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I have been following this forum for some time and have been following the attempts by CRNAs in Louisiana to do pain. Outside of wether or not they should be doing this, I have a question on how they would bill.
I will preface this by saying that I understand PA billing very well and teach classes on this (and by inference NP billing). I have read the Medicare guidlines on anesthesia billing and have what I think is a fair grasp of what is involved. Hopefully some of the anesthsilogists that have a good grasp of this can direct me.
First of all my understanding of pain is mostly on the outpatient basis. There are number of PAs that work with pain specialists (both Physiatry and Anesthesiology). They generally work similarly to any specialty. PA or Physician sees the patient, develops a plan impliments the plan with the necessary input from the physician (in the PAs case).
The billing is pretty straightforward. You can bill for an initial consult and then the follow up visits as well as any procedures. The main way things work around here is that the MD sees the patient and develops the plan. Schedules any procedures and the PAs see the patients in follow up and to manage meds. In this case you could also use incident to billing.
In looking at billing, Medicare allows five entities to bill for consults and follow up visist. These are physician, CNM, CNS, NP, and PA. I see that medicare will issue a NPI and UPIN to CRNAs but I don't see how they can bill for any services done as an outpatient as they are not a qualified provider.
So my question is - are they doing procedures only and billing as anesthesia services or is there another billing route they are using? Or are they doing inpatient work only? Also how would they bill if they did an inpatient or outpatient consult? It is obvious that Medicare never envisioned CRNAs working outside of the OR providing anesthesia services. I am wondering how CRNAs get around this (there have been statements that CRNAs are doing pain in other states).
David Carpenter, PA-C
I will preface this by saying that I understand PA billing very well and teach classes on this (and by inference NP billing). I have read the Medicare guidlines on anesthesia billing and have what I think is a fair grasp of what is involved. Hopefully some of the anesthsilogists that have a good grasp of this can direct me.
First of all my understanding of pain is mostly on the outpatient basis. There are number of PAs that work with pain specialists (both Physiatry and Anesthesiology). They generally work similarly to any specialty. PA or Physician sees the patient, develops a plan impliments the plan with the necessary input from the physician (in the PAs case).
The billing is pretty straightforward. You can bill for an initial consult and then the follow up visits as well as any procedures. The main way things work around here is that the MD sees the patient and develops the plan. Schedules any procedures and the PAs see the patients in follow up and to manage meds. In this case you could also use incident to billing.
In looking at billing, Medicare allows five entities to bill for consults and follow up visist. These are physician, CNM, CNS, NP, and PA. I see that medicare will issue a NPI and UPIN to CRNAs but I don't see how they can bill for any services done as an outpatient as they are not a qualified provider.
So my question is - are they doing procedures only and billing as anesthesia services or is there another billing route they are using? Or are they doing inpatient work only? Also how would they bill if they did an inpatient or outpatient consult? It is obvious that Medicare never envisioned CRNAs working outside of the OR providing anesthesia services. I am wondering how CRNAs get around this (there have been statements that CRNAs are doing pain in other states).
David Carpenter, PA-C
