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Physician Assistant

Peter Posted Fri 11th of November, 2011 17:30:01 PM

Our practice has both MD and a PA. The PA has both his Medicare and Medicaid numbers. Do we have to file under his numbers or can we file under the practice? I understand that when our MD is out, we file under our PA's numbers.

SuperCoder Answered Fri 11th of November, 2011 21:31:50 PM

Any entity that files claims electronically, checks benefits eligibility online, or receives payments electronically needs an NPI.
Let's take Dermatology Practice as Example:-
A dermatology practice submitting claims electronically to payers (even if they are submitted through a billing service) must have an NPI.
-A solo dermatologist: If you are a solo dermatologist, your individual NPI also is the practice's NPI. You will only apply for and receive one NPI.
-Groups: If a dermatologist and his or her colleagues do not file claims under a group number, they will have to file under their own NPI. Even if a dermatology practice does file under a group number, the individual physicians who render billed services must be identified on electronic claims submitted to both Medicare and private payers, so they should obtain individual NPIs as well. If you participate in Medicare, you must use the NPI as your ID number on all claim forms, including paper; all health plans will eventually require the NPI.

-Consulting physicians: Any dermatologist who refers patients to a hospital or accepts consultation requests from other physicians will likely need an NPI, as the physicians with whom they coordinate care will need to include the dermatologist's NPI on claim forms to be paid.

-Non-physician providers: Besides physicians, other health care providers, including nurse practitioners and physician assistants, who now file claims or have their services billed under a legacy number need NPIs.

Peter Posted Fri 11th of November, 2011 23:09:59 PM

Both MD and PA have NPI numbers. When the physician is in the office and the PA sees the patient, do we use the physicians numbers or do we have to file using the PA's? I understand when the physician is out of the office, we must use the PA's but isnt it different when the MD is in office??

SuperCoder Answered Sat 12th of November, 2011 02:56:03 AM

When the MD is in the office and PA is providing service, then it can be considered as Incident-To service and be billed under MD's NPI, if the Initial Service to the patient had been provided by the MD earlier and the subsequent service was provided by PA when MD is present in the office.

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