Yes
Billing under the PA's own provider number allows PAs to see new Medicare patients, patients when the physician is off site, or established patients with new problems. Improper use of incident to may lead to fraud and abuse allegations. The physician must personally treat the patient and establish the diagnosis on the patient's first visit to the practice. The physician must also treat established patients who come to the practice with a new medical condition. Physicians who have billed for services provided by the mid-level provider in POS 22 when the shared/split guidelines did not apply should refund Medicare the difference in payment. Physicians are allowed at 100% of the Medicare Fee Schedule and mid-level providers are allowed at 85%.  Yes. If the NPP will be providing services to Medicare patients, and you want to bill for such services Medicare mandates that all NPP's have a NPI number. It would be wise to do a compliance audit with your company or billing entity to assure that proper NPI numbers are on the CMS1500 for services provided by NPP's. Services covered by Medicare incident to are those services furnished in a physician office. It is not applicable in the hospital setting--either inpatient or outpatient --and as such it is not applicable in the emergency department. How can you afford not to? The reimbursement for a level-I established patient office visit according to the 2001 Medicare physician fee schedule is $19.89. If you provide even four such visits a day without billing for them, your practice could be losing nearly $400 per week, or approximately $20,000 per year.  Question: Can a mid level provider such as a nurse practitioner, physician assistant, clinical nurse specialist, or certified nurse midwife perform the wound care procedure codes 97597 and 97598? Answer: A MD/DO providing the service can use time to choose the procedure code. A mid level providing the service can use time to choose the procedure code. Time cannot choose the procedure code when the service is a shared/split service between the MD/DO and mid level provider. You can bill the service as a new patient under the PA provider number as long as no other PA in your group has billed an initial visit. The MD/DO and mid level provider are different specialties. Medicare enrolls a mid level based on their designation, such as physician assistant (97), rather than the clinical area to which they have specialized. Answer: A MD/DO providing the service can use time to choose the procedure code. A mid level providing the service can use time to choose the procedure code. Time cannot choose the procedure code when the service is a shared/split service between the MD/DO and mid level provider. This document reflects changes to the Medicare Carriers Manual by the Centers for Medicare and Medicaid Services (CMS) pursuant to Transmittal 1776 implemented on October 25, 2002. (http://www.cms.hhs.gov/transmittals/downloads/R1776B3.pdf). Services covered by Medicare incident to are those services furnished in a physician office. It is not applicable in the hospital setting--either inpatient or outpatient --and as such it is not applicable in the emergency department. Mid Level providers and Appropriate Billing. Question: Our MD/DO saw the patient 2 years ago. The patient is now coming for services by the physician assistant (PA.) Is it appropriate to bill these evaluation and management services (E/M) as a new patient or should I submit the services as a subsequent patient. Answer: A MD/DO providing the service can use time to choose the procedure code. A mid level providing the service can use time to choose the procedure code. Time cannot choose the procedure code when the service is a shared/split service between the MD/DO and mid level provider. Incident to is a Medicare reimbursement policy, whereby, under certain circumstances, the physician can bill and be paid for services that were provided by non-physician practitioners who are employed by the physician. Services covered by Medicare incident to are those services furnished in a physician office. It is not applicable in the hospital setting--either inpatient or outpatient --and as such it is not applicable in the emergency department. This process works best if you’ve already thought about thevolume of patients you expect the new mid-level practitioner tosee each week, what types of patients he or she will see mostoften, and to what extent you or another physician in your prac-tice will need to be on the premises to supervise. Inde-pendent visits—that is, those made to a mid-level practitionerbut not to a physician—are reimbursed at a lower rate, often85% of the normal rate for a physician visit. “Incident to” visitsare billed at the same rate as
http://www.fapaonline.org/node/139 http://www.wpsmedicare.com/j8macpartb/resources/provider_types/mid-level-providers-incident-to-guidelines-pos22.shtml https://www.acep.org/content.aspx?id=30478 http://www.aafp.org/fpm/2001/1100/p23.html http://www.wpsmedicare.com/j8macpartb/resources/provider_types/mid-level-providers-qanda.shtml http://www.wpsmedicare.com/j8macpartb/resources/provider_types/mid-level-providers-qanda.shtml https://www.acep.org/content.aspx?id=30478 http://www.wpsmedicare.com/j8macpartb/resources/provider_types/mid-level-providers-qanda.shtml https://www.acep.org/content.aspx?id=30478 http://www.doctorsdigest.net/pdf/0705/DoctorsDigest_GettingPaidMidlevelServices.pdf
can a mid level see new patients per medicare guidelines