jmj11 Posted October 26, 2015 Share Posted October 26, 2015 I am in the middle of a physician forum discussion. Someone started by stating that a physician must be in the office when a PA does a procedure . . . or that procedure is not reimbursed. I know that is not true in my state and pointed out that the only situation where the physician must be in the office is with incident to billing. Now a physician from Massachusetts states that in her state physician assistants are not allowed to do procedures unless a physician is in the office. Before I make a fool of myself, is there any way this is true? I know that Massachusetts has their own system but I would like to see that in writing. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted October 26, 2015 Moderator Share Posted October 26, 2015 You say it doesn't exist, they say it does. Burden of evidence on them. Seriously though, I've never heard of such a thing and I doubt it's the case in that state. I could kinda see it if it was Alabama, but not even they do that. Link to comment Share on other sites More sharing options...
Guest JMPA Posted October 26, 2015 Share Posted October 26, 2015 old medicare rules used to reflect something similar, it has long since been changed. certain states require the physician to be present for workers comp visits. Link to comment Share on other sites More sharing options...
jmj11 Posted October 26, 2015 Author Share Posted October 26, 2015 Well here is the state law and the way I read 5.04:4 is clear that it is up to each practice to write their own protocol. How do you read it. Link to comment Share on other sites More sharing options...
DiggySRNA Posted October 26, 2015 Share Posted October 26, 2015 ...it is up to each practice to write their own protocol. That's how I interpreted it too. Keyword....or Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 26, 2015 Moderator Share Posted October 26, 2015 I am in MASS no such law exists I do house calls and procedures (and my doc is no where around) PA can not do "major surgery" with out doc there - but not even sure this is state law or just reality..... Doc's are sometimes ill advised - had a department director that stated I could not do a trigger point, knee injection, shoulder injection or anything with a needle unless she was in the department - I suspect this was more a trying to bill everything under the doc PIN then law. Nnever passed the sniff test to me Feel free to tell the MASS doc that they are wrong..... Link to comment Share on other sites More sharing options...
jmj11 Posted October 28, 2015 Author Share Posted October 28, 2015 I am in MASS no such law exists I do house calls and procedures (and my doc is no where around) PA can not do "major surgery" with out doc there - but not even sure this is state law or just reality..... Doc's are sometimes ill advised - had a department director that stated I could not do a trigger point, knee injection, shoulder injection or anything with a needle unless she was in the department - I suspect this was more a trying to bill everything under the doc PIN then law. N never passed the sniff test to me Feel free to tell the MASS doc that they are wrong..... Yes, I was finally able to convince the group, with the law linked, that they were wrong. I'm just glad I was part of that list serve, otherwise this wrong information would be perpetuated. After I was able to convince them that was not the law, then the physicians started to claim that the problem was that no insurance would pay for procedures done by a PA if the doc was not in the office . . . if not the room. I was able to call them on that as well. I look at every EOB generated by our office and never, ever has a procedure been rejected because a PA (me) did it or because the PA works alone. Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 29, 2015 Moderator Share Posted October 29, 2015 Yes, I was finally able to convince the group, with the law linked, that they were wrong. I'm just glad I was part of that list serve, otherwise this wrong information would be perpetuated. After I was able to convince them that was not the law, then the physicians started to claim that the problem was that no insurance would pay for procedures done by a PA if the doc was not in the office . . . if not the room. I was able to call them on that as well. I look at every EOB generated by our office and never, ever has a procedure been rejected because a PA (me) did it or because the PA works alone. BUT they have to bill under the PA and this only gives the practice 85% instead of 100% if the doc is in the office (but this is REALLY REALLY stretching) The bean counters have likely started this myth to get paid more.... Link to comment Share on other sites More sharing options...
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