We had the opportunity to speak with a large urgent care group in Florida and something interesting came up during our conversation. The group has been using the same billing company since they started (six years ago) and are preparing to change vendors due to a myriad of issues. We, as we always do, presented the potential client with a litany of questions to better understand the business and current pain points. One of our questions was in regards to how they bill for their 9 physician assistants that they currently employ. Apparently, there current billing company cannot give them a straight answer when it comes to the incident-to question. The group also does not have access to their EOBs as they all go to billing company and the billing company is unwilling to share the information. We informed them that they are likely billing everything incident-to because of the higher reimbursements, why else would the billing company put the walls of secrecy when it comes to this question. The billing company was supposedly credentialing all of the PAs, but I am sure we will find the otherwise once we take over managing this practice.

Okay, so now to the point of this post. The incident-to question led us to the next topic which was of more concern to the urgent care, and that is, the limit on supervising physician assistants. Most of us who have built or managed a large business understand that there are only so many mid-level providers that can legally work under a physician’s license. Unfortunately, most office managers and physicians are unaware of this important fact. Each state varies when it comes to the actual number, but it is usually between 3-5 physician assistants depending on whether or not it is an under-served area. This particular urgent care group had a total of 9; yes, nine physician assistants working under the license of their Medical Director. Talk about red flags. The physician has repeatedly asked the group if the PAs were billing under him and the group has been unable to provide him with an answer because of their billing situation. As it turns out, this particular urgent care group is in Florida and is not located in an MUA. This means means that the maximum number of PAs that the physician can legally supervise is only 4 (four).