Wiki Incident-To Billing for new PA


Palmer, AK
Best answers

We have a new physician assistant that joined our group. We are waiting on her credentialing to be finished up with several payers. If the supervising physician is on-site and incident-to requirements are met, and the supervising physician is in network and credentialed with a payer, then can we bill incident-to for the noncredentialed physician assistant? And still get reimbursed under the contract/credentialing of the in-network physician?

PA is not credentialed with BCBS. Physician has an in-network contract with BCBS. PA sees the BCBS patient in follow-up. We bill BCBS. Will BCBS reimburse as in-network or out-of-network?

For incident-to billing, does the physician sign the visit note or does the PA sign the visit note?

Thank you
The PA does not need to be credentialed in order to bill ‘incident to’ because only the physician’s credentials are going onto the claim form. The payer will not even know that the services were performed by the PA (unless they audit the records) and it will pay just as if it was the physician’s own claim.

However, you should review the policies of each payer to which you would be submitting claims to confirm that they will allow this. Not all commercial plans will necessarily follow Medicare’s guidelines for ‘incident to’ billing.

The PA will always sign their own note, but you’ll need to check your state’s PA licensing board’s supervision requirements for more information about whether and when the physician needs to also review and/or sign the PA’s notes.