Billing services performed by a medical assistant

Does the provider have to be on site in order for service to be billed out under their name? Flu shots for example are often done on a day the provider is out of the office, but his medical assistant has filled the day doing just a flu shot clinic.

re: Billing services performed by a medical assistant

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1026.pdf

re: Billing services performed by a medical assistant

That link isn't really helpful. I need to know if the medical assistants in my clinic can perform services billed out under a providers name when that provider is not here physically. The flu shot item was meant to be an example. They also give other injections, such as testosterone or B12. Anything along those lines. There is always a doctor in the building, but often times they are submitting the charges under a doctors name that is not in the building/on vacation, whatever.

Say Dr A is on summer vacation in Europe and while he is gone his long standing patient comes in for their normal B12 injection. This is Dr A's patient, but Dr A is out of the country.

Dr. B is in the clinic seeing his own patients.

The bill for the B12 injection gets submitted under Dr. A's name because it is his patient and his medical assistant that performed the injection.

Is it ok for that bill to be under Dr A's name, or should it be under Dr B's name because Dr B is on site?

re: Billing services performed by a medical assistant

my own understanding is that the services can be billed out ONLY under whomever is the prescriber ON-SITE, even if that is not the primary provider for that Pt/Clt. So in your example, the service would need to cite DrB as the provider on-site. I believe it is more to do with potential supervision than which provider is the PCP. It doesn't change that the Clt/Pt is still using DrA for PCP, just that the provider on-site (and who therefore validates the billing for that day and site) is DrB, and so must be listed that way. On our medical notes, we list both so there is less confusion in-house with what needs to occur for billing purposes.

I guess we'll also see what the list moderator adds to this?

re: Billing services performed by a medical assistant

Bill under physician on site.
Injections
? When billing for a diagnostic or therapeutic injection, the requirements for incident to must be met.
? POC must show the correct drug, correct dosage, correct route and correct frequency.
? Same incident to rules apply when billing for chemotherapy.
? Medical record documentation for the specific date of service must show: Dosage given, Time involved, Name and signature of the person giving the drug.
? POC documentation showing the correct drug, correct dose, correct route and correct frequency as ordered
? Injections as part of a diagnostic test can be submitted as incident to when all requirements are met.
? Document supervising practitioner’s physical presence in the office setting.
http://wpsmedicare.com/j8macpartb/training/on_demand/_files/2013-0723-incident-to-services-handout.pdf

re: Billing services performed by a medical assistant

That was my feeling too, but I can't find anything in writing to support this and my doctors will want something showing them this is a fact. It effects their bottom line, so I need to be sure.

re: Billing services performed by a medical assistant

per the newsletter "MLN Matters", #SE0441 (update of 9 April 2013)
pg#1of3: regarding "incident to" services, . . . "you do not have to be physically present in the Pt's Txroom while these services are provided, but you must provide direct supervision, that is you must be present in the office suite to render assistance, if necessary."
pg#2of3: "in your office ... you do not have to be physically present in the treatment room while the service is being provided, but you must be present in the immediate office suite to render assistance if needed. If you are a solo practitioner, you must directly supervise the care. If you are in a group, any physician member of the group may be present in the office to supervise."

re: Billing services performed by a medical assistant

Thank you so much. I spent so long looking and just hit a brick wall and had to ask for help. I really appreciate all of the answers and documentation to help me. Yay!