Question SUPERVISING PROVIDER FOLLOWING NPs/PAs

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Glendale, AZ
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I have a supervising provider that is following NPs and PAs under his supervision. Can we or how do we bill for this to let the insurance know that he is doing his duties as a supervision physician? I have tried looking this up and only come up with "incident-to" which is not what we are looking to do.
 
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5
Location
Glendale, AZ
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Is this required to do it this way? I have had multiple people tell me different things. Example: For PAs, we can bill them as the supervising provider because the MD accepts responsibility for the PA and their billing. NPs can be billed on their own, without the supervising MD.

Is this right? My billing training really didn't hit on this.
 

SharonCollachi

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Clovis, CA
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I'm not understanding your response, as it appears different than your original question. You asked how to indicate who the supervising provider was, and that goes in box 17.

Every state has their own laws about scope of practice for different licensing levels. If you are billing an NP on their own and not as incident-to, then they do not have a supervising provider FOR THAT SERVICE, but does your state require that the person who is taking responsibility for them have to be indicated on every claim? Or are your NPs allowed to practice as sole practitioners without any supervision whatsoever?
 
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Glendale, AZ
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Our NPs practice without supervision. Our PAs practice with supervision.

I guess my ultimate question is: Are the PAs allowed to be billed as their supervising MD or do they need to be billed as the rendering provider with their supervisor in Box 17?
 

SharonCollachi

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Clovis, CA
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Our NPs practice without supervision. Our PAs practice with supervision.

I guess my ultimate question is: Are the PAs allowed to be billed as their supervising MD or do they need to be billed as the rendering provider with their supervisor in Box 17?
Who is the word "their" referring to in the sentence?
 

SharonCollachi

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Clovis, CA
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Do you mean the Physician Assistants? (Licensed Physician Assistants)? Why would you list a PA as a supervising MD and also as a rendering MD?

If your PA is providing an incident-to service, then bill it under the MD name as an incident-to service.

Medicare: Medicare Reimbursement
• Claims for services are submitted on the 1500 Claim Form.
• Medicare does allow PAs to submit claims under their own NPI as the rendering provider.
• Medicare does not allow PAs to “direct bill” (receive payment directly).
• Reimbursement is made to the PA’s employer.
• Services provided by PAs and Nurse Practioners (NPs) are generally reimbursed at 85% of the Physician Fee Schedule.
• There are provisions for 100% reimbursement (“Incident to” and “Shared Visits” discussed later).

More info: https://www.aapa.org/wp-content/upl...rector-Page-Redesign-Reimbursement-101-v2.pdf
 
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