Wiki Pa in hospital billing

[yem5173]

I have a question that I can not find the answer to. Can a private speciality practice PA bill for a hospital consult? Are there rules with this billing, e.g. physician must sign off, physician must be in room, etc.? We are a private practice and have our PA's on call during the weekend. Any tips or information would be extremely helpful. Thank you

 

[RebeccaWoodward*]

A PA may bill using their own provider number. Chapter 12 section 30.6.10... Chapter 15 also elaborates on the requirements for a PA to perform services. Unless state law requires, the MD is not required to sign off on the PA's chart. Also, keep in mind that "incident to" does not apply to consults. If it is within the PA's scope of practice, he/she would submit the claim under his/her NPI number.

Specifically, a consultation service is distinguished from other evaluation and management (E/M) visits because it is provided by a physician or qualified nonphysician practitioner (NPP) whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source. The qualified NPP may perform consultation services within the scope of practice and licensure requirements for NPPs in the State in which he/she practices. Applicable collaboration and general supervision rules apply as well as billing rules;

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf



Physician Supervision

The PA’s physician supervisor (or a physician designated by the supervising physician or employer as provided under State law or regulations) is primarily responsible for the overall direction and management of the PA’s professional activities and for assuring that the services provided are medically appropriate for the patient. The physician supervisor (or physician designee) need not be physically present with the PA when a service is being furnished to a patient and may be contacted by telephone, if necessary, unless State law or regulations require otherwise.

http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf

Section 190