Results 1 to 4 of 4

Kick-Back?

  1. #1
    Location
    Grand Rapids, MI
    Posts
    17
    Question Kick-Back?
    Exam Training Packages
    If a General Medicine physician sublets his office on nights/weekends to a PA who does cosmetic procedures (mostly botox), can that provider be assigned as the supervising physician for the PA without violating the Anti-Kickback Law?

    Either way - if you could provide a specific regulation, it would be most helpful!

    PS: The PA is doing his own billing, not the Dr's staff.

    KLB, CPC

  2. #2
    Location
    Columbia, MO
    Posts
    12,571
    Default
    If the PA sublets the office then this is his own practice. He is in a collaborative agrement with the physician as required under the state law, which states the physician must be reachable by fax or pager, or phone with in a certain time or distance. So he must bill this as his own practive so he must bill under his own NPI and not under another physician as the supervising, because a physician cannot supervise someone who has their own practice.
    This does not violate the anti kick back unless they are referring patients to each other with the patients being given the choice of providers.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Grand Rapids, MI
    Posts
    17
    Default
    I just want to make sure I'm understanding you correctly...

    1. If the PA sublets our space, he should not be using my physician as his supervisor. He would have no association with our practice other than a tennant. He can pay us rent without violating the kick-back regulation.

    2. If the PA is using us as his practice, with my physician as the supervisor and our NPI for billing, the PA may use our space but should not be paying us rent. If this is the case, the PA should not being paying us at all right? We should be billing for his services and he would recieve payment as an employee.

    Either way, there should be no referrals between the two without documentation of a choice being offered to the patients.

    Have I got it all??
    KLB, CPC
    "Sucess is not final, failure is not fatal; it is the courage to continue that counts." Winston Churchill

  4. #4
    Location
    Columbia, MO
    Posts
    12,571
    Default
    As far as #2: You can bill under your physician NPI as long as Incident to has bet met. That is this visit is a followup encounter to a visit by your physician for the same thing and it cannot be a new patient or a new problem, also the physician must be present in the office while the patient is there. That is incident to and while it is a Medicare policy, we must remember that Medicare is the gold standard that other carriers are expect to follow unless they have a written policy then states different.
    Otherwise what you have stated looks correct.

    Debra A. Mitchell, MSPH, CPC-H

Similar Threads

  1. If you can't get your foot in the door... Kick a hole in the wall!!!
    By vwash in forum Employment General Discussion
    Replies: 17
    Last Post: 02-14-2012, 01:25 PM
  2. Athena kick back
    By coder1 in forum Billing/Reimbursement
    Replies: 4
    Last Post: 09-27-2010, 06:42 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.