Wiki Billing for a physician's assistant

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tobieforte

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Hi,

My office is contemplating getting a PA. I have never billed for a PA so, I'm want to know the correct way of billing for a PA? Should I just bill the way I bill for my physician, and her NPI will inform the insurance companies that she is a PA? Should I attach a modifier with my charges to show that she's a PA? Or, is there another way that I'm not realizing?
I appreciate your help.
 
It depends on what you are billing for. I work for a surgeon's office and we have to bill the assistant surgeon charges different for our NP/PA than we do if one fo the other surgeon's performed the assist. On E&M charges you will bill the same as you would for any of your other providers, but you will just get reimbursed less.
 
Billing for PAs

Hi

You can bill for Physician assistant using their own NPI numbers. You do not need to attach a modifier to the claim. If you are billing under the doctor's NPI, the doctor would then need to co-sign the notes.

PAs get reimbursed 80% and physician at 100%.

Hopes this helps.
 
This really will vary by payer, and whether or not each individual payer you deal with will credential PA's. Most of ours do, and pay at the same contracted rate that they pay our physicians. You need to check with each one individually.

Medicare will allow PA's to see patients under their own NPI numbers; they reduce the payment to 85% of the usual allowed amount. DO NOT have your docs just co-sign the PA notes in order to put the doc's name on the claim to get 100% reimbursement; this would be considered an Incident-To situation, and the guidelines for Incident-To are much stricter than just having the MD sign the note. Search Incident-To on the CMS site, or on your MAC's site for specific info.

Hope this helps some.
 
There are many guidelines for billing with a PA. A new medicare patient must see an MD or DO first to establish care, and for follow up appts the pt can see the PA with the MD periodically assessing the pt. There is no set "time frame" for this to be done... Some payers do not recognize PA's like Blue care network MI and you would have to either not schedule BCN pt's with the PA at all or bill on the claim "incident to" and take a small hit. I have to bill incident to on the claim and take the hit. Just research ahead of time and have a good grasp of the guidelines so that your reimbursement does not get held up.
 
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