credentialing question

[arlake]

I am a recent graduate and started a position at an outpatient practice who has never used midlevels before. I was recently credentialed through medicare, but am waiting on credentials from the other insurance companies that my practice takes. In terms of seeing patients and billing, how does it typically work if you are not credentialed through all of the insurance companies? Am I able to see patients and bill under my SP as long as my SP also sees and examines those patients? Since my SP has never employed a mid-level, both of us are unsure of how this typically works in other practices.

 

Thanks!

[coloradopa]

I am a recent graduate and started a position at an outpatient practice who has never used midlevels before. I was recently credentialed through medicare, but am waiting on credentials from the other insurance companies that my practice takes. In terms of seeing patients and billing, how does it typically work if you are not credentialed through all of the insurance companies? Am I able to see patients and bill under my SP as long as my SP also sees and examines those patients? Since my SP has never employed a mid-level, both of us are unsure of how this typically works in other practices.

 

Thanks!

Ask how they have traditionally billed for other physicians. Some may have you hold and bill when credentialed (unlikely). Most will have you bill under another physician. Finally very few insurance plans credential PAs and have you bill under the physicians NPI.

[ventana]

in general

 

if the Insurance company credentials PA's you can see the patient (and for IM or FP you can see them with out regard to where your SP is - not sure about surg and specialities)

for Insurance company that does not credential you (GRRRRRR) - most will allow you to bill under the SP PIN but many times with restrictions - the Blues for years in MA mandated that a PA could see a patient ONLY if the SP was in the office suite at the moment you were seeing the patient... what a pain and stupid as NP's are fully credentialed. Also the logic defy's me as the PA rate is 85% of the MD rate so in the long run it would save them money! I always try VERY HARD to not bill incident to. Just would rather bill under my PIN for limiting legal exposure and to better reflect me.....

[arlake]

Thank you so much for your help. My SP and I are still trying to navigate through this system. We were told by our billing supervisor that if I see a medicare pt and my SP also sees the patient then we can bill under her PIN without incident to. Does this sound correct? If my SP does not see the patient, but is in the building do we still get reimbursed at 100% or only 85%?

 

Thanks so much! They never teach the insurance side of things in school, so i greatly appreciate your input.

[coloradopa]

Thank you so much for your help. My SP and I are still trying to navigate through this system. We were told by our billing supervisor that if I see a medicare pt and my SP also sees the patient then we can bill under her PIN without incident to. Does this sound correct? If my SP does not see the patient, but is in the building do we still get reimbursed at 100% or only 85%?

 

Thanks so much! They never teach the insurance side of things in school, so i greatly appreciate your input.

Thats not quite correct. If either one of you sees the patient then that person bills under their own number. What determines who gets to bill, is who documents the HPI, PE, and A/P. If the physician is going to do this why do they need you? Basically its easier and safer if you bill for yourself. What it sound like they are trying to do is some form of shared billing which isn't allowed for outpatient billing.

 

Incident to is a special case where the SP has to see the patient for every problem and then you can follow up those problems at 100% as long as the SP is present in the suite.