Wiki Mid level providers

[KAROLEH]

I have been trying to find information on mid level providers billing for new simple problems such as colds, UTI's, bronchitis, etc. Our providers are thinking that the mid level providers cannot bill for these services since they are considered a new problem. Our mid level providers are credentialed thru Medicare and BCBS, but not any of the other insurances and we bill out under the mid level provider instead of incident to. The information that I have found on Medicare website does not state that the mid level provider can actually see a pt for the simple problems that are considered new. I think that they can, as you have the walk in clinics where the mid level's are seeing the pt's for the simple problems. Can someone give us some guidence on billing incident to.

 

[KMorris23]

This is a real pain. You have to rely on the information form the insurance company that you are billing. Most follow incident to rules, some as the one that I work for do not. The company that I work for does not credential PAs, but they do credential NPs and the like. So make sure that you are following the rule for that particular company. It is safe to follow the incident to rule. If the patient is new, then they must have first seen the supervising physician to establish care, but new problem does not consitute new patient so you are right. Those can be billed for mid-level providers.

I have been trying to find information on mid level providers billing for new simple problems such as colds, UTI's, bronchitis, etc. Our providers are thinking that the mid level providers cannot bill for these services since they are considered a new problem. Our mid level providers are credentialed thru Medicare and BCBS, but not any of the other insurances and we bill out under the mid level provider instead of incident to. The information that I have found on Medicare website does not state that the mid level provider can actually see a pt for the simple problems that are considered new. I think that they can, as you have the walk in clinics where the mid level's are seeing the pt's for the simple problems. Can someone give us some guidence on billing incident to.

 

[capricew]

My understanding is that PA-C's can see patients for a new problem but you cannot bill that visit under incident to. The only visits that can be billed incident to are those in which the supervising physician has established an "initial plan of care". If the patient has a new problem they either have to be seen by the supervising physician first before allowing the PA-C to see them or the PA-C sees them but does not bill incident to for that problem.

Hope this helps

 

[mitchellde]

correct, incident to means that this encounter is INCIDENT TO having been seen by <the provider>. If you have a payer that profess to not follow incident to rules , then you need this as a written policy that cleary states the payer recognises that by not following the incident to definition the patient may have not been previously attended to by the physician for this same issue and may not be in the office at the time of the encounter.