azpa Posted January 8, 2012 Share Posted January 8, 2012 Hi - I am very new to this Forum but came across it when I was trying to find information on starting my own PA business of first assisting. Are there any PAs out there who do this? I know many first assistants have their own business doing this and claim they make a lot of money. I know as PAs we are able to assist in more surgeries which would include medicare patients. I have worked as an employee for so long that I have no idea where to start or what I need to get this going. Do I need every surgeon I assist to sign papers to be my SP when working with them? How do I get contracted with insurance companies or do I need to since I already am contracted through my current job? I have a very knowledgeable biller who seems to be somewhat familiar with working with PAs in this situation but she claims it is not too complicated. I appreciate any feedback or advice. Thanks a bunch!:;-): Link to comment Share on other sites More sharing options...
Francee Posted March 18, 2012 Share Posted March 18, 2012 Oooh Me too!! I hope someone can share some input soon. Here's what I found on another forum site: http://forums.studentdoctor.net/showthread.php?t=322139... ..I'll update as I find more. Link to comment Share on other sites More sharing options...
Francee Posted March 18, 2012 Share Posted March 18, 2012 Oooh Me too!! I hope someone can share some input soon. Here's what I found on another forum site: http://forums.studentdoctor.net/showthread.php?t=322139... ..I'll update as I find more. Link to comment Share on other sites More sharing options...
jmj11 Posted March 18, 2012 Share Posted March 18, 2012 When did SDN create a page for NPs and PAs??? Anyway, back to the original question, while I don't first assist, I do own my own practice. You WILL have to credential with each insurance company if you are going to direct bill for your services. If you work as contractor for the hospital or the surgeons, where they pay your directly for your services, but then they turn around and bill the insurances, then they will have to credential for their practice setting. Regarding the SP situation, you will either have to list each physician as a SP on your practice agreement, unless one surgeon is willing to act as your SP for all cases, including those performed by others. This will mean that his/her malpractice insurance would have to accept that arrangement, that you are first assisting for other surgeons when the primary SP is not in the OR. Some malpractice insurers would not allow that. So, even if you have your own coverage, the SP will have to have his/her coverage for you as well and that could be difficult if you are acting as a First Assistant on cases where they are not present. But I'll leave that up to those who know much more about it than I do. Link to comment Share on other sites More sharing options...
jmj11 Posted March 18, 2012 Share Posted March 18, 2012 When did SDN create a page for NPs and PAs??? Anyway, back to the original question, while I don't first assist, I do own my own practice. You WILL have to credential with each insurance company if you are going to direct bill for your services. If you work as contractor for the hospital or the surgeons, where they pay your directly for your services, but then they turn around and bill the insurances, then they will have to credential for their practice setting. Regarding the SP situation, you will either have to list each physician as a SP on your practice agreement, unless one surgeon is willing to act as your SP for all cases, including those performed by others. This will mean that his/her malpractice insurance would have to accept that arrangement, that you are first assisting for other surgeons when the primary SP is not in the OR. Some malpractice insurers would not allow that. So, even if you have your own coverage, the SP will have to have his/her coverage for you as well and that could be difficult if you are acting as a First Assistant on cases where they are not present. But I'll leave that up to those who know much more about it than I do. Link to comment Share on other sites More sharing options...
burnpac Posted March 22, 2012 Share Posted March 22, 2012 I currently first assist through my own corporation. I direct bill insurance companies, and have not had any problem getting paid for procedures that allow a first assist. My practice is limited to one facility, and the majority of the patients come from our hospital's IPA (I'm the first PA to have a contract with them), Kaiser, and workers' comp. We do a smattering of cosmetic cases (which of course pay cash, so billing is not an issue here), and are working to increase this part of the practice. 1. Some procedures pay well, but you are not going to get rich doing this in this day and age. 2. Your state's regulations dictate reporting requirements for relationships with SPs. I can only speak for California, where I can be supervised by any physician, as they did away with a SP license some time ago. As long as I have a valid delegation of services agreement with my SP, I can work with any SP in any setting in Ca without notifying anyone. 3. I haven't had to go through any credentialling process outside of my hospital's medical staff, and none of the carriers have asked to credential me prior to paying me directly. Inquiries have been limited to my tax ID #. 4. Your biller needs to be very familiar with billing for PA first assist, or you will get a lot of denials for coding and modifier mistakes. 5. Your procedure coding must exactly match what the surgeon bills or you will be doing a lot of rebilling. My surgeon and I use the same biller so we avoid the issue. 5. You don't need to incorporate, but it has been helpful in my situation to deal with all the taxation and accounting issues. For example, if you bill as an individual, there is mandatory withholding that you can't avoid. But, if the payment is to a corporation, there is no withholding on the front end. Of course you have to pay taxes on corporate profit and distributions, but my goal each year is to have none. Hope this helps. Link to comment Share on other sites More sharing options...
