Rules on extender billing procedures can vary widely
Large growth expected in physician assistants
As more practices increase their use of nurse practitioners and physician assistants to increase productivity, it becomes even more important that they correctly code and bill Medicare and private payers for their services.
Some 66,000 physician assistants currently work in various health care settings nationwide, according to an estimate by the Bureau of Labor Statistics. The American Academy of Nurse Practitioners places the present number of nurse practitioners at about 70,000. By 2008, the government predicts the ranks of physician assistants will jump by nearly half again, with similar growth among nurse practitioners.
When it comes to commercial billing, each insurer has its own particular way of treating physician extenders. "Every insurer has a different application form; the policy by which you code is different, and there’s no set standard," notes family physician Baretta Casey, MD, of Pikeville, KY. However, there are some basic billing principles that tend to be common to all kind of payers.
Billing methods
The first thing you want to determine is whether the extender’s services are being billed to the physician services or billed independently.
• Direct billing. If they are to be billed independently, this is known as direct billing. Here the physician extender bills for his or her services using his or her own provider number. Physician extenders can obtain a provider identification number by filling out the Centers for Medicare and Medicaid Services form 855 for general enrollment, which is available on-line at www.hcfa.gov/medicare/enrollment/forms/. Services billed for independently by a physician extender are reimbursed at 85% of the physician’s fee.
• Incident to. Physician extender services can also be billed "incident to" physician services under Medicare. These services are submitted to Medicare under the physician’s provider number and are reimbursed at 100% of the Medicare fee schedule for physicians.
Note: To qualify for "incident to" billing, the services performed by the physician extender must first meet several requirements, says Todd Welter, a consultant with Medical Group Management Association in Englewood, CO.
To bill a physician extender’s services as "incident to":
— the physician extender must be employed by the physician;
— the physician must perform the initial examination of the patient;
— the physician must directly supervise the physician extender who treats the patient.
When it comes to commercial insurers, some require physician extender services to be billed using the physician extender’s provider number, and others require physician extenders to be billed under the physician’s provider number. Even others, including Medicare, allow both direct and "incident to" billing, depending on the circumstances.
If you are not sure how a particular payer wants to be billed, call its director of provider relations for details. Also be aware that state law can influence extender billing procedures. When in doubt about what to do, most experts advise you to follow Medicare’s regulations for billing physician extenders.
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