decisionhealth Newsletters, Coder Pink Sheets - 2004 Issue 1 (January)
PAs and new patients
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Article Overview
This article explains a common Medicare billing issue in physician practices: how services performed by physician assistants and other non-physician providers are handled when new patients are seen or when established patients present with new problems. It is aimed at coders, billers, and practice managers who need to understand the broad framework of incident-to billing, supervision, and allowable payment levels under Medicare.
Why This Topic Matters
The article matters because it addresses whether a practice can seek full Medicare payment or must bill at a reduced allowable when a non-physician provider sees a patient first. It highlights compliance risk for practices that bill under the wrong framework.
Article Sections
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Medicare billing for PA visits with new patients
Introduces the office-practice scenario and the general Medicare billing issue involving physician assistants and new patients.
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Incident-to billing and physician involvement
Summarizes the discussion of Medicare incident-to billing and the role of physician supervision and initial physician involvement in the care plan.
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Established patients with new problems
Addresses how billing may differ when an established patient presents with a new issue that requires physician evaluation.
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Operational considerations for practice workflow
Notes the practical staffing and billing implications for offices that use non-physician providers to manage routine care while reserving physicians for more complex cases.
What You Will Learn
- How Medicare billing is discussed when physician assistants see patients first
- What the article says about incident-to billing in a practice setting
- How new problems in established patients are presented in the billing discussion
- Why practices may consider different billing approaches for non-physician provider services
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Physician office administrators
- Ob-Gyn practice staff
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