Can ARNPs and PAs see new patients without the participation of a physician?
Yes, but Medicare rules state the ARNP or PA may ONLY bill under their own number and cannot bill under the physician’s number when either 1) performing a service on their own or, 2) for outpatient services only, when combining or splitting an Evaluation and Management Service (E/M) with a physician for: a new patient; a consultation; or an established patient with a new problem. When combining E/M services with a physician that do not fall under the provisions of the “incident to” rules, the bill must be submitted under the name and provider number of the ARNP or PA. It is also important that the ARNP or PA always sign the encounter form when involved in a service. Please be aware that commercial insurers’ rules and, at present, most only pay for services submitted under a physician’s billing number. Such distinctions are the function of billing personnel. Please note that we don’t vary our DOCUMENTATION, we simply expect that billing is done pursuant to the Medicare standards unless
