Wiki Physician Assistan vs Billing Provider

[YesicaRuedas]

Hi All,

We are trying to bill services for a Physician Assistant and the Billing Provider. Each individual has an NPI number. If the Physician assistant is the actual provider performing the services but the Dr.B is the Billing provider do we need to have both NPI's on the claim. What would be the appropriate way of billing. Do we have any obligation to add Physician Assistant in the claim form?

Please let me know if there's any guidelines we need to follow.

Thanks!

 

[Stefanie]

There are a few different issues here. 1. Are you following the "Incident-To" rules when billing Dr. B on your claims. These are strict guidelines. 2. If you aren't following the "Incident-To" rules, you can't put Dr. B on your claim to Medicare, you will have to submit the PA's name and accept the 85% reimbursement. If you aren't familiar with the "Incident-To" rules, go to your MACs website, they should have this information available. Below is the latest from MLN Matters on the subject. Hope this helps.

http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/se0441.pdf