendering and with either deny or be considered out of network. The problem then is did you inform the patient that the PA was a non credentialed provider with their payer? You may have a difficult time getting reimbursed for this encounter.

 

[NMURPHY8366]

Now, does the provider has to in the room with the PA or just in the office?

 

[dfranklin]

Only if the provider was in the suite while the PA rendered the services.

 

[mitchellde]

Now, does the provider has to in the room with the PA or just in the office?[/QUOT
The physician does not have to be in the room with the PA but he must be in the immediate vicinity of the office suite (not upstairs or downstairs or across at the hospital or in the OR). However some states have laws indicating the PA must be in the room with the PA so be sure to check in your state if the PA requires over the shoulder supervision.