Wiki Mid level Service Providers (PA)

[nishaganesh]

Our Physician Assistant (PA) has submitted claims both with and without a supervising provider listed, but all claims have been denied. She is contracted with Medicare. Could you clarify Medicare’s requirements for billing under a mid-level provider? Additionally, does Medicare reimburse only 85% of the contracted fee for services provided by a PA, even when a supervising provider is specified on the claim? We want to ensure compliance with Medicare billing guidelines for mid-level providers.

 

[csperoni]

If ALL claims have been denied, I would imagine there is an issue with the way you are submitting, or with her provider enrollment. Once you figure out why they are denied, you can delve further.
Yes, ACPs receive 85% reimbursement from Medicare for professional services.
The supervising provider is to help determine what specialty the ACP is working in to help determine if a patient meets new/established patient criteria.
Not sure who your MAC is, but this helps explain the supervising physician https://med.noridianmedicare.com/we...ysician-practitioner-in-multi-specialty-group

 

[nishaganesh]

Thank you very much, csperoni! Iappreciate your response!