Medicare's PA Reimbursement Discrimination

[Rock Solid]

Please google Medicare Integrity Manual Chapter 15

 

Scroll down to page 78 and read about how Nurse Practitioners can directly contract with and get paid by Medicare.  Section number 15.4.4.8

 

Then scroll to page 83 and read how Medicare does NOT allow PAs to contract with nor receive direct payment from Medicare.  Section number 15.4.4.11

 

This madness has to stop.  I know what type of PA education I received and it consisted of sharing medical school classes, taking medical school exams, and being held to medical school standards.  I also know that my clinical rotations were long days and nights on the wards with medical students, residents, and attendings. 

While I have many NP collegues, you cannot compare the training of a PA and NP.  Medical model vs nursing model, clinical trial evidence vs nursing theory, demanding rotations vs weekend prn rotations so long as the NPs get there hours signed off on.  Come on guys, this is ludicrous and down right insulting.  I am not asking to be superior to NPs, though I think we are, I am only asking to have a level playing field.

 

 

 

[LKPAC]

I agree. Have you contacted AAPA?  What are they doing about this?

[dmdpac]

I agree. Have you contacted AAPA?  What are they doing about this?

 

This was my first thought, too.

[Guest Paula]

We are dependent practitioners and assistants.  Why do you think we are discriminated against? AAPA just doesn't seem to have the will and focus to really advocate for PAs where it counts, IMHO.

 

Call or email them and ask them to start a process to change the CMS rules.   Perhaps Obama could take his phone and his pen and change the law in one fell swoop as he threatens to do (and does) in other areas of government.  

 

CMS rules have worsened since ACA and one rule is the one that does not allow PA/NP to sign our own DME orders.  Must be signed off by a physician to reduce fraud.  LOL!

[LT_Oneal_PAC]

We are dependent practitioners and assistants. Why do you think we are discriminated against? AAPA just doesn't seem to have the will and focus to really advocate for PAs where it counts, IMHO.

 

Call or email them and ask them to start a process to change the CMS rules. Perhaps Obama could take his phone and his pen and change the law in one fell swoop as he threatens to do (and does) in other areas of government.

 

CMS rules have worsened since ACA and one rule is the one that does not allow PA/NP to sign our own DME orders. Must be signed off by a physician to reduce fraud. LOL!

I doubt Obama would do that since he has used fewer executive orders than any other president since FDR.

[Guest Paula]

His pen is worthless.

[coloradopa]

Please google Medicare Integrity Manual Chapter 15

 

Scroll down to page 78 and read about how Nurse Practitioners can directly contract with and get paid by Medicare.  Section number 15.4.4.8

 

Then scroll to page 83 and read how Medicare does NOT allow PAs to contract with nor receive direct payment from Medicare.  Section number 15.4.4.11

 

This madness has to stop.  I know what type of PA education I received and it consisted of sharing medical school classes, taking medical school exams, and being held to medical school standards.  I also know that my clinical rotations were long days and nights on the wards with medical students, residents, and attendings. 

While I have many NP collegues, you cannot compare the training of a PA and NP.  Medical model vs nursing model, clinical trial evidence vs nursing theory, demanding rotations vs weekend prn rotations so long as the NPs get there hours signed off on.  Come on guys, this is ludicrous and down right insulting.  I am not asking to be superior to NPs, though I think we are, I am only asking to have a level playing field.

Its been like that since 1987. You just noticed it now? The reality is for 98% of PAs and NPs it makes no difference. You fill out a form that assigns your collection rights to whomever you work for. For the 2% of PAs that own their own clinic it can be painful, but you can assign your collections to a clinic (that you own) and bill. Tons of ways around this. Makes no difference in reality. 

[Rock Solid]

Its been like that since 1987. You just noticed it now? The reality is for 98% of PAs and NPs it makes no difference. You fill out a form that assigns your collection rights to whomever you work for. For the 2% of PAs that own their own clinic it can be painful, but you can assign your collections to a clinic (that you own) and bill. Tons of ways around this. Makes no difference in reality.

 

1). Well I guess I did just notice. I wasn't quite interested in reading the medicare manual in 1987. Was to busy being a 13 yo.

2). It does matter. Especially since we are continuously being compared with NPs yet are not recognized nor rewarded by medicare in doing the same work that NPs do.

2). You are not correct on your statement that there are many way around this. To reassign your benefits both you and the supplier (clinic) have to already be enrolled in medicare. Since they don't let you be a sole proprietorship in your company then your company will never be enrolled and thus you have no company recognized by medicare to reassign your benefits to.

[Guest Paula]

Can anyone answer this question?  A PA is enrolled in medicare, works in FP at an FQHC.  The physician thought he was enrolled but it came to light he hadn't been for years.  The PA is asked to sign for DME for the physician by the Home Medical Supplies company and was told by the nurses that the supply co said it was ok.  PA signs once then gets more requests, and refuses to sign.  The PA has a conversation with the HMS company regarding this as says "I believe I am being asked to sign fraudulently so am refusing to sign any orders, plus this one patient I have never seen and know nothing about her condition."

 

The HMS company says, oh, we made a mistake.  We will check with our legal department.  We will have to take back the O2, wheelchair and walker and CPAP machine from those pts.  Just shred that last request because you didn't do a F-F visit with the pts.  We think you can still do the F-F, sign it and then have the MD c0-sign.

 

The PA then queries:  If the MD is not enrolled in PECOS then is it still allowed for him to sign the F-F visit of a PA for CMS purposes?

 

Dunno.  We will check.

 

The PA:  I will email AAPA. 

 

The PA now concerned with fraud.....and the new knowledge that the MD has not been enrolled in medicare for 5 years!!!!  Unknown to either of the PA/MD.  MD actually found out 6 mos ago and PA just found out 1 week ago.  MD says it takes 3  more months to get enrolled....apparently a 9 month waiting period. 

 

Oh, oh.  Is the PA in trouble?  Quaking here.  And had a huge argument with the MD. The PA also requested at the beginning of employment that NO incident to billing be done for the PA.  Will be checking this out to verify next week.