Wiki Billing Physician Assistant in Family Practice

[clikens]

Our office recently added a physician assistant and we tried to credential him with Humana. Humana currently does not credential PAs but we have sent letters to the Humana adding the PA to our office and showing that our physician who is almost always in the office supervises the PA. I filed the claims with the PA as the rendering physician in block 24j, but I am now dealing with a few claims that have been allowed, but the allowed amount applied to the deductible. The physician's name appears in block 31. Can anyone who bills for a PA in an office setting please tell me whose information should be in blocks 24j, 31, and 33? UHCs customer service department is overseas and isn't very helpful.

Thank you,

 

[sdwasinger]

The office I am with bills out Practice EIN and Supervising Dr's NPI in 24j, Supervising Dr's name in 31, Practice's info in 33. Our EMR autoloads this info. On the progress note it has the PA's name. Because the contract is with the practice and the doctor, we can't bill out under the PAs info without the claim being processed as out-of-network. None of our commercial insurers have had a problem with the way we do it, but I am curious to hear if anyone is doing it differently.

 

[mitchellde]

If you are going to bill under the physician when a PA performs the service and you have not met the incident to requirements, you should check with the payer and inquire as to whether they allow you to set aside the Medicare definition of incident to when billing for PA. Incident to is a Medicare definition however most commercial payers have adopted the Medicare policy as their own since Medicare is consider the "Gold Standard". The definition says that this is a followup visit where the physician has a plan of care that includes this visit as a followup and is present in the office while the patient is being seen. CR 144 issued April of 2004 explains exactly how to complete the 1500 for billing. The physician that saw the patient for the same problem is to be in box 17 and 17b the supervising physician is to be in 24J and line 31.