burnpac Posted March 22, 2012 Share Posted March 22, 2012 I currently first assist through my own corporation. I direct bill insurance companies, and have not had any problem getting paid for procedures that allow a first assist. My practice is limited to one facility, and the majority of the patients come from our hospital's IPA (I'm the first PA to have a contract with them), Kaiser, and workers' comp. We do a smattering of cosmetic cases (which of course pay cash, so billing is not an issue here), and are working to increase this part of the practice. 1. Some procedures pay well, but you are not going to get rich doing this in this day and age. 2. Your state's regulations dictate reporting requirements for relationships with SPs. I can only speak for California, where I can be supervised by any physician, as they did away with a SP license some time ago. As long as I have a valid delegation of services agreement with my SP, I can work with any SP in any setting in Ca without notifying anyone. 3. I haven't had to go through any credentialling process outside of my hospital's medical staff, and none of the carriers have asked to credential me prior to paying me directly. Inquiries have been limited to my tax ID #. 4. Your biller needs to be very familiar with billing for PA first assist, or you will get a lot of denials for coding and modifier mistakes. 5. Your procedure coding must exactly match what the surgeon bills or you will be doing a lot of rebilling. My surgeon and I use the same biller so we avoid the issue. 5. You don't need to incorporate, but it has been helpful in my situation to deal with all the taxation and accounting issues. For example, if you bill as an individual, there is mandatory withholding that you can't avoid. But, if the payment is to a corporation, there is no withholding on the front end. Of course you have to pay taxes on corporate profit and distributions, but my goal each year is to have none. Hope this helps. Link to comment Share on other sites More sharing options...
cinntsp Posted March 22, 2012 Share Posted March 22, 2012 When did SDN create a page for NPs and PAs??? 12 years ago, lol. Link to comment Share on other sites More sharing options...
cinntsp Posted March 22, 2012 Share Posted March 22, 2012 When did SDN create a page for NPs and PAs??? 12 years ago, lol. Link to comment Share on other sites More sharing options...
tinylilron Posted August 10, 2012 Share Posted August 10, 2012 I am confused. Clearly PAs can have their own practice. I was just at an open house for a PA graduate school at Arcadia University and I believe the director said that PAs do not open up their own practices, only NPs and MD/DOs could do that. However, I see that several PAs on this forum are opening up their own practices. Is AAPA against PAs having their own practices? I am currently applying to PA programs and I have a couple of questions. Can PAs who are very competent and successful in their lateral movements into various fields incorporate the various skills that they used in their own practice? For instance, I am interested in serving in an area that is under-served and may lack a lot of health care providers. As a PA do I have to stick to practicing in only one field of medicine such as pediatrics or can I do gerontology too (for example), especially in an under-served area where health care providers are needed? I have one island in mind which is part of the US which residents complain that the access to health care is very poor and I am sure there are several similar locations in the US and beyond. Do I need to hire a doctor to be part of my practice/clinic if I decide to practice medicine there? Does the doctor need to be a resident of the island/area as well? Thank you for all your help. I want to make sure that I have a good understanding of the PA profession before I submit my application for the graduate programs. (I am interested in PA/MPH dual degree programs by the way and I also hope to be able to do community based research to improve community health care, etc.) I appreciate all your feedback. Thank you for all your help, Verónica Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted August 10, 2012 Moderator Share Posted August 10, 2012 I am confused. Clearly PAs can have their own practice. I was just at an open house for a PA graduate school at Arcadia University and I believe the director said that PAs do not open up their own practices, only NPs and MD/DOs could do that. However, I see that several PAs on this forum are opening up their own practices. Is AAPA against PAs having their own practices? I am currently applying to PA programs and I have a couple of questions. Can PAs who are very competent and successful in their lateral movements into various fields incorporate the various skills that they used in their own practice? For instance, I am interested in serving in an area that is under-served and may lack a lot of health care providers. As a PA do I have to stick to practicing in only one field of medicine such as pediatrics