When a support professional provides a service in a physician's office, it usually must be billed as if the physician had provided the service himself or herself. Such services are reimbursed at the physician's rate and are known as services rendered incident to the physician's professional services. First, the physician must directly supervise the support professionals. Direct supervision in the office setting does not mean that the physician must be present in the same room. But the physician must be in the office suite and immediately available to provide assistance and direction throughout the time the aide is performing services.
Many state laws permit certain support professionals to operate far more independently.
And for a while some Medicare carriers tacitly condoned this looser supervision. It doesn't help that the Health Care Financing Administration is mute on many of the specifics about the proper role of nonphysicians treating Medicare patients. Medicare officials do acknowledge that Medicare could appropriately be billed for services provided by a PA when the physician did not see the patient. Medicare does pay specifically for services provided by a nonphysician during a minimal office visit with an established patient, even when a physician isn't present. However, officials in the Office of Coverage and Eligibility Policy have noted that the types of services thus covered by Medicare depend on the patient's history, the prior involvement of the physician and the level of services provided.