Medicare and PA owned practice question

[AERogers]

I am in the process of starting my own practice (a PLLC) in NC. Per the NC Medical Board, a PA can own 100% of a practice. Per the AAPA, it's 99%, with each state's rules taken into consideration. I have structured a contract with my supervising MD for 97/3 ownership, but I am having issues now with credentialing for Medicare. The company I've contracted with is telling me I can't own that much of the practice. 

Can someone provide some insight? If I'm investing 100% financially and will be the only on-site provider, I don't want to hand over 50+% of my business to someone else. There must be a way to get this to work.

Thanks,

Anita Rogers

[ventana]

you need a new billing company, they stink and are dead wrong (and it is not AAPA making decisions it is CMS - and that only applies if you are billing medicare)

 

I had a practice (still around on paper)

I owned 99%

doc owned 1%

medicare guidelines says PA can own 99%

State laws sometimes have rules about it, but you have already researched that side

 

tell you billing co to figure it out, or get a new company

 

[SophiaG]

Hi I have started my own billing and collection company just for this purpose. I would be more than happy to help you with this.

Please let me know. 

[ventana]

BTW Medicare is almost 100% going to drop the 1% rule

so even by Medicare you can own 100%

[SmokeyBear]

On 11/1/2021 at 6:42 PM, ventana said:

BTW Medicare is almost 100% going to drop the 1% rule

so even by Medicare you can own 100%

Wondering if this would be applicable in states where PAs are eligible for independent practice like Utah, or North Dakota. 

If a PA is given independent practice in those states, would they still have to follow CMS as thats federal? 

Do you have a link or source on them dropping the 1% rule? 

Full disclosure, I'm in Utah and meet eligibility to practice without an SP, and really considering it, and wondering if it's worth it to even bother with Medicare. Would this be a similar rule with Medicaid? 

Edited November 16, 2021 by SmokeyBear

[gsoames]

Not true.  99% is the rule.  I own 99%, and gave 1% to my wife, who is a lawyer.  You need a new credentialing company.

[VentiMacchiato]

Because of PECOS application, it had to be 94-6 split. My 99-1 application was denied. 

 

 https://physicianpracticespecialists.com/credentialing/medicare/reporting-physician-assistant-ownership-for-clinics-group-practices/amp/

 

[Bradshealth]

I am opening a practice as we speak in Utah. I was told by 2 different companies that the Medicare rule is 95% ownership. 
Sadly there are also 2 insurance companies that wont credential me at all if I’m not credentialed on Medicare. 
So, I’m pursuing a direct primary care model that will be cash pay instead at this point. 

[ventana]

Medicare now allows direct bill. No company needed. 
states can set their own rules but the can not overrule the federal rule 

I have not heard if Medicare officially requiring 100% ownership but it is null and void as direct pay now.  
yes enroll in Medicare -  then choose the one option to not accept it.  But you likely need pecos.