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PolakPA

Michigan Reimbursement Questions

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I know that private practice reimbursements are not the best from third-party payers for PAs. I was wondering if the following piece of legislation can aid with this in Michigan for private family practice:

 

THE NONPROFIT HEALTH CARE CORPORATION REFORM ACT (EXCERPT)

Act 350 of 1980

 

 

550.1401d Services performed by physician's assistant; reimbursement; conditions; applicability of section; supervision by physician; definitions.

Sec. 401d.

 

(1) Subject to subsections (2) and (3), if a health care corporation group or nongroup certificate provides for health care benefits for services performed by a physician's assistant, those benefits or reimbursement for those benefits at the prevailing rate shall not be denied if the services were performed by a physician's assistant acting within the scope of his or her license and provided that the following are met:

 

(a) If the services were performed by a physician's assistant working for a physician or facility specializing in a particular area of medicine, a physician that specializes in that area of medicine was physically present on the premises when the physician's assistant performed the services.

 

(b) If the services were performed by a physician's assistant working for a physician or facility engaging in general family practice, a physician need not have been physically present on the premises when the physician's assistant performed the services so long as a consulting physician is within 150 miles or 3 hours' commute to where the services are performed.

 

(2) This section applies to a physician's assistant who performs services in any of the following:

 

(a) A county with a population of 25,000 or less.

 

(b) A certified rural health clinic.

 

© A health professional shortage area.

 

(3) For purposes of subsection (1), a physician supervising a physician's assistant shall do so from within Michigan or from a state bordering Michigan.

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