Wiki Physical Therapist Billing HELP!

[heatherrellias]

Hey billers out there!

We have a Physical Therapist that has joined our group. We've been billing her services incident to the MD. He will be out of the office 2 days this month. Does anyone know if we are able to bill her services under the PA? The therapist is not currently credentialed with the Payors yet, so we cannot bill directly under her NPI/license.

Any feedback is greatly appreciated!

Thanks!

 

[cmcnear]

Hi heatherrellias!

There are some plans that have an actual incident to policy (i.e. Medicare, BCBS) and as I have found most plans don't have guidelines at all. In these cases, it can be particularly tricky when billing therapy services.

Nonetheless, when billing through any provider other than the therapist, I recommend checking the provider manuals. In your care,, it's important to determine if the PA is credentialed with the commercial policies . There may be some plans that don't acknowledge mid levels; one of which is Cigna. Often times, they will deny the claim completely. You may also possibly get a denial that the services rendered are outside of the provider's scope of practice.

FYI, there are some plans that require you to be through the therapist (i.e. Aetna, Medicaid plans (Amerigroup, Peachstate) and Tricare). The short version to answer your question, you much check the policy as well as the credentialing status of the provider you bill through.

I hope this helps. If you need any more clarification, please let me know.