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Click here for more sample CPC practice exam questions and answers with full rationale

refund request for an assistant surgeon

Do we need to refund an insurance company that we do not PAR with if they paid us the whole amount for the surgery? A third party now is requesting 84% TAKE BACK of our claim that was submitted correctly with the 80 modifier. It is well over a year and we have no relationship with the insurance company. What are our options<

thank you
New Jersey

Medical Billing and Coding Forum

Medical assistant scope of practice

If a medical assistant sees the patient without a doctor in the room for services that are within her scope (injection, suture removal, bandage change, etc.), how much is she permitted to actually do? ie:

Can she perform and document a brief exam of the affected area?
Can she perform and document a pertinent HPI?
Can she consult with the doctor about the plan of care and then document his plan?

Medical Billing and Coding Forum

Billing for Assistant at Surgery at hospital “affiliated” with medical college

I’d appreciate any help/advice here. Our physicians practice at a community hospital that is "affiliated" with the local medical college so students and residents rotate through the hospital. What obligation do we have to make sure that a qualified resident was not available to be able to bill for our PA assisting in surgery?

Thanks

Medical Billing and Coding Forum

In Urgent Care setting, Can a Physcian Assistant bill a new pt using his/her own NPI?

Hi coder family:)

I guess my question is can P.A’s see new patients in Urgent Care?

I am auditing our P.A.’s who see patients Monday-Sunday in Ortho Urgent Care. My question is, if a new patient comes in to be seen and a P.A. see’s them for the first time. Would the P.A. be able to bill under their own NPI or because the patient is new and a treatment plan has not been established, P.A. would need to bill incident to and bill using the Supervising doc’s NPI? I think a P.A has to use their own NPI when supervising doctor has no involvement in patients treatment?

Any help is appreciated and if anyone has reference materials to back it up, that would be awesome. Thanks!

Medical Billing and Coding Forum

Assistant Surgeon Payment Indicators

I am hoping someone can clarify this for me. What does "Concept does not apply" under Assistant at Surgery payment indicator mean? They can be paid? They can’t be paid? I can’t find anywhere that states what those 4 words mean. My physician is stating if the concept doesn’t apply then our assistant should be paid. I say if the concept doesn’t apply then no payment. I hope someone can direct me to formal information I can present to my doctor either way.

Thank you in advance for your help. I am pulling my hair out at this point.

Medical Billing and Coding Forum