Wiki Supervising billing Medicare

menorani

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Hi,

Does anyone have any experience billing under a supervising provider? On the HCFA 1500 for an office visit for a Physician Assistant. Can we bill commercial insurance under a supervising provider? Who’s NPI is listened as the rendering provider for the procedure billed? The supervising provider or the ordering provider?
 
IF your visit meets incident-to AND the payor follows incident-to, then basically only your physician information is billed. If you are not billing incident to, then it's your PA/NP name/NPI on the claim (box 24J if I recall correctly), with supervising physician info in box 17/17a.
 
General documentation/EM question and a long post but feel I need to give some background. We are an inpt SUD facility with additional programs such as outpt MH, MAT clinic and Primary Care. Our medical director is a CRNP with extra certification in MH. He admits all inpt clients and uses standing orders. Included in the orders a general blood panel. He does not review the results. The ARNP who is seeing clients in our PC office is reviewing all inpt charts and then scheduling a PC visit to "review labs". She suddenly started using Z71.2 to meet leveling criteria and also using it as primary and sometimes only dx. When queried she says was advised by med director. Conversation with him and DON was not pleasant as they are adamant that is a billable code. I agree yes billable but not as primary. She has since started listing all lab results and generally the only additional diagnosis to come out of it Iron Deficiency Anemia. With most of our population being homeless, not receiving regular medical are and being in substance abuse treatment I would think that is an appropriate finding. One of many issues I am dealing with now is the attending is not documenting findings, the PC providing is doing this. She is not on the inpt treatment team and there doesn't seem to be a policy around this action. I have asked for attending to document abnormal labs for reason for referral, and then the PC provider to document acknowledgement of referral as reason for having a PC visit. I mean, where did this patient find out he/she had abnormal labs needing review. I am getting a LOT of push back and would love any information to support the visit and would really appreciate sources as that is the first thing I am asked? "Who says"? TIA
 
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