Wiki Physician Assitant Billing

[AshleyMartin]

I need some feedback on the correct way to bill for PA services.

We have a PA that works both in the office and in the hospital. We bill "incident to" for the services that she performs in the office. My question is more related to the billing for the work she does at the hospital. Can she see the patient, document under the physician's name on the EMR, then he sees the patient seperately. Together, they review the patient's note and he then signs it electronically. Is this sufficient for billing a split/shared service?

Basically, my question is, in the EMR world, what is the correct way to document for split/shared visits and what amount of work should the PA and MD be performing on each patient and documenting in order to be compliant with the guidelines? This has been a running issue here for a long time and I want to make sure we are doing everything the correct way!

Ashley

 

[pamsbill]

I need some feedback on the correct way to bill for PA services.

We have a PA that works both in the office and in the hospital. We bill "incident to" for the services that she performs in the office. My question is more related to the billing for the work she does at the hospital. Can she see the patient, document under the physician's name on the EMR, then he sees the patient seperately. Together, they review the patient's note and he then signs it electronically. Is this sufficient for billing a split/shared service?

Basically, my question is, in the EMR world, what is the correct way to document for split/shared visits and what amount of work should the PA and MD be performing on each patient and documenting in order to be compliant with the guidelines? This has been a running issue here for a long time and I want to make sure we are doing everything the correct way!

Ashley

For shared/split hospital billing, the MCM states the following:

"When a hospital inpatient/hospital outpatient or emergency department E/M is shared between a physician and an NPP from the same group practice and the physician provides any face-to-face portion of the E/M encounter with the patient, the service may be billed under either the physician's or the NPP's UPIN/PIN number. However, if there was no face-to-face encounter between the patient and the physician (e.g., even if the physician participated in the service by only reviewing the patient's medical record) then the service may only be billed under the NPP's UPIN/PIN. Payment will be made at the appropriate physician fee schedule rate based on the UPIN/PIN entered on the claim."

I believe the biggest issue with what you have stated is the documentation of the PA is being documented as if the physician performed the service. That is very concerning as I believe documentation should always reflect the actual person who provided th service.

Technically, as long as the physician sees the patient face-to-face and documents the portion of the encounter s/he provided you are okay to bill it under the physician but it is crucial the documentation reflects the accurate provider performing the service.

I am not an auditor so anyone please feel free to correct me on this.

PJM