Wiki Actual Provider 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!

 

[Bready]

Actual Provider vs Billing Provider

Check the "incident to" guidelines on Medicare website. I believe Medicare requires PA to bill under their own NPI. For commercial insurance carriers, it might be good to check with them--some may want you to bill under the PA's NPI as the reimbursement is lower but others may prefer that you bill under the physician's NPI. Just ask them what they require for PA billing. Better to hear it from the horse's mouth. Good luck.