Question Incident to requirements

wynonna

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For an Ear, Nose and Throat practice, is it permissible by CMS and other insurance companies to have a Physician's Assistant see and treat a new patient in the office and to have the Physician's assistant be billed as rendering provider? (with and MD as supervisor)
 

cpc2007

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If the physician's assistant is seeing a new patient, the visit would have to be billed under the name and NPI of the Physician's Assistant for Medicare and those payers following Medicare guidelines. Here is a link from one of the Medicare Administrative Contractors (Novitas) that may be helpful: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00004947.

Novitas is stating that it would be considered a claim error to bill a new patient visit performed by a non-physician provider (such as a PA) under the physician as an incident to service. They clarify that the initial visit must be performed by the physician to establish the physician-patient relationship and create a treatment plan (once the treatment plan is in place, you may be able to bill incident to services for the PA on future visits if the rest of the incident to criteria is met). This article gives a really good outline of that criteria as well. But new patient visits cannot be billed as incident to.

I hope that helps.

Kim
www.codingmastery.com
 

Orthocoderpgu

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The function of a PA is to take the lighter work off of the MD and put it on the PA. The PA needs to follow the treatment plan as set forth by the MD. So the MD will initially diagnose and treat a patient first, then the PA will follow that treatment plan on follow up visits. Keeping that in mind, you can see why the PA cannot see new patients, unless you bill under the PA's NPI.
 
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CatchTheWind

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To clarify what I believe Orthocoderpgu is saying, it is perfectly fine for a PA to see a new patient and bill with the PA as the rendering/billing provider. It is only when billing "incident to" (with the doctor as the provider) that the PA needs to be following the doctor's plan.
 
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