I am pretty well versed on PA billing when they are employed by the physician. I am getting confused on what to do when they are employed by the hospital.
http://www.cms.hhs.gov/manuals/Downloads/clm104c12.pdf
pg 158 and 159
Effective on January 1, 1998 and after, restrictions were removed on the type of areas and settings in which the professional services of NPs, CNSs, and PAs are paid under Medicare. Additionally, payment for the professional services of NPs, CNSs and PAs is unbundled when furnished to both hospital inpatients and outpatients. (However, hospitals are required to bill their fiscal intermediary for the facility fee associated with the provision of these nonphysician practitioner's professional services in the hospital setting.)
Ok This I understand that the PA has to be built into the facility fee, they go on however and state
The employer or contractor of a PA must bill the Part B carrier for the professional services of PA's furnished to hospital patients and payment is always made to the PA's employer or contractor at 85% of the physician fee schedule. Since PAs cannot bill the program directly for their professional services, they do not have the option to reassign payment for their professional services to their employer or contractor. However, in the case where a hospital is the PA's employer or contractor, the hospital must bill the program for the PA's professional services furnished to its patients. Payment for PA services is made only on an assignment-related basis.
Is this saying there should be 2 bills for PAs employed by a hospital, the fac fee and the pro fee? Or is it stating if they work for a hospital they can only be included in the fac fee?
We are trying to figure out how to structure to allow for a group of PAs to be employed by the hospital and bill for their services. The physicians they will work with that will oversee them are not employed by the hospital so we can't link the PAs to them and bill out the pro fee like we normally do with our physician employed PAs.
Also, since we don't have a group to link them to can they be linked to the medical director over their area for billing? I don't think this sounds right but I don't normally work on hospital based issues like this so I'm hoping for some help.
Thanks
Laura, CPC, CPMA, CEMC
http://www.cms.hhs.gov/manuals/Downloads/clm104c12.pdf
pg 158 and 159
Effective on January 1, 1998 and after, restrictions were removed on the type of areas and settings in which the professional services of NPs, CNSs, and PAs are paid under Medicare. Additionally, payment for the professional services of NPs, CNSs and PAs is unbundled when furnished to both hospital inpatients and outpatients. (However, hospitals are required to bill their fiscal intermediary for the facility fee associated with the provision of these nonphysician practitioner's professional services in the hospital setting.)
Ok This I understand that the PA has to be built into the facility fee, they go on however and state
The employer or contractor of a PA must bill the Part B carrier for the professional services of PA's furnished to hospital patients and payment is always made to the PA's employer or contractor at 85% of the physician fee schedule. Since PAs cannot bill the program directly for their professional services, they do not have the option to reassign payment for their professional services to their employer or contractor. However, in the case where a hospital is the PA's employer or contractor, the hospital must bill the program for the PA's professional services furnished to its patients. Payment for PA services is made only on an assignment-related basis.
Is this saying there should be 2 bills for PAs employed by a hospital, the fac fee and the pro fee? Or is it stating if they work for a hospital they can only be included in the fac fee?
We are trying to figure out how to structure to allow for a group of PAs to be employed by the hospital and bill for their services. The physicians they will work with that will oversee them are not employed by the hospital so we can't link the PAs to them and bill out the pro fee like we normally do with our physician employed PAs.
Also, since we don't have a group to link them to can they be linked to the medical director over their area for billing? I don't think this sounds right but I don't normally work on hospital based issues like this so I'm hoping for some help.
Thanks
Laura, CPC, CPMA, CEMC