Wiki Incident to for a PA

[lharding512]

We recently hired a new PA, and our doctor is now on vacation for 2 weeks.
I explained to our staff that the PA cannot see patient's in the office while the doctor is out.
Someone said that since she does have documentation for "alternative supervising physician" for 2 local physicians (within a 60 mile radius) that she can see those patient's without a physician in the office suite.
I am not familiar with the alternative supervising physician requirements.
Any help would be appreciated.

 

[rlh27]

If the physician is off-site (i.e., outside the office suite and not able to provide direct supervision), the PA would need to bill under his/her own NPI, when possible. If the payer doesn?t credential NPPs, the claim would be billed under the physician?s NPI/PIN even if incident-to requirements have not been met.

However, if at least one of the physicians that is a part the alternative supervision agreement is in the office with the PA, you can bill incident to.

http://wpsmedicare.com/j5macpartb/resources/provider_types/2009_0803_incident.shtml

this is a good faq for incident to billing.

 

[mitchellde]

If the payer does not credential the PA then you cannot bill under the physician NPI if they are not onsite and/or have never exams the patient for the same diagnosis. Incident to requirements must be met to use the physician NPI and that physician must be present in the office suite.

 

[lharding512]

I was thinking the same thing about incident to requirements. But, does anyone know the point of the alternative supervising physician??? I don't know the purpose of that form.

 

[mhstrauss]

I was thinking the same thing about incident to requirements. But, does anyone know the point of the alternative supervising physician??? I don't know the purpose of that form.

My understanding is that PA's can see patients on their own, but the supervision requirements state that the PA's supervising physician must be available by phone for assistance. So when Doc A is on vacation, I'm sure he doesn't want to be bothered with work phone calls...which leaves the alternative doc to "supervise" the PA so he can continue to see patients for those couple weeks. Of course, this may vary by state. And this is for clinical supervision, not incident to requirements, I just wanted to clarify that. Still must meet payer guidelines for billing under the PA's NPI.

HTH!

 

[cheermom68]

PA

The PA scope of practice for your state needs to be checked. For example, in Indiana, PA's are required to have physician sign off on a percentage of notes ranging from 50-100% depending on the length of time they have been employed by the practice. Also, the supervising/signing physician must be within one county of where the PA is practicing, that county can cross state lines but must be adjacent/touching the county of practice.
Each state is different.

LeeAnn