Can a physician assistant see patients in a nursing facility without a physician signing each encounter? How do we bill this? Can we do wellness visits too?
- A physician assistant or an advanced practice registered nurse (an NP) may see patients independently in a nursing facility but must bill under their own provider number. They may not bill these as incident to or shared services with the physician. You have to bill under the NP/PA number, and receive 85% of the Medicare fee schedule amount.
- Only a physician may bill the initial nursing facility visits 99304-99306 in a skilled nursing facility or nursing facility. (There is an exception to this in a nursing facility who is not employed by the facility). Sometimes, the PA/NP sees the patient at an earlier date than the physician, who comes and does the admission. In that case, the PA/NP bills a subsequent visit, even though the initial has not been billed. This is a Medicare rule.
- I am not aware of any restrictions against billing wellness visits in the nursing facility, provided it is appropriate to do a preventive plan for the patient.
Here is a link to the MedLearn matters article. It discusses frequency of mandated physician visits.
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