Wiki PA seeing new patients

tworrock

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Hi all,

Our physician wants the PA to start seeing some of the new patients. I don't know anything about this process. Can a PA see new patients? Is there anything that needs to be done prior to them seeing the patient?

Thank you!
 
It's no different billing a new patient visit by a PA vs. by a physician - the same coding rules apply. The one thing you have to keep in mind though is that the visit with the PA may not be billed under the MD's credentials - 'incident to' billing is not allowed for new patients.
 
It's no different billing a new patient visit by a PA vs. by a physician - the same coding rules apply. The one thing you have to keep in mind though is that the visit with the PA may not be billed under the MD's credentials - 'incident to' billing is not allowed for new patients.
We bill under our group NPI. Does that make a difference?
 
The individual servicing providers are identified in box 24J even if the claim itself is billed under the group NPI.
Ah, okay. I just double-checked my last batch of claims (sorry, I'm new to this), and we used the PA's NPI for her follow-up patients. So it's okay to continue doing it that way?
 
Hi,

I have a couples questions,

incident to guidelines -
credentialing/contracting PA/NP

1. if PA/NP see's patient office setting-(NOT new, no new problem)- and MD/DO is available @tos- we can bill under the supervising provider(MD/DO), and receive 100% reimbursement?- this is an example of incident to guidelines

2. office setting-if PA/NP see's established patient new condition, this must be billed under PA/NP? since it does not follow incident to guidelines and receive 85% reimbursement?
Or patient must be seen by MD/DO and they will bill for services

3. office setting-if PA/NP see's new patient-incident to guidelines do not apply and service must be billed under PA/NP?

From what I understand, Medicare follows incident to guidelines and will reimburse at 100%. If PA/NP bill Medicare they will be paid at 85%
Commercial payers, may not follow incident to guidelines. If not how would we bill for PA/NP?
PA/NP would need to be contracted/credentialed with commercial payer and would receive 85% reimbursement

4. are there any procedures that have different guidelines?

Thank You,
OB/GYN-New York
 
1. If the NPP is enrolled with Medicare and a physician is in the office suite and immediately available during the visit - Yes.
2. For a new problem you will always bill under the NPP unless the physician comes in during the visit sees the patient, creates a new plan of care and turns them back over to the NPP.
3. Yes.

Incident-to is a Medicare rule that is only an option in the office. Some private payers follow it, others do not. You'll need to review each private payer's policy to determine how to bill the NPP's services.

Hope this helps.
 
Hi,

I have a couples questions,

incident to guidelines -
credentialing/contracting PA/NP

1. if PA/NP see's patient office setting-(NOT new, no new problem)- and MD/DO is available @tos- we can bill under the supervising provider(MD/DO), and receive 100% reimbursement?- this is an example of incident to guidelines
1. If the NPP is enrolled with Medicare and a physician is in the office suite and immediately available during the visit - Yes.
I would clarify, that just because it is an established dx, does not, necessarily, make it incident-to.

if the PA/NP is creating a new treatment plan OR changing the previous plan, it is NOT incident-to.
if the PA/NP is following a treatment plan that was created by the MD/DO, that would be incident-to the provider's plan.

per CMS MLN Matters - Incident to Services (emphasis NOT added by me):

To qualify as “incident to,” services must be part of your patient’s normal course of treatment, during which a physician personally performed an initial service and remains actively involved in the course of treatment. You do not have to be physically present in the patient’s treatment room while these services are provided, but you must provide direct supervision, that is, you must be present in the office suite to render assistance, if necessary. The patient record should document the essential requirements for incident to service.
More specifically, these services must be all of the following:
• An integral part of the patient’s treatment course;
• Commonly rendered without charge (included in your physician’s bills
• Of a type commonly furnished in a physician’s office or clinic (not in an institutional setting); and
• An expense to you.
 
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