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We recently hired a PA to work in the office/hospital, mainly office work. My question is this, for the insurances that do not credential PAs and she sees one of those patients, am I correct in saying that these are non-billable services, or can they be incident to? (Her supervising doctor is present in the office).

What about in the hospital when she and the doc sees the patient on the same day, can I count this as a shared visit?

I have searched the Medicare (CMS) website as well as the American Academy of Physician Assistants with no luck in finding these answers.

Thanks for your help!
 
There is much written on this.. for shared encounter go to CR1776 which was written on 02, it states that you may bill under the physicians numebr if the physician and NPP shared the patient as long as the physician sees the same patient on the same day and writes his own note, recently on the AMA website they gave examples of acceptable documentation, the physician signing the PAs note is not acceptable he must write something to the effect of I have seen and examined the patient and agree with......
As far as if they are not credentialed then you are correct, you cannot bill as incident to unless it meets the definition, that is it must be a follow up encounter and the physician must be on site. another CMS transmittital on this is CR148 which was put out in April of 04. I hope this helps, Good Luck!
 
We have a physicians assistant and bill the office visits incident to--like you said, when the supervising physician is present in the office. Our PA has a Medicare provider number that we bill if the physician is not present in the office, i.e. she will work on a Saturday with the physician being available by phone, not present in the office.

Our physicians do not see patients in the hospital, so I cannot help with that part of your question.

I hope this information is of help to you.

Teresa Collins, CPC
 
Office/Clinic Setting

In the office/clinic setting when the physician performs the E/M service the service must be reported using the physician’s UPIN/PIN. When an E/M service is a shared/split encounter between a physician and a non-physician practitioner (NP, PA, CNS or CNM), the service is considered to have been performed “incident to” if the requirements for “incident to” are met and the patient is an established patient. If “incident to” requirements are not met for the shared/split E/M service, the service must be billed under the NPP’s UPIN/PIN, and payment will be made at the appropriate physician fee schedule payment.

Hospital Inpatient/Outpatient/Emergency Department Setting

When a hospital inpatient/hospital outpatient or emergency department E/M is shared between a physician and an NPP from the same group practice and the physician provides any face-to-face portion of the E/M encounter with the patient, the service may be billed under either the physician's or the NPP's UPIN/PIN number. However, if there was no face-to-face encounter between the patient and the physician (e.g., even if the physician participated in the service by only reviewing the patient’s medical record) then the service may only be billed under the NPP's UPIN/PIN. Payment will be made at the appropriate physician fee schedule rate based on the UPIN/PIN entered on the claim.

http://www.cms.hhs.gov/transmittals/downloads/R178CP.pdf

For non-Medicare patient's it will depend on the scope of practice within your state for your NPP's. I would check with your individual carriers for their billing requirements for NPP's.

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

If you begin reading at 30.6 you may find the answers to some of your other questions.
 
Commercial Insurance

For the commercial insurance carriers that do not separately credential the PAs or NPs ... when the PA or NP independently sees a patient we bill their services out under the physician's name.

For Medicare / Medicaid, PAs and NPs are billed out under their own name/NPI UNLESS the services is incident-to.

F Tessa Bartels, CPC, CEMC
 
Even though we have some carriers that do not necessarily credential our PA's, we still bill those services under the PA's name/NPI and still get paid for them (unless its a code they state the surgical assists not allowed). It makes it much easier than trying to follow the "incident to" guidelines.
 
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