Wiki Incident to....new PA to our clinic...please help

[nneecole44]

Ok. I have researched this extensively and I just can't come to a clear answer. Please help.

I work at a clinic with 4 docs and 2 PA's. We just hired a new PA and she is bringing 200 of her established patients with her.

1. All of the new PA's patients would be billed as established?
2. Does all of the new PA's Medicare patients have to be seen by a doctor in our new clinic first to bill incident to? And do I bill them new or established to the doctor? (Same specialties.)

I am so confused.

 

[anabuchele@icloud.com]

CMS guidelines state that if the patient has been seen by the NP/PA in the last 3 years using her/his NPI #, it's considered an established patient. They're not allowed to bill a new patient visit if Medicare has paid under their NPI for any visits with those patients before.

I'm not sure about the incident-to guidelines for the supervising physician to be able to bill for those, I think they have to see the patient at least once under their care before the PA/NP can start billing for office visits under their NPI #. At least that's how our providers work at our clinics.