help with billing!

[KMKPA]

Hello,

I just joined an otolaryngology practice and I am their first PA.  I have been in practice for 9 years, but, embarrassingly enough, I have limited knowledge of billing. My previous ortho practice did not share any information about billing and basically, all of my dictations had to say "I am dictating as a scribe on behalf of Dr. Soandso."    I had minimal autonomy and had no access to any collections and never had my own clinic.  My experience prior to that was working in the ED for a large public university and we never really talked about collections or billing.   With this new practice, I will be in clinic (eventually my own clinic time without a physician in the same locale) and I will spend some time first assisting in the OR. The practice is essentially asking how to bill for me, as they have never had a PA.  I know the reimbursement is usually 85% for a PA from Medicare and a lot of other carriers.  I also know that a lot of practices bill under a physician's name to get the full 100%  (incident-to).  I will be seeing a mix of new and established patients in clinic, doing a fair amount of procedures, etc.  Obviously, the practice wants to make as much money as possible and are asking me specifics on Incident-to, etc. I have read a lot about it and it sounds pretty complicated and specific.  Are there any other ways to bill under a physician other than incident-to?  I feel it just may be best, to avoid confusion and error, to just bill under my own name for most things....unless I specifically have a doc come in and examine the patient with me.  Is this typical or do a lot of PAs still bill under a physician's name?  A friend of mine who works in pediatrics just told me that her practice bills under the physician's name for her patients almost exclusively....but I don't really see how that is possible when she is in a separate local from her supervising physician.  Am I missing something?

 

They are sending me to a billing and coding seminar in August, but, we are trying to get some things figured out, as I have started seeing consults in the hospital already (I'm still training in clinics with the docs) and I will be seeing patients autonomously in clinic in the next month or so.  The practice has a consultant that they frequently use, but, she seemed a little unaware of the exact rules, too. 

 

Can anyone help me or at least point me in the right direction? 

 

Thanks!

[ventana]

Even if you occassaionally give up the extra 15% for billing under the doc - NEVER bill under the doc

 

It makes you "invisible" for productivity and value

 

85% is still good enough

 

 

It does however mean you likely have to be credentialed with each and every insurance company - something that is time consuming and a PIA

So -for the private insurance companies (whom may not even credential PA) you m might have to bill under the doc PIN - but these should be tracked and directly attributed to you

 

 

 

As for you previous job - that line you had to put in each and every chart was insurance fraud - and you we contributing to it. Don't ever do that......

[KMKPA]

Thank you for the response. The new practice is getting me established with payers. I think I will recommend to just bill under my name. It just seems like the most direct way and there is no question if it's right or wrong.

 

As for the other practice, I don't think I was committing fraud because I was actually seeing every patient with the physician....hence why I left. They didn't utilize PAs appropriately.

[rev ronin]

As for the other practice, I don't think I was committing fraud because I was actually seeing every patient with the physician....hence why I left. They didn't utilize PAs appropriately.

Yeah, you were indeed a really expensive scribe. Blah.  I agree your job is to practice medicine, not write up charts.