Results 1 to 4 of 4

Billing for a Physician Assistant

  1. Default Billing for a Physician Assistant
    Medical Coding Books
    Hi,
    I bill for a family practice who has taken on a Physician Assistant. I am not sure how to bill for him. If I use her NPI that does not seem right and if I use his - he is not a member of any insurance companies yet so those claims will be not be processed correctly...I looked on the Medicare website but really did not get it...any help?

    thanks
    Kathy

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default Credentialing
    You will need to get the PA credentialed with the payers. How you bill will then depend on the services provided and whether a particular payer follows the "incident to" rules.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Default
    would you use the NPI of the PA though? I would think so, because the only situation I can think of that you would use someone else's NPI would be Locum Tenens. and if they wait to bill until after the PA is credentialed, is that retro-active or does it only apply to DOS after the credential date? kinda curious about that for myself too.

  4. #4
    Default
    Quote Originally Posted by kjoseph View Post
    Hi,
    I bill for a family practice who has taken on a Physician Assistant. I am not sure how to bill for him. If I use her NPI that does not seem right and if I use his - he is not a member of any insurance companies yet so those claims will be not be processed correctly...I looked on the Medicare website but really did not get it...any help?

    thanks
    Kathy
    The rules vary by payer, but here's a short run-down (please check with your payers to be sure):
    Medicare - you should contract the PA under his own rendering NPI (eg, the one that goes in 24J) - since he's part of a group, he will likely have the same NPI as the MD in 33a (billing NPI). You can bill the PA as the MD (using the MD's rendering NPI in 24J) under a few circumstances (called "incident-to") - it can't be for new patients, or acute conditions - basically, the only time you can bill the PA as the MD to Medicare, is when the MD has already initiated a treatment plan, and the patient is seeing the PA for a follow-up visit. The MD must also be physically present in the office suite at the TOS.
    Medicaid: Varies by state...I can't help you without knowing where you're at.
    Commercial: Many payers will allow you to bill under an MD's name, following the same type of rules as Incident-to; since the PA is an employee of the MD, it's allowed - but you'll need to check on an individual payer basis, to ensure that you're not violating any of your contracts.

    The reason you'd bill under the MD's rendering NPI (versus the PA's), is that PA's are typically paid at a reduced rate (anywhere from 80%-90% of the MD fee schedule, depending on the payer); So even when you're allowed to bill under the MD's #'s (because you haven't contracted the PA yet, usually), you still have to do something to flag the claim, so that they know to apply the discount, in most cases. (Most want you to add a modifier, like the SA modifier, to your charges). Because of all of the hurdles involved in billing PA's under the MD's rendering info, it's usually better to bill under the PA's own #'s, when you can - that means that you'll need to make sure that the PA's contracted with the payers. If you need help finding the rules for specific payers, let me know what state, and I'll send you some links. Hope that helps!

Similar Threads

  1. Physician Assistant Billing
    By moralesc17 in forum Billing/Reimbursement
    Replies: 2
    Last Post: 05-12-2014, 01:05 PM
  2. Physician Assistant Billing
    By cwilson3333 in forum E/M
    Replies: 1
    Last Post: 03-19-2013, 04:19 PM
  3. Replies: 4
    Last Post: 11-08-2012, 08:49 AM
  4. Billing for Physician Assistant
    By Texascoder64 in forum Billing/Reimbursement
    Replies: 3
    Last Post: 08-20-2012, 04:09 PM
  5. Billing/Physician Assistant
    By careyd in forum Medical Coding General Discussion
    Replies: 5
    Last Post: 02-07-2012, 12:15 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.