Results 1 to 4 of 4

Need advice for billing for PA

  1. #1
    Location
    Salt Lake North
    Posts
    691
    Cool Need advice for billing for PA
    Medical Coding Books
    We have a PA starting in our office soon. I need to brush-up on guidelines for this. Can anyone direct me to a good resource for that? I think we have to bill under a physician and not the PA? Does the doc have to be in the clinic while the PA sees the patients?

  2. Default
    In regards to the PA, my office bills folllow up visits with the PA. Fortunately, the PA is only here when the doctor is. There should be a supervising physician on all office charges. If there is a surgery, it is different billing procedures for surgeries and billing a PA. Hope this helps.

  3. #3
    Location
    North Carolina
    Posts
    3,126
    Default
    http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf

    Section 190

    1) New patient/New problem/Consults, Alone in clinic: The PA submits claim under his name/NPI provided the PA is within the scope of your states licensure/training

    2) Incident to: The physician needs to be in the suite (accessible) and file under supervising MD

    Other information...specifically consults...

    http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

    Section 30.6.10

    Specifically, a consultation service is distinguished from other evaluation and management (E/M) visits because it is provided by a physician or qualified nonphysician practitioner (NPP) whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source. The qualified NPP may perform consultation services within the scope of practice and licensure requirements for NPPs in the State in which he/she practices.

  4. #4
    Default
    In additon to the CMS info you really need to get your states guidelines for the PA scope of practice. They vary state to state and sometimes change from time to time within each state. CMS states their coverage of PA services is based on what they are allowed to do by their state.

    Also check with your payers. Some credential PAs and some don't. The trend we are seeing in Michigan is the payers that didn't used to credential midlevel providers are now starting to. Which makes sense if they want to follow CMS lead and pay them less than the doctors. The credentialing process is slow and full of hurdles so start on that yesterday!

    Good luck

    Laura, CPC, CEMC

Similar Threads

  1. Advice for new billing student
    By dianadawn in forum Billing/Reimbursement
    Replies: 0
    Last Post: 06-16-2013, 08:25 AM
  2. Prolotherapy billing advice
    By larkatin in forum Anesthesia
    Replies: 2
    Last Post: 09-22-2011, 04:36 PM
  3. Advice needed for vaccination billing
    By Bamboo in forum Medical Coding General Discussion
    Replies: 6
    Last Post: 01-13-2011, 07:20 AM
  4. Need expert billing advice!
    By Love Coding! in forum E/M
    Replies: 0
    Last Post: 12-29-2009, 11:44 AM
  5. ASC billing advice
    By donnar in forum Outpatient Facilities
    Replies: 11
    Last Post: 01-20-2009, 12:25 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.