NPI Numbers > NPI Numbers
Are Physician Assistants required to have NPI numbers?
Kimrhodes0309:
I am having an issue with an insurance claim due to PA's in a specialist's office (dermatologist) not having an NPI number. The doctor's office keeps billing my visit under the doctor's NPI number because of the PA's not having their own. Is that legal, since I was seen by the PA & didn't see the doctor?
Michele:
The PA should have his own NPI for the carriers that do credential PA's separate.
RichardP:
--- Quote from: Kimrhodes0309 on June 06, 2013, 04:31:46 AM ---The doctor's office keeps billing my visit under the doctor's NPI number because of the PA's not having their own. Is that legal, since I was seen by the PA & didn't see the doctor?
--- End quote ---
Yes - this is legal. When any PA does work, they can either bill under their own NPI number (smaller payment from insurance) or bill under the Supervising Physician's NPI number (larger payment from insurance). That is per CMS regulation. I don't know of any commercial carrier that doesn't abide by that, but maybe your carrier doesn't??
A doctor can hire employees who do work for him, and that work is billed under his name and NPI number. That setup is legal. (e.g., nuse gives a shot; doctor bills for it in his name)
I know that Nurse Practitioners and Physician Assistant's can acquire NPI numbers and can do work on their own (when certain conditions are met) and bill with their Type 2 (who gets paid) NPI number. I know they can do this. So far as I know, they are not required to do this.
Is your carrier wanting the PA's Type 1 NPI number (who did the work) in Box 24J of the CMS 1500 form?
Michele:
Sorry, I didn't actually answer your question, but Richard did. :) PA's can and should have their own NPI but as Richard stated they can also bill under the Supervising Physician's NPI. Most larger carriers and Medicare allow this. There are a couple of smaller (actually one that I can think of) in our area that credentials the PA's and wants their NPI on the claim. It's because as Richard stated, the reimbursement is lower so they save money.
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