Wiki Need advice for billing for PA

[Orthocoderpgu]

We have a PA starting in our office soon. I need to brush-up on guidelines for this. Can anyone direct me to a good resource for that? I think we have to bill under a physician and not the PA? Does the doc have to be in the clinic while the PA sees the patients?

 

[banderson77]

In regards to the PA, my office bills folllow up visits with the PA. Fortunately, the PA is only here when the doctor is. There should be a supervising physician on all office charges. If there is a surgery, it is different billing procedures for surgeries and billing a PA. Hope this helps.

 

[RebeccaWoodward*]

http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf

Section 190

1) New patient/New problem/Consults, Alone in clinic: The PA submits claim under his name/NPI provided the PA is within the scope of your states licensure/training

2) Incident to: The physician needs to be in the suite (accessible) and file under supervising MD

Other information...specifically consults...

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

Section 30.6.10

Specifically, a consultation service is distinguished from other evaluation and management (E/M) visits because it is provided by a physician or qualified nonphysician practitioner (NPP) whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source. The qualified NPP may perform consultation services within the scope of practice and licensure requirements for NPPs in the State in which he/she practices.

 

[LLovett]

In additon to the CMS info you really need to get your states guidelines for the PA scope of practice. They vary state to state and sometimes change from time to time within each state. CMS states their coverage of PA services is based on what they are allowed to do by their state.

Also check with your payers. Some credential PAs and some don't. The trend we are seeing in Michigan is the payers that didn't used to credential midlevel providers are now starting to. Which makes sense if they want to follow CMS lead and pay them less than the doctors. The credentialing process is slow and full of hurdles so start on that yesterday!

Good luck

Laura, CPC, CEMC