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Physician Assistant Billing - Medicare products

  1. Default Physician Assistant Billing - Medicare products
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    Hi, I have a question about coding for a physician assistant. I understand about "incident to" and Medicare or Medicare products but does incident to apply to private insurances also or is it just Medicare? I've called a couple of insurance companies and they say to bill under the supervising doctor's NPI number. Does that mean the PA can see new patients? Any help would be appreciated. Thank you.

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default INcident to is MediCARE only
    The official rules for "incident to" billing apply ONLY to MediCARE (and perhaps your state's MedicAID if they follow Medicare to the letter).

    We do not bill "incident to." Our PAs and NPs are credentialed with Medicare and Medicaid and bill services they provide under their own names/NPI numbers.

    Our commercial carriers do not credential PAs and NPs. They ask that we submit services by these allied health professionals under the name/NPI of the supervising physician - which is what we do.

    Our coding/billing software allows us to enter the charges under the actual provider (e.g. PA Smith), while sending the claim out under the supervising physician (e.g. Dr Jones). This way we have a clear understanding of who actually provided the service.

    We have no problem getting paid - even when documentation is requested.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 02-09-2010 at 01:14 PM.

  3. Default
    THanks Tessa! Just to be absolutely clear, for the commercial carriers, you can bill out new patients under the supervising physician's NPI number?

  4. #4
    Default From Florida
    I'm in FL and BCBS recently started credentialing ARNP's and PA's. The only problem is, they are considered a specialist (believe it or not) so the patient may have a higher co-pay. This is not making our pts very happy.
    adrianne, cpc

  5. #5
    Location
    Evansville Indiana
    Posts
    451
    Default Incident to
    Many of the commercial carriers follow incident to guidelines. You would need to check with the individual carriers. We had someone call all our major carriers and they pretty much all said they follow CMS guidelines, and if that is the case, then no, they can't see new patients. Your best bet is to check with each individual carrier.

  6. #6
    Location
    Columbia, MO
    Posts
    12,573
    Default
    You cannot charge incident to for a new patient since the physician you are billing under has had no material participation in this patient's care and that is one of the basic provisions of incident to.

    Debra A. Mitchell, MSPH, CPC-H

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