Most payers cover midlevel providers
Most practices bill the same as for physician visits
In addition to allowing the practice to see more patients more efficiently, physician assistants and nurse practitioners can have a positive effect on your practice’s bottom line. Midlevel providers earn far less than physicians, but in most cases, your practice can be reimbursed for services at close to the same level you would charge for physicians.
If you submit claims under the physician assistant or nurse practitioner’s provider number, Medicare will reimburse you for 85% of physician fees. Medicare regulations allow for services of physician extenders to be billed as "incident to" physician services under certain circumstances, meaning reimbursement will be 100% of the physician fee schedule.
In this case, the claim must be submitted under the physician’s provider number and must meet strict Health Care Financing Administration regulations. The physician extender must be an employee of the physician, the physician must perform the initial examination, and the physician must provide direct supervision of the extender.
In its 2001 Work Plan, the Office of Inspector General stated its intention to examine the scope of practice of nurse practitioners, clinical nurse specialists, and physician assistants to ensure that they meet Medicare requirements when their services are billed as "incident to" physician services. (For details, see Physician’s Managed Care Report, December 2000.)
Most insurance companies credential physician assistants and accept claims under the PA’s provider number, says Beverly Kimball, PA-C, a physical therapist with Allina Medical Center in Forest Lake, MN. If the company does not credential the PAs, the practice submits the claim under the supervising physician’s number.
Bristol Street Pediatrics in Elkhart, IN, charges the same amount for nurse practitioner visits as for physician visits. "Every time we get a complaint, we ask them if they feel like they got qualified medical service, and if so, why should they get it for less," says Anne Meden-Cutler, practice administrator.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content