or can I do gerontology too (for example), especially in an under-served area where health care providers are needed? I have one island in mind which is part of the US which residents complain that the access to health care is very poor and I am sure there are several similar locations in the US and beyond. Do I need to hire a doctor to be part of my practice/clinic if I decide to practice medicine there? Does the doctor need to be a resident of the island/area as well? Thank you for all your help. I want to make sure that I have a good understanding of the PA profession before I submit my application for the graduate programs. (I am interested in PA/MPH dual degree programs by the way and I also hope to be able to do community based research to improve community health care, etc.) I appreciate all your feedback. Thank you for all your help, Verónica He may have been speaking for his area, as it is different for some states. You can open up your own practice with a supervising physician hired by you. Then you can practice whatever he does. Link to comment Share on other sites More sharing options...
jmj11 Posted August 10, 2012 Share Posted August 10, 2012 He may have been speaking for his area, as it is different for some states. You can open up your own practice with a supervising physician hired by you. Then you can practice whatever he does. And, as a practice owner, don't sense any negativity from the AAPA regarding practice ownership. They seemed to be on our corner on this issue, even though they might disagree with me on the name issue. Link to comment Share on other sites More sharing options...
Moderator ventana Posted August 10, 2012 Moderator Share Posted August 10, 2012 if you are going to bill medicare there is a few issues 1) PA's are not allowed to direct bill for their services - you MUST bill through a corp or a Doc that is using his own SSN as their billing info 2) medicare requires at least 1% of practices being owned by a non-pa- hence your SP will likely need to own 1% and you can own 99% 3) If you are going to do you own billing (you could be a 1099 employee of your SP but they you loose ALL control over your billings) you MUST incorporate - 4) best way - for a PC - 99% PA ownership 1% SP ownership - carry all your own insurances, do all your own billing, run your own company - pay your SP 5-8% of gross collections - but try not to pay his/her malpractice insurance as that is big $$$$ plan plan plan Link to comment Share on other sites More sharing options...
balbak Posted September 30, 2012 Share Posted September 30, 2012 im a PA from CA and i was working in private practise for cardiac surgery for 7 years. now im trying to start PA first assist independently. I dont know where to start, however. Im trying to obtain my privileges in 3 hospitals. I do have a supervising physician. In all 3 hospitals im requesting a non physical first assist as well as out patient surgical centers. I do have my own malpractice insurance. How do i start to assist? do i need to get the contract with insurances so i can get reimbursed Should i talk to the biller of my supervising physician? Can anyone advise me what first steps i need to make? Link to comment Share on other sites More sharing options...
niraray Posted November 16, 2012 Share Posted November 16, 2012 "4) best way - for a PC - 99% PA ownership 1% SP ownership - carry all your own insurances, do all your own billing, run your own company - pay your SP 5-8% of gross collections - but try not to pay his/her malpractice insurance as that is big $$$$" This varies state to state. In CA, an MD has to own 51% of a corporation in order for the corp to be a "Medical Corporation." Only Medical Corporations have payable Tax ID #'s by Medicare, Blue Cross and Blue Shield. Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 17, 2012 Moderator Share Posted November 17, 2012 "4) best way - for a PC - 99% PA ownership 1% SP ownership - carry all your own insurances, do all your own billing, run your own company - pay your SP 5-8% of gross collections - but try not to pay his/her malpractice insurance as that is big $$$$" This varies state to state. In CA, an MD has to own 51% of a corporation in order for the corp to be a "Medical Corporation." Only Medical Corporations have payable Tax ID #'s by Medicare, Blue Cross and Blue Shield. Are you positive of this? In MASS you can have a medical PC as long as each share holder has to be a licensed professional - MD DO NP PA all are okay 51% would mean that it by default would be a medical corp - but I wonder if with permission of the PA board and medical board you would be able to incorp with a minority doc owner it really important that you contact an attorney that is really well versed and even then you will need to pay them more money to research and make sure that you get them to give the end all answer - you are breaking new ground and have to willing to truly find out what the law says and not what people "think" Link to comment Share on other sites More sharing options...
