PAs and NPs: How to bill for their services (Medical Economics Special Section)

July 1, 2007

Whether you're reimbursed 'incident-to' your own services or under a midlevel's ID number, be sure to follow these rules.

To help you do that, we asked two experts-Virginia Martin of Healthcare Consulting Associates of Northwest Ohio in Waterville, and Betsy Nicoletti of Medical Practice Consulting in Springfield, Vt.-to lay out the rules and warn against possible pitfalls. Here's their advice.

The dos and don'ts of "incident-to" reimbursement

Under the midlevel's provider identification number, or:

In the latter instance, you'll be paid at 100% of your normal fee schedule; reimbursement drops to 85% if you use the midlevel's provider number. So, naturally, you'll want to bill "incident-to" whenever possible.

CMS defines "incident-to" services as those that are "furnished incident-to physician professional services in the physician's office (whether located within a separate office suite or within an institution) or in the patient's home."

According to Martin and Nicoletti, for services to qualify as "incident-to", you must meet these requirements:

What do these requirements mean in practice? Nicoletti provides this example: You see Ms. Brown for diabetes, determine a treatment plan, and record the plan in the medical record. Then you tell her that you'd like her to see your physician assistant for follow-up visits for glucose monitoring, medication checks, and other services related to the diabetes, because your PA is skilled at managing chronic diseases. You also tell Ms. Brown that you'll see her every fourth visit.

After Ms. Brown sees your PA, review the chart notes. And document in the chart that you were on-site when the PA provided the services.