- Both the PA and the physician must have a common employer (e.g., same group practice, same hospital, or PA employed by a solo physician).
- The service provided is not a consultation evaluation and management (E/M) service, procedure or a critical care service.
- The physician must provide some face-to-face portion of the E/M visit; simply reviewing and/or signing the patient's chart isn't sufficient to qualify for a shared service.
- Both the PA and the physician's professional services for the patient must be clearly documented on the patient's chart.
- Both the PA and the physician must see the patient on the same calendar day.
Shared Services Billing for PAs: Do You Do It?
September 26th, 2012 2 Min readHow can billing be maximized in the hospital setting? The concept of "incident-to" billing is an outpatient-only application. While physician assistants (PAs) may not bill incident-to in a hospital, they may bill under the physician they are working with and collect 100 percent reimbursement if the shared billing criteria are met.
What is Shared Billing?
Shared billing is a provision that allows a medical service predominately provided by a PA to be billed under the name and Medicare number of the supervising physician at 100 percent, as opposed to 85 percent if the service had been billed under the PA's name and NPI.
While a physician must provide a face-to-face service to a patient in addition to the PA's service for a shared visit to be billed, it is appropriate for the PA to have performed the majority of care (as much as 90 percent, for example) for that patient. As long as the physician has some participation in the care of the patient, the combined services of both the physician and the PA may be attributed to the physician on the claim form.
How Do You Bill?
The Centers for Medicare & Medicaid Services (CMS) rules give PAs and their supervising physicians some flexibility in hospital billing for evaluation and management services.
The requirements, found in Medicare Transmittal 1776 [PDF], allow PAs and physicians who work for the same employer to "share" visits made to patients on the same calendar day by billing their combined work under the physician's NPI number. The reimbursement will then be at 100 percent of the fee schedule, even if the PA performed the majority of the work.
Criteria for Shared Visits (These must all be met and clearly documented in the patient record):
Author
Lisa Shock
Lisa P. Shock, MHS, PA-C, is a seasoned PA who is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs and NPs in the health care system. Contact her at lisa@pushpa.biz