Desperate for answers...

rinny

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I will try to put this in simple terms.

I work for a company that does not credential their P.A. with any carrier. Because they are a Pediatric PA, no need to worry about Medicare. Here is my problem, the P.A. wants to bill Assit Surgeon on every procedure that they are in the O.R. with the surgeon.

I have been reading multiple websites and have found that some carriers may or may not cover this and if they do not, then a bill is sent to the patient.

When an authorization is requested from the carrier for the surgeon, should we also inform them of the Assit. Surgeon?

Because I am new at coding surgery charges in general, I am not comfortable saying anything regarding my hesitations on billing. I am not even sure how to bill.

So with this dilemma, I turn to AAPC for help.

Thank you in advance.
Rinny
 

kboyd22

Networker
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They should be getting the PA credentialed with the insurance carriers. Most carriers with the exception of the one's listed below require the PA or NP to be credentialed and then any services performed billed under the PA or NP.
OSMA, OK Health Network, Multiplan/PHCS, Humana, GEHA, Community Care, Cigna, Beechstreet, Aetna. The carriers I just listed allow services to be billed under the supervising physician, however I do not believe if that provider is the surgergeon that you could also bill assist services under the same physician.
 

rinny

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I really wish that they would credential the NPPs, however they just do not feel it is necessary. I just don't feel comfortable billing it, knowing that if it denies, they plan to bill the patient.

I do appreciate your reply and the information you have listed. I plan to keep an eye on how things are handled.

Thanks,
Rinny
 
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