Wiki Physician Assistant as an assistant surgeon

Create Wiki
B

bethb

Guru
Messages
121
Location
Beaver Falls, PA
Best answers
0
Anyone out there have information regarding billing for our physician assistant who is an assistant surgeon to the M.D. for UPMC Health Plan insurances? Here is my dilemma:

UPMC Health Plan is not forthcoming with their rules and guidelines for billing such services. I have contacted customer service and the provider relations representative. Both tell me they cannot "tell me how to bill", which is funny to me, because I did not ask how to bill. Their guidelines are not within their provider manual. The last documented information I can find on the topic is from 2009. I do know this insurance does not credential PA-Cs, so we cannot bill the PA-C charges as a servicing and billing provider. We probably can bill the PA-C under the supervision of the M.D., however, unlike most of carriers in our area (including Medicare) I cannot find UPMC's rules. One of our major carriers wants an -80 and -AS modifiers on the physician's assistant charges, which is strange since an -80 is typically considered an M.D. / D.O. assisting, but at least I was able to find those guidelines to show our practice manager.

I have a huge back log of charges and cannot seem to get any at UPMC to help me with this. Could anyone out there share any advice? Maybe I am not looking in the right place(s) for guidelines...


THANKS!
 
I don't have experience in billing UPMC so I apologize that my reply isn't an exact answer to your question. My opinion is that you should bill them with the "AS" modifier & get them filed. You don't want to run into timely filing issues. I would then somehow track those claims for that payer to later verify how they are processed. I think sometimes payer preferences are only discovered by trial & error. :)

I bill various commercial & government plans for the PA assistant surgeon & only use the AS modifier. Some plans allow us to bill under the PA, some require to be reported under the physician.
The main problem I run into is that certain payers who deny the "AS" claim against the physician's claim as duplicate or exceeded allowed per patient/date of service. Depending on the payer, a simple reconsideration request or appeal is all it will take to have it reprocessed.

Good luck!
 
Any update on this?

Any update on UPMC guidelines? Our office has the same issue. They don't want the AS and 80 but will not give us any info on what they do want.

Thanks!
 
You must log in or register to reply here.
Top