Wiki New Patient w/PA for Medicare & Advantage Plans

[Dawm1234]

In an office setting (location 11 - dermatology practice), can midlevel providers see new patients or patients with new problems when they have a Medicare Advantage insurance?

If so, can the visits be billed under the PAs credentials and not incident to? Does an overseeing doctor need to be involved in the visit at all or come into the room if we are billing under the PAs credentials?

 

[Saedron]

Remember that Medicare Advantage plans for the most part follow Medicare guidelines. If your non-physician providers are credentialed with Medicare they can bill independently using his or her own NPI.

You cannot bill new patients or new problems as incident-to because there has been no established plan of care set forth by a physician as of yet.

Bill the visits you described under the non-physician provider's NPI.