Coding & Billing for Physician Assistants: Navigating CMS/Medicare and Commercial Carrier Guidelines

Billing Methodologies: A Deep Dive into Incident to, Split or Shared, and Direct Billing

Healthcare provider shortages are being filled in many areas by Physician Assistants.This is especially true for hospital owned practices.Whether in the hospital rounding, performing procedures or seeing patients in the office, these valuable providers are being seen more and more. CMS/Medicare calls them NPP’s. Other names include Mid-Levels or Physician Extenders. Whatever the name, these valuable providers have three unique methods of billing available to them, per CMS/Medicare. Other commercial carriers add a fourth.  Understanding each of these methods, what the patient care model is for it and deciding which will work best for your practice is imperative to avoid non-compliant billing. The area of billing for NPP’s is one that I have seen where the logic is “because we have always done it that way” and not because of any carrier rules or policies. This type of logic exposes your practice to audits, and possible sanctions if the “traditions way” of billing is not the current compliant way.

CPT for 2024 has seen major changes in their Guidelines for Split or Shared visits. These changes are not surprising but need to be understood to see if your practice is following them in 2024.  CMS/Medicare has also made a major change in their definition of Split or Shared visits and this may create compliance issues if the new Guidelines are not incorporated into your policies and procedures for the care your NPP’s give. 

This timely webinar will give you the valuable updates in Guidelines for your Physician Assistant for 2024 but will also review the other methods of billing for their services. This will ensure that your practice can have compliant documentation, coding and billing of your Physician Assistant’s services.

Webinar Objectives

The three methods of billing for services that CMS/Medicare allows will be discussed in detail with examples of compliant and non-compliant documentation. 

The fourth method that commercial carriers sometimes utilize will also be discussed.

This webinar aims to provide healthcare professionals with a comprehensive understanding of the billing methods available for Physician Assistants (PAs), as recognized by CMS/Medicare and other commercial carriers. By examining the three primary billing methods for PAs—Incident to, Split or Shared, and Direct Billing—participants will gain insights into compliant documentation, coding, and billing practices. Additionally, the webinar will address the nuances of billing under a physician and highlight key updates in the 2024 CPT Guidelines for Split or Shared visits. Attendees will leave with a clear understanding of how to navigate these billing methods to ensure compliance and avoid potential audits or sanctions.

The fourth method that commercial carriers sometimes utilize will also be discussed, providing participants with a comprehensive overview of billing practices for PAs.

Webinar Agenda

• What is the scope of practice for your Physician Assistant – what does scope mean?
• Billing Methods – This will include Guidelines, Policies and Documentation requirements.
  •      Incident to
  •      Split or Shared
  •      Direct Billing
  •      Billing under a physician

Webinar Highlights

• Scope of practice – what is it, where to find it and why should I care
• Incident to billing – what is the physician’s role in this methodology, what documentation is needed and how is it billed
• Split or shard – what is new in 2024 for both CPT and CMS/Medicare rules – how does that change your practice’s model for Physician Assistant services
• Direct Billing – is it as simple as it sounds?
• Physician Billing for PA services – what are the requirements and why can this be a compliance nightmare?

Who Should Attend

Coders, Billers, Office Managers, Office Administrators, Practice Administrators, Physician Assistants