Mid level providers

Can a CRNP or PA-C bill an admission code (99221-99223)? What if they don't have admitting privileges?

Comments

  • edited May 2017
    Michelle:

    Everything is driven by state scope of practice.

    I am *not* a mid-level expert, but may give you some things to think about and/or stimulate discussion from others.

    I believe the CRNP or PA seeing patients in the hospital setting and employed by the hospital will come out on the cost report (of which I know nothing about).

    If the CRNP or PA works for a group participating with Part B - then admitting privileges will be dictated by the state scope of practice and the job description set up by the group.

    So:

    (1) You need to know if the mid-level has admitting privileges under their licensure in your state, and

    (2) Does the patient's plan credential the mid-level separately for billing purposes.

    We have others who have been on the list in the past that are far more polished than I when it comes to answering your question, and if they don't surface, at least you'll have what you need to investigate further.

    In Maryland, CRNP's and PA's can be in independent practice, but must have a collaborative agreement with an MD. Therefore, if they have a patient that must be admitted, the patient is sent to the hospital and admitted under the collaborative physician's name.

    Hope this helps,

    Karen A. Hurley, BS, CMM, CPC, CNA
    President, HPMSI
    PO Box 409
    Parrish, FL 34219-0409
    Tel: (941) 776-4822
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