Hemegroup Posted November 17, 2012 Share Posted November 17, 2012 "4) best way - for a PC - 99% PA ownership 1% SP ownership - carry all your own insurances, do all your own billing, run your own company - pay your SP 5-8% of gross collections - but try not to pay his/her malpractice insurance as that is big $$$$" This varies state to state. In CA, an MD has to own 51% of a corporation in order for the corp to be a "Medical Corporation." Only Medical Corporations have payable Tax ID #'s by Medicare, Blue Cross and Blue Shield. This is correct. Link to comment Share on other sites More sharing options...
Contrarian Posted November 17, 2012 Share Posted November 17, 2012 you are breaking new ground and have to willing to truly find out what the law says and not what people "think" Most VALUABLE sentence on this entire website... For me to do what I'm doing... I had to "Educate" quite a few licensed, attorneys and healthcare personnel who were presumably trained in the business. I had lots of folks raising flags and trying to tell me what I couldn't do... based upon what they "THINK" the law says or means... Thing is... fortunately for me... in the 1980s, when I was a young soldier, full of "piss and vineger"... and getting in all sort of trouble on various military bases and in South America and Europe, I had a "Old-Wise-Fatherly" platoon sergeant take me under his wing and teach me ... Whenever I'd do something stoooopid... instead of putting me infront of the chain of command and ruining me, he would come up with some really creative ways to punish me... that always resulted in me learning a valuable lesson. One such lesson was, "He who truely knows the rules... RULES." So I was taught at the ripe ole age of 19, that it is imperative that you personally read, KNOW, under/overstand the rules (AR 670-1 for example). Why...????? Because you have to KNOW them to bend/manipulate them to your advantage... or to know when those in assumed authority positions are breaking them, disregarding/ignoring them, or simply making up schitt to maintan dominion... Years later... this understanding helped at various times when school (Paramedic/LPN/RN/PA program) officals tried to exert their will, based upon personal preferences and biases (Not officially codified in "the Rules") upon the students, and also helped a few times when law enforcement officials would "pull a stunt"... and take liberties in the face of "Liberty." Why....??? Because I've worked in healthcare organizations that initially held a "dim view" of PAs because the nurses/NPs in the administration had the organization convinced that EVERY document produced by a PA needed to be co-signed... in this state where the actual written law clearly states that there is NO co-signature requirement of PA-Cs...:heheh: No one bothered to look at the actual PA practice act... and I cleared that schitt up real quick by simply printing out the applicable paragraphs and submitting them to a PA friendly SP (Actually, I made 20 copies, used a bright orange highlighter on the pertinent parts, and put one in EVERY one of the physicians mailboxes that worked there. So that they would know, and could stop whining about "being required by law" to co-sign any/all of the PAs documentation... and stop using that as a reason to only hire poorly trained NPs instead of PAs)... Moral of the story... YOU... as a professional who needs to know where the professional boundries are in your practice... needs to personally read EVERY word of EVERY state law and state RULE that pertains to and/or directs the practice of medicine by PAs in the state you plan to practice in. YOU need to OVERstand the laws that govern/promote/restrict your practice...!!! So when someone trys to restrict your practice and says, "You can't do that"... Either you already knew that, or you can confidently say, "according to paragraph X of rule x... yes I can"... Or... at the very least, politely say... "Please show me the LAW that states I can't... :wink: Just a few thoughts.... Contrarian Link to comment Share on other sites More sharing options...
