How does your practice bill for midlevels in the hospital setting for commercial payers that want claims billed under the supervising physician? Since incident-to does not apply to hospital setting, is it appropriate to bill under the supervising physician if split/shared visit is NOT performed and the doctor is not physically present at the hospital? The PAs/NPs are employed by us, not the hospital.
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Tag Archives: MidLevel
Shared Visit: Doctor treats new problem & mid-level treats follow-up problem
CMS has stated explicitly that if a shared visit is not incident to, it must be billed under the mid-level. But one of my doctors is questioning why we can’t bill it under him if the patient has two problems: the mid-level provider only treats follow-up problem, and he (the doctor) evaluates and treats the new problem.
Technically, this is a shared visit, and it is not incident to. Yet it seems that it would be perfectly fair to bill the visit under the doctor, since the mid-level is only performing that portion which is incident to. Can we do this?
Mid-Level Billing
I’m trying to get some clarification for one of my physicians. He currently has a PA that does the initial exam on some of his patients. They review the exam results, imaging and previous records prior to the physician discussing the treatment plan with the patient. Since the physician is not the one actually performing the exam, it doesn’t seem to fit the incident-to requirements, but he is actively involved in the appointment and treatment plan. Any suggestions for the most appropriate way to bill? Should it just be billed under the PA and the physician just doesn’t get credit for his part?
Thanks in advance for your input!!