PA direct reimbursement is HERE!

[True Anomaly]

FINALLY!!!!!!

https://www.aapa.org/news-central/2020/12/coronavirus-relief-omnibus-agreement-authorizes-pas-to-receive-direct-payment-under-medicare/

[True Anomaly]

Nothing?

This truly is landmark for our profession.  We finally have the largest payor allowing us to be able to control our own financial destiny by billing and being reimbursed for the care we provide.  And many third-party payors take their cue from Medicare.  It all begins here.

This was the single biggest thing we could’ve done to advance our profession.  Name change doesn’t have the same impact, because at the end of the day money talks- and if you can’t control your financials as a provider, you ultimately don’t have a path forward autonomous of everyone else

[Cideous]

4 minutes ago, True Anomaly said:

Nothing?

This truly is landmark for our profession.  We finally have the largest payor allowing us to be able to control our own financial destiny by billing and being reimbursed for the care we provide.  And many third-party payors take their cue from Medicare.  It all begins here.

This was the single biggest thing we could’ve done to advance our profession.  Name change doesn’t have the same impact, because at the end of the day money talks- and if you can’t control your financials as a provider, you ultimately don’t have a path forward autonomous of everyone else

Definitely a good thing, but control our own financial destiny?  That would be true if we were not slaves to supervision rules...something NP's are not.

[LT_Oneal_PAC]

44 minutes ago, True Anomaly said:

Nothing?

This truly is landmark for our profession.  We finally have the largest payor allowing us to be able to control our own financial destiny by billing and being reimbursed for the care we provide.  And many third-party payors take their cue from Medicare.  It all begins here.

This was the single biggest thing we could’ve done to advance our profession.  Name change doesn’t have the same impact, because at the end of the day money talks- and if you can’t control your financials as a provider, you ultimately don’t have a path forward autonomous of everyone else

This is huge! *sends another donation to PAC* 

[sas5814]

This is HUUUUUGE! Most PAs won't understand why and that is OK.

[PACali]

Probably best news in 2020. Join the AAPA people! 

[TexasPA28]

So does this mean we get paid 100% of what Medicare pays to an MD?  Or are we still slaves only getting 85% for doing the same work as MDs?

 

 

[MSPAC2]

I heard Trump refused to sign this bill though.

Edited December 25, 2020 by MSPAC2

[Hope2PA]

Great news for PA’s!
 Wish they were also included in the $5 million NP’s are getting for post grad fellowships included in the COVID Relief Bill. 

[kang1208]

On 12/25/2020 at 12:08 AM, MSPAC2 said:

I heard Trump refused to sign this bill though.

News has it that Trump just signed the coronavirus relief bill...so does this mean it’s official?

[ventana]

yes  

done deal

https://www.congress.gov/bill/116th-congress/house-bill/1052/text?r=77&s=1

 

116th CONGRESS 1st Session

H. R. 1052

 

To amend title XVIII of the Social Security Act to provide for direct payment to physician assistants under the Medicare program for certain services furnished by such physician assistants.

---

IN THE HOUSE OF REPRESENTATIVES

February 7, 2019

Ms. Sewell of Alabama (for herself and Mr. Smith of Nebraska) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

---

A BILL

To amend title XVIII of the Social Security Act to provide for direct payment to physician assistants under the Medicare program for certain services furnished by such physician assistants.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. DIRECT MEDICARE PAYMENT FOR SERVICES FURNISHED BY PHYSICIAN ASSISTANTS.

 

(a) In General.—Section 1832(a)(2)(B) of the Social Security Act (42 U.S.C. 1395k(a)(2)(B)) is amended by adding at the end the following new clause:

“(v) services of a physician assistant but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services;”.

(b) Effective Date.—The amendment made by subsection (a) shall apply with respect to services furnished on or after July 1, 2020.

 

[ventana]

So this is one of those little vicotries that has HUGE long term effect

 

We are now listed as providers and any incentive monies or programs should include us almost automatically.....

 

 

here is to hoping

 

 

This happened due to AAPA PAC going at it like a pit bull

This takes $$$    I give them $20/month automatically on my CC - it is simple, cheap and really helps - the scary thing is they say I am one of the best contributors....  come on folks it is now or never to fund these changes - any PA should be able to afford $20/month to help protect and advance our profession

Yes you do need to be an AAPA member to donate the PAC - IRS regulations, not AAPA rules

[sas5814]

^^This. I set up a $25/month recurring donation and I don't even notice it. Imagine the work we could get done if 50k PAs did this.

[ventana]

1 hour ago, sas5814 said:

^^This. I set up a $25/month recurring donation and I don't even notice it. Imagine the work we could get done if 50k PAs did this.

/EXACTLY!!!!!

it is a nothing thing to do - making 100,000 per year to give them $25/month you will not even feel

but if everyone does this AAPA has CASH to fight for us in DC

CASH is what wins political battles, plain and simple

[TexasPA28]

So does this give PAs 100% equal reimbursement to MDs for Medicare now or not?

 

 

[ventana]

2 hours ago, TexasPA28 said:

So does this give PAs 100% equal reimbursement to MDs for Medicare now or not?

 

 

no, that is nothing to do with this

 

this is direct bill and pay

[cbrsmurf]

Please excuse my ignorance. Can someone explain how this advances our profession?

[sas5814]

11 hours ago, cbrsmurf said:

Please excuse my ignorance. Can someone explain how this advances our profession?

Until now we we were the ONLY medical profession that could not bill directly for services. Physicians, NPs, PTs, OTs etc could all bill for their services. Our billing had to be done in the name of the physician. This kept us tied to physicians in another way and made our work invisible to anyone trying to determine how much work we were doing and how much revenue we were generating.

