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Guidance Needed - Billing State MCOs for Surgical Assist Services

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Hi all, 

 

Hoping I can get a little help from some surgical PAs who know how to handle billing MCOs that use incident-to billing for surgical assist services.  I'm working for an OB/GYN practice and I'm the first PA they've had who actually wants to go to the hospital to assist in the OR with surgical cases.  In the past, my SP has used hospital-provided PAs as 1st assists, so we're trying to figure out the billing aspect of taking me instead.  There are a few state MCOs, (Amerigroup and United Health Care) that pay PAs solely under incident-to and don't credential us separately.  So if I assist my SP with a C-section, I don't have a separate provider number to bill for my services.

 

I found this article from the American College of Surgeons, (http://bulletin.facs.org/2014/05/billing-for-services-performed-by-nonphysician-practitioners/), that essentially says I should be billed under my SP as "an expense to the practice."  Other than that, I haven't found much in my research online, and talking to the actual MCOs is about as helpful as punching myself in the face.

 

So- I thought maybe some of my fellow PAs that work in Ortho, (or any of the other surgical specialties that utilizes PAs employed by the surgeon's practice instead of the hospital), might be able to shed some light on this.  If anyone can help, I would be most grateful.

 

Thanks!

 

Kate

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Hi all,

 

Hoping I can get a little help from some surgical PAs who know how to handle billing MCOs that use incident-to billing for surgical assist services. I'm working for an OB/GYN practice and I'm the first PA they've had who actually wants to go to the hospital to assist in the OR with surgical cases. In the past, my SP has used hospital-provided PAs as 1st assists, so we're trying to figure out the billing aspect of taking me instead. There are a few state MCOs, (Amerigroup and United Health Care) that pay PAs solely under incident-to and don't credential us separately. So if I assist my SP with a C-section, I don't have a separate provider number to bill for my services.

 

I found this article from the American College of Surgeons, (http://bulletin.facs.org/2014/05/billing-for-services-performed-by-nonphysician-practitioners/), that essentially says I should be billed under my SP as "an expense to the practice." Other than that, I haven't found much in my research online, and talking to the actual MCOs is about as helpful as punching myself in the face.

 

So- I thought maybe some of my fellow PAs that work in Ortho, (or any of the other surgical specialties that utilizes PAs employed by the surgeon's practice instead of the hospital), might be able to shed some light on this. If anyone can help, I would be most grateful.

 

Thanks!

 

Kate

I am currently billing for a contracted SFA. She is a Ortho SFA and I can tell you we have alot of WC cases that are paid. UHC is the best paying insurance company. Cigna does pay but they do try to bundle many codes. Medicare does not recognize SFA so they will not pay. Would love to chat more with you First Assist Billing. My email addresss is spartanburgmedicalsolutions@gmail.com

 

Sent from my LG-D415 using Tapatalk

 

 

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