Wiki Physician Assistant and Medicaid

[krystle8402]

I have a PA who gave me a charge, but it's for a Medicaid patient. From what I gather, Medicaid won't accept that. They want a supervising physician, but there is no supervising physician with the note, and we're part of a hospitalist group with multiple providers. Anyone know how I go about that? I've been searching for an answer, but not having any luck. Thanks!

 

[JEYCPC]

I think you are looking for Incident to rules:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/se0441.pdf

 

[thomas7331]

CMS guidelines do not allow for 'incident to' billing in a hospital setting - that applies only to an office setting.

If your Medicaid payer does not allow for a PA to bill under their own credentials, I'd recommend you reach out to them get their guidelines. All PAs have to have a supervising physician, even if it's not recorded in the documentation and if the payer requires all claims to be billed that way, then I'd think you would just need to find out which MD was supervising for that service and bill accordingly.

 

[krystle8402]

CMS guidelines do not allow for 'incident to' billing in a hospital setting - that applies only to an office setting.

If your Medicaid payer does not allow for a PA to bill under their own credentials, I'd recommend you reach out to them get their guidelines. All PAs have to have a supervising physician, even if it's not recorded in the documentation and if the payer requires all claims to be billed that way, then I'd think you would just need to find out which MD was supervising for that service and bill accordingly.

Thank you. . .I'm going to have to find the most appropriate supervising physician for this. Since being a hospitalist group, we have more than one who may see a patient in a time frame. since no other provider is on her note, I may look back to see who the admitting physician is. I would think that would be most appropriate? I appreciate your help!