It is one more big step towards being our own grown-up fully mature profession.

[VeryOldPA]

2 hours ago, sas5814 said:

Until now we we were the ONLY medical profession that could not bill directly for services. Physicians, NPs, PTs, OTs etc could all bill for their services. Our billing had to be done in the name of the physician. This kept us tied to physicians in another way and made our work invisible to anyone trying to determine how much work we were doing and how much revenue we were generating.

It is one more big step towards being our own grown-up fully mature profession.

Not exactly.....

This legislation has nothing to do with billing but rather REIMBURSEMENT.  Billing for PA services MUST always be done under the PA's NPI number NOT the physician's.  Because the reimbursement rate for PAs is 85% of the physician's rate billing under the physician's would not be looked upon favorably by CMS.

Currently the reimbursement for PA services goes  to the SP/practice not the PA.  All other providers bill under their NPI  and receive the reimbursement directly. This is what the legislation changes.  As of January 1, 2022 PAs will receive the reimbursement directly from Medicare same as all other providers. 

See: Coronavirus Relief & Omnibus Agreement Authorizes PAs to Receive Direct Payment Under Medicare 

 

 

[ventana]

7 hours ago, VeryOldPA said:

Not exactly.....

This legislation has nothing to do with billing but rather REIMBURSEMENT.  Billing for PA services MUST always be done under the PA's NPI number NOT the physician's.  Because the reimbursement rate for PAs is 85% of the physician's rate billing under the physician's would not be looked upon favorably by CMS.

Currently the reimbursement for PA services goes  to the SP/practice not the PA.  All other providers bill under their NPI  and receive the reimbursement directly. This is what the legislation changes.  As of January 1, 2022 PAs will receive the reimbursement directly from Medicare same as all other providers. 

See: Coronavirus Relief & Omnibus Agreement Authorizes PAs to Receive Direct Payment Under Medicare 

 

 

Sorry untrue. 
please read about “incident to”billing. This is the dirty little secret in the outpatient world.  Hire a PA/NP. Doc immediately available, bill under doc, get full 100% while paying only half the salary to a PA/NP as compared to doc 

also this does not address incident to billing, only rather we can direct bill 

also don’t understand your billing versus reimbursement statement.  You can not separate the two.  Billing is what generates reimbursement and how you bill is what this addresses.  Prior to this a PA could NOT direct bill. No matter what. You could bill with your upin but it still was under the Corp or doc.  Then they get the payment.  Impossible for PA to direct bill or receive payment directly from Medicare.   Now we can.  Also the reimbursement follows this billing in that you can now(1/1/22) be paid directly as well    
 

also almost all providers sign an “assignment of benefits” to their employer so the company gets the revenue.  But it does bring in the reality thst a small practice of a few PA’s (or even one PA)now can direct bill. Yes 
 

I don’t mean to insult but it does not appear that the true inner rules/regulations/guidelines to billing are totally understood.  

[mmiller3]

On 12/22/2020 at 4:26 PM, Cideous said:

Definitely a good thing, but control our own financial destiny?  That would be true if we were not slaves to supervision rules...something NP's are not.

This.

It is a good step, but we still have the major obstacle remaining, which is being tethered to a supervising physician. AAPA needs to focus on eliminating this; once (if) they start really working on that, I will become a member again.

 

[sas5814]

They have been working on it for 2 years. OTP is about, among other things, eliminating state mandated supervision in favor of privileges and utilization being determined at the practice level. It also included direct reimbursement, having our own boards and a couple of other things.

Since OTP became policy several (I have lost exact count) states have eliminated state mandated supervision. This work is being done by the state orgs with AAPA support.

Time to join AAPA and your state society. You might also consider a donation to the PAC

[mmiller3]

4 minutes ago, sas5814 said:

They have been working on it for 2 years. OTP is about, among other things, eliminating state mandated supervision in favor of privileges and utilization being determined at the practice level. It also included direct reimbursement, having our own boards and a couple of other things.

Since OTP became policy several (I have lost exact count) states have eliminated state mandated supervision. This work is being done by the state orgs with AAPA support.

Time to join AAPA and your state society. You might also consider a donation to the PAC

I was a member of the Colorado Academy of PAs; they have been talking about OTP for the past few years, and the most we have seen is uncoupling liability from the supervising physician (if you have 3+ years of experience). Still need the supervising physician, they just don't have any malpractice liability.

Our profession is baby-stepping while NPs are long-jumping, and the AAPA allowed it to happen. Until I see something more substantial from the AAPA than an expensive name-change survey, I will continue to be cynical.

[sas5814]

I'm always interested in the ideas for making giant leaps. I have been working PA policy and politics for 20 years and the chance to make giant leaps are few and far between. I too stayed out of the AAPA for many years because I felt they were a tone deaf star chamber. The last 4 or 5 years have been a seismic change for the organization.

What you are seeing on the NP side of the house is the results of a relentless campaign that has gone on for more than 20 years and is supported and funded by a lobby that is orders of magnitude larger than ours in numbers and capitol. The idea that suddenly they are just making giant leaps and we could do the same doesn't hold water. It would be like comparing a political effort by the US to one undertaken by Guam. 

Be cynical. But understand without money and numbers nothing gets done. There are too many people waiting for something to get done before they contribute when they should be lending their time and their money to the effort.

[OrthoSurgPA]

I agree that this is a massive step to modernize the profession.  Does this include all service such as first assisting in surgical cases? or will there be restrictions like NY had with there expanded provider laws for WC that have done nothing for patients in need of surgery with PA/MD OR teams