Wiki Midlevel Billing Commercial Payers in Hospital Setting

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clarkmegan

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How does your practice bill for midlevels in the hospital setting for commercial payers that want claims billed under the supervising physician? Since incident-to does not apply to hospital setting, is it appropriate to bill under the supervising physician if split/shared visit is NOT performed and the doctor is not physically present at the hospital? The PAs/NPs are employed by us, not the hospital.
 
Midlevel Billing Commerciakl Payers in Hospital Setting

I think you need to do two things:
1) Review the contract with the commercial payer to determine whether or not there is an expectation that you bill midlevel provider services a certain way; and
2) Research via commercial payer policy manuals.

Not all commercial payers follow Medicare's incident-to or shared billing rules and each plan may vary.

Maryann
 
clarkmegan said:
How does your practice bill for midlevels in the hospital setting for commercial payers that want claims billed under the supervising physician? Since incident-to does not apply to hospital setting, is it appropriate to bill under the supervising physician if split/shared visit is NOT performed and the doctor is not physically present at the hospital? The PAs/NPs are employed by us, not the hospital.
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You need to establish the commercial payer policy for billing for PA and NP services. Most commercial payers do not credential PAs and NPs and instruct you to bill under the physicians NPI. This is not shared/split billing but commercial billing under the physician NPI.

Here is a policy statement from AAPA:
https://www.aapa.org/wp-content/uploads/2017/01/Third_party_payment_2017_FINAL.pdf
 
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