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Billing under PA or MD

  1. Default Billing under PA or MD
    Medical Coding Books
    I was wondering the guidelines for billing an OV or consult that the PA does under the Dr.
    I believe there is certain criteria like the MD has to do part of the exam or special dictation... My dr is questioning because of the obvious higher reimbursement and want to give him an answer
    Please help.
    Thank You

  2. #2
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    Columbia, MO
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    If a PA does a consult it must be billed under the PA, Consults and New patients cannot be billed incident to or as a shared encounter. What you are describing is like a shared encounter where the PA performs part of the encounter and the MD does part, but even for a shared encounter the MD must document a face to face encounter with the patient, just signing off on the note is insufficient. You can bill a regular established patient OV under the physician as long as it meets the incident to rule that this is a follow up encounter as long as the provider is on site, or as a shared encounter as long as the MD dictates a separate note indicating his face to face portion and references the PAs note.
    If the PA sees a new patient, or an established patient with a new problem, or any patient while the MD is out of the office then the PA must bill using his own NPI number.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Quote Originally Posted by mitchellde View Post
    If a PA does a consult it must be billed under the PA, Consults and New patients cannot be billed incident to or as a shared encounter. What you are describing is like a shared encounter where the PA performs part of the encounter and the MD does part, but even for a shared encounter the MD must document a face to face encounter with the patient, just signing off on the note is insufficient. You can bill a regular established patient OV under the physician as long as it meets the incident to rule that this is a follow up encounter as long as the provider is on site, or as a shared encounter as long as the MD dictates a separate note indicating his face to face portion and references the PAs note.
    If the PA sees a new patient, or an established patient with a new problem, or any patient while the MD is out of the office then the PA must bill using his own NPI number.
    Thanks Debra, I was on the same page as you and advised my MD of the response and his response was this:
    I see all patients after Patrick does the H&P. After he sees the patient, I then see the patient at the same encounter. I lay hands on the patient( ie. physical exam) and discuss the plan of action. I then dictate a note. This is in the form a letter to the referring physicians.
    I believe this qualifies for billing under my services, and I have discussed this with other physicians; who agree.
    I would like you to bill all consults and H&P under my numbers.
    Patrick saw 3 new patients on Monday; please bill these under me.
    We will discuss this further next week.

  4. #4
    Default
    If MD is in the office and available for immediate consultation then PA can see follow up patient and follow plan of care established by MD. This can be billed unde MD. PA can not see new patients. If MD if not available and PA sees an establishe patient you should bill under PA's numbers (you'll get 85% of MD's fee).

  5. #5
    Location
    Columbia, MO
    Posts
    12,526
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    Quote Originally Posted by melissalynnfalkowski View Post
    Thanks Debra, I was on the same page as you and advised my MD of the response and his response was this:
    I see all patients after Patrick does the H&P. After he sees the patient, I then see the patient at the same encounter. I lay hands on the patient( ie. physical exam) and discuss the plan of action. I then dictate a note. This is in the form a letter to the referring physicians.
    I believe this qualifies for billing under my services, and I have discussed this with other physicians; who agree.
    I would like you to bill all consults and H&P under my numbers.
    Patrick saw 3 new patients on Monday; please bill these under me.
    We will discuss this further next week.
    Except you cannot share new patients or consults.. see CR 1776 look under shared encounters

    Debra A. Mitchell, MSPH, CPC-H

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