Wiki credentialing question

[heart123]

Can a PA bill under the DR ???

 

[csperoni]

There are circumstances this is permitted.
For office visits, incident-to must be met. Here are some of the requirements:
1) Cannot be new patient or a new problem
2) Physician must be onsite and immediately available
3) Must be an established problem with a plan of care that the PA/NP is following
4) PA/NP must be employed by physician, or the same group that employs physician
Please note incident-to is Medicare guidance. Not all insurance payors follow the incident-to. Some payors that do accept incident-to want the claims billed with -SA modifier.

For hospital inpatient care, there are split/shared visit requirements, and include that the physician must also personally see the patient on the same day.

https://www.aapa.org/news-central/2019/12/top-5-reimbursement-questions-youve-always-wanted-to-ask/

https://www.3mhisinsideangle.com/blog-post/em-coding-incident-to-vs-shared-visit-guidelines/

https://med.noridianmedicare.com/web/jeb/topics/incident-to-services

https://www.aapc.com/blog/44912-seven-incident-to-billing-requirements/

https://www.aapc.com/blog/40821-satisfy-incident-to-and-physician-extender-requirements/

https://www.aafp.org/fpm/2015/0300/p15.html