Incident to

What is the correct way to bill for a Physician Assistant on incident to. We have looked at the Medicare web site on the National Coverage Provision, and still do not understand what is the correct way to bill.

Thanks for your help1

Incident to

How to bill it is easy: bill it under the MD's provider number.

The harder question is: Does the service meet the criteria of incident to services, or must you bill it under the PA's own provider number? (Incident to, under MD=100% of Medicare Fee Schedule, direct, under PA=85% of Medicare fee schedule.)

Incident to is a Medicare rule. Many Medicaid programs follow it. It is not a commercial rule.

http://www.codapedia.com/~article_318_.cfm

http://www.codapedia.com/~article_222_.cfm

http://www.codapedia.com/~article_356_.cfm

incident to

Question~can you bill a PA under their own number to Medicare and then bill under the MD number for all other insurances?

And if you can what are the rules for the MD not being in the office suite, can they still see patients as long as the MD is readily available? And what defines available?

Thank you sooo much in advance!

Incident to

A PA in the office setting cannot apply Incident To - to a new patient, they must bill under their own number and take the reduction (Medicare). If the physician has provided the initial service for the specified diagnosis, subsequent encounters for the condition can be seen by the PA and billed under the physician (100% of allowed amount).
There is no "Incident To" in a hospital setting.
There is a different policy for "shared services" in a hospital site of service.
Nancy

PA's

Nancy,

We have PA's in the office setting and we DO NOT bill incident to - Can the PA see new patients, do the notes need to be signed, does the supervising Doc need to be immediately available and what is that defined as...how do the practice guidelines "scope of practice" play into that part when credentialing. I have researched the State Med Board and am not coming up with a clear answer and could really use one by tomorrow for a meeting clarification. Thank you for your expertise.

PAs

Yes, as long as visits with new patients are allowed by state law, a PA may see a new Medicare patient. This visit should be billed using the PA’s Medicare number for reimbursement at 85 percent of the physician fee schedule.
The "Supervision" guidelines are defined by State Laws and the NPPs Scope of Practice in that state.
Medicare: Physician Supervision.--The PA's physician supervisor (or a physician designated by the supervising physician or employer as provided under State law or regulations) is primarily responsible for the overall direction and management of the PA's professional activities and for assuring that the services provided are medically appropriate for the patient. The physician supervisor (or physician designee) need not be physically present with the PA when a service is being furnished to a patient and may be contacted by telephone if necessary, unless State law or regulations require otherwise.

PA's

Thanks Nancy, In an audit the notes still need to be signed by the supervising though regardless of the billing correct? Should that method also be described in the outlined delineation of scope of practice as well?

Pa

States generally do not require full-time, physical supervision of the PA, but rather that the supervising physician and PA register with the state before the PA can practice under the physician’s supervision. Relevant state law should be consulted. No supervision beyond that required by the state license is required to bill the Medicare program in this manner, under General supervision. Physicians must consider the potential liability aspects from being responsible for the actions of another health care professional who they may supervise only on a "general" level. Documentation will follow State law and there could be required countersignature by Physician but the agreement per State law will dictate the requirements.