Wiki How to bill for a Physician Assistant

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kalexj

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I need help...I work for one physician (Owner) and a Physician Assistant. While credentialing my PA with Medicare I found out that I had to re-register/credential my physician also, which ment my single practice has now become a "group practice". I was told by MCR that I had to get an NPI number for my "group". Now our practice has 3 NPI #'s; one for the MD, PA, and the group which is attached to the MD.

I have 4 scenerios and I want your help in how would YOU bill...

1. Both MD and PA are seeing patients on this day. The patient has BCBS, Aetna, UHC, Commercial ins. etc. Whose NPI # do I use... the MD or PA's? (I talked to BCBS and they stated while you have to credential the PA, they essentially don't want to see the PA's NPI# on the claim).

2. Both MD and PA are seeing patients on this day. The patient has MCR. Whose NPI# do I use...the MD's or PA?

3. The PA is the only person working on this day. The patient has BCBS, Aetna, UHC, commercial ins., etc. Whose NPI # do I use...the MD or PA's?

4. The PA is the only person working on this day. The patient has MCR primary and BCBS secondary. Whose NPI # do I use...the MD or PA's?

I have made several calls to MCR and BCBS. I do not want to make any "issues" with MCR, because I do not want our very small practice to be audited. Needless to say I am pretty new to this practice and the person previous me, made many major mistakes that I had to clean up. It took me 5 months to do this. I feel like I am being placed between a rock and a hard place, but I want to see this office grow financially and not illegally.
 
Yes - with the addition of the PA - you will have to fill out the 855B (group app), an 855I for the PA, and 855R's to reassign benefits to the group for both the MD and the PA. You will also have send in the participating agreement.

Furthermore, you will need to login to NPPES and link the Medicare PTAN's for both the individual NPI's of the MD and the PA, as well as the group PTAN to the group NPI. If this is not set up correctly, this will affect your payments.

We have over 250 physician clients and because some of our physicians were credentialed many, many years ago... there have been SO MANY discrepancies with the "crosswalking" and "linking" of the NPI's. Everything has to match and link perfectly. You literally have to jump through hoops if someone along the way made an error - It is such a nightmare sometimes.

1. Both MD and PA are seeing patients on this day. The patient has BCBS, Aetna, UHC, Commercial ins. etc. Whose NPI # do I use... the MD or PA's? (I talked to BCBS and they stated while you have to credential the PA, they essentially don't want to see the PA's NPI# on the claim).

PA's can only be credentialed/participating w/ Medicare and Medicaid. All insurances in between are billed w/ the servicing provider as the PA (we use this for productivity - not sure if you can/can't do this) and billing provider the MD. So you would use the MD's NPI.

2. Both MD and PA are seeing patients on this day. The patient has MCR. Whose NPI# do I use...the MD's or PA?

For Medicare patients, the PA can see them before the PA becomes credentialed and you can retroactively bill. If you want to bill under the MD, you will have to follow incident to guidelines. Brief summary for incident to:

-They must be an integral, although incidental, part of the physician’s professional service.

- They must be commonly rendered without charge or included in the physician’s bills.

- They must be of a type that is commonly furnished in physician’s offices or clinics.

- They must be furnished by the physician or by auxiliary personnel under the physician’s direct supervision.



3. The PA is the only person working on this day. The patient has BCBS, Aetna, UHC, commercial ins., etc. Whose NPI # do I use...the MD or PA's?

If the PA is the only person working - for privates (and again, check with them) but here, they have to be under the supervision of the physician - which may mean the physician must be present or they can be a phone call away, readily available, and within a certain distance from the practice in event of emergency.


4. The PA is the only person working on this day. The patient has MCR primary and BCBS secondary. Whose NPI # do I use...the MD or PA's?

If the PA sees a Medicare patient and the physician is not physically present, you cannot bill incident to for Medicare. If the PA is seperately enrolled in Medicare (does have their own #) here are some points:

-They are the types of services that are considered physician services if furnished by a doctor of medicine or osteopathy.

-The services are performed by a person who meets the qualifications for receiving a physician assistant Medicare billing number.

-The services are performed under the general supervision of a physician.

-The services are not otherwise precluded from coverage because of a statutory exclusion.

"General supervision" per CMS - means the supervising physician doesn't need to be present - unless the service requires supervision under state law.



Hopefully this helps...
 
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