Wiki Medicare ?'s

[hmgriffith]

We are in the process of adding a PA to our practice. We have always been a single provider practice so I seem to be swimming in questions!! So I am gonna list a few and any help would be greatly appreciated!!

1. New PA is coming to our practice from another practice that also has a VA clinic. She will have some patients that are following her to our practice. It is my understanding that if she has seen these pts in the last 3 yrs that they will be considered established patients. That new pts vs estab pts is provider specific not facility specific. Do I understand this correctly?

2. PA seems to think that as long as MD is in the building that she can just poke her head in the door and meet patient and this satisfies incident to billing. From my understanding incident to would only work for an established patient of MD's that has a chronic problem that MD had developed plan of care for. And incident to would only apply if PA was following that plan of care and just doing a follow up not addressing any new issues or making changes to care plan. Do I understand this correctly?

I would also love any feedback from someone that works in a smaller practice that has Docs and mid levels to have as an reference point for all of the gazillions of issues that are sure to come up! Lol! My email is hollie_griffith@hotmail.com

Thanks in advance for all your help!

 

[cspotter29]

Cpc

You are correct! If the patient has seen the PA within the last 3 years they are considered an est. patient. The rule follows the provider not the practice that they are working in.

Also, Medicare has very strict rules when it comes to "incident to" billing. And I might say it is very difficult to meet those guidelines. Medicare credentials it's PA's so it is very important to bill under the PA number as appropriate. You may want to review the information on CMS.gov. Hope this helps!