zepoPA Posted November 17, 2012 Share Posted November 17, 2012 This varies state to state. In CA, an MD has to own 51% of a corporation in order for the corp to be a "Medical Corporation." Only Medical Corporations have payable Tax ID #'s by Medicare, Blue Cross and Blue Shield. Indeed CORRECT. The California Med Association has made sure that Medical Corporations remain 51% owned by MDs. A lot of debate for many years, but so far, the above remains a fact. Anyone who wishes to bill third party payers, must have "in legal documents", at least, 51% MD ownership. Let me repeat: "in legal documents", at least... Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 17, 2012 Moderator Share Posted November 17, 2012 Most VALUABLE sentence on this entire website... For me to do what I'm doing... I had to "Educate" quite a few licensed, attorneys and healthcare personnel who were presumably trained in the business. I had lots of folks raising flags and trying to tell me what I couldn't do... based upon what they "THINK" the law says or means... Thing is... fortunately for me... in the 1980s, when I was a young soldier, full of "piss and vineger"... and getting in all sort of trouble on various military bases and in South America and Europe, I had a "Old-Wise-Fatherly" platoon sergeant take me under his wing and teach me ... Whenever I'd do something stoooopid... instead of putting me infront of the chain of command and ruining me, he would come up with some really creative ways to punish me... that always resulted in me learning a valuable lesson. One such lesson was, "He who truely knows the rules... RULES." So I was taught at the ripe ole age of 19, that it is imperative that you personally read, KNOW, under/overstand the rules (AR 670-1 for example). Why...????? Because you have to KNOW them to bend/manipulate them to your advantage... or to know when those in assumed authority positions are breaking them, disregarding/ignoring them, or simply making up schitt to maintan dominion... Years later... this understanding helped at various times when school (Paramedic/LPN/RN/PA program) officals tried to exert their will, based upon personal preferences and biases (Not officially codified in "the Rules") upon the students, and also helped a few times when law enforcement officials would "pull a stunt"... and take liberties in the face of "Liberty." Why....??? Because I've worked in healthcare organizations that initially held a "dim view" of PAs because the nurses/NPs in the administration had the organization convinced that EVERY document produced by a PA needed to be co-signed... in this state where the actual written law clearly states that there is NO co-signature requirement of PA-Cs...:heheh: No one bothered to look at the actual PA practice act... and I cleared that schitt up real quick by simply printing out the applicable paragraphs and submitting them to a PA friendly SP (Actually, I made 20 copies, used a bright orange highlighter on the pertinent parts, and put one in EVERY one of the physicians mailboxes that worked there. So that they would know, and could stop whining about "being required by law" to co-sign any/all of the PAs documentation... and stop using that as a reason to poorly trained NPs instead of PAs)... Moral of the story... YOU... as a professional who needs to know where the professional boundries are in your practice... needs to personally read EVERY word of EVERY state law and state RULE that pertains to and/or directs the practice of medicine by PAs in the state you plan to practice in. YOU need to OVERstand the laws that govern/promote/restrict your practice...!!! So when someone trys to restrict your practice and says, "You can't do that"... Either you already knew that, or you can confidently say, "according to paragraph X of rule x... yes I can"... Or... an the very least politely say... "Please show me the LAW that states I can't... :wink: Just a few thoughts.... Contrarian very well put lots of people "think they know the law" very few people actually do...... don't be afraid to challenge those that think with the the "facts" any atty is expensive but worth their weight to dispell those that "think" they know more then they do As for CA and 51% - okay so a medical corp has to be 51% MD/DO but is their a law stating that a C-Corp can NOT practice medicine - "Prevention of the corporate practice medicine" if they do not exclude this then you might be able to be a C-Corp - elect Sub S - incorp with 1% doc owner and still bill - very convultued - need atty - then their is the whole incorporate in a different state and get a guest certificate in the other state..... not sure, need legal advise Link to comment Share on other sites More sharing options...
Arizona Dave Posted June 7, 2013 Share Posted June 7, 2013 We use PA4FREE.COM for our billing. Didn't feel like battling with insurance companies and they will do it for you. Def recommend them Link to comment Share on other sites More sharing options...
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