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Medicare billing for NPPs

  1. #1
    Question Medicare billing for NPPs
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    I have a NP and a PA at my office and we currently bill all claims for them incident to. The PA seems to think that if he wants to see patients outside of the incident to rules that we can simply bill him as the servicing provider and the DO as the billing and append some sort of modifier that says this is not an incident to claim, even thou he is not credentialed with Medicare nor does he have his own NPI. Has anyone ever heard of this??? Know of any sources disproving this that I can present to him. Any help would be really great. Thanks.

  2. #2
    Location
    North Carolina
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    He can not bill under his name if he is not credentialed with Medicare...

    Effective for services rendered on or after January 1, 1998, any individual who is participating under the Medicare program as a physician assistant for the first time may have his or her professional services covered if he or she meets the qualifications listed below and he or she is legally authorized to furnish PA services in the State where the services are performed.

    http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf

    Section 190

  3. #3
    Location
    North Carolina
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    3,126
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    This site should be helpful, also...

    http://www.aapa.org/advocacy-and-pra...verage-for-pas

  4. #4
    Default
    I have never heard of the billing situation you described. If you put the PA as the servicing provider and the DO as the billing provider, then this is an incident-to claim by definition. There is no modifier that you can use to get around the rules.

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