Can we bill for a PA employed by the hospital?

Can we bill for a PA employed by the hospital?

September 5, 2019

Question:
Our local hospital employs Physician Assistants. When our doctors are on call for the ED, the hospital-employed PA will call our doctor for their opinion and advice after seeing and evaluating the patient. At times our physician will go to the ED, see the patient and perform surgery. The question my doctors have is can they bill an E/M service for the visit performed by the PA?

Answer:
Under Medicare rules, a physician cannot bill for the work performed by a hospital-employed PA. In the scenario you present, if the physician goes to the ED to see the patient, in order to report an E/M service he or she would be required to perform and document the history, examination, and medical decision-making, and any E/M code used for billing could be based only on their documented note.

When the physician and PA are employed by the same group practice, Medicare allows a method of reporting called “Split/Shared”. Under these rules, in the hospital setting a physician and PA can combine the work they perform on the same day to report a single E/M code when the physician provides a face-to-face portion of the encounter. In your scenario, the physician and PA are not employed by the same group, and the option for reporting E/M services in a split/shared format is not applicable.

*This response is based on the best information available as of 09/05/19.

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