Wiki Mid Level Billing

[gcohen]

In PA, NP's or PA's cannot see new patients. I would like to know if they have been seen in another practice with the same tax and we do not bill as a New Patient, can they still be seen by the mid level provider.

Thanks

 

[vnorman]

First were they seen at another practice or a different location for the same practice? If you are billing under the same TIN, it would be the same practice. How long ago was the patient seen? If the patient was being seen at a different location and they are moving to a different location and provider you can not bill a 'New Patient' unless it is 3 years or more as the patient was previously being treated by the same practice (same tax ID).

 

[csperoni]

I must first question your statement that NPs & PAs cannot see new patients in Pennsylvania. Over the years, I have many times come across the misunderstanding of incident to billing not applying to new patients interpreted as though NPs and PAs may not see new patients. I am not familiar with PA scope of practice laws, but could not find anything online prohibiting either PAs or NPs from treating new patients in Pennsylvania. Incident to is simply regarding how the claim is billed, not whether or not it is within the scope of practice or legal for these midlevels to provide the service. Incident to billing not applying to new patients requires the bill to be submitted with the PA/NP name, and not the name of the supervising physician.
If PA law truly stipulates that midlevels may not treat a new patient, then I interpret your question as to whether or not this is a new patient. The other practice with the same TID must be the same specialty. Same TID but different specialty is a new patient. And of course, as mentioned above, new patient is more than 3 years.