United Healthcare decision on incident-to billing will hurt PAs and NPs

[TexasPA28]

https://www.texmed.org/TexasMedicineDetail.aspx?id=55946&utm_source=Informz&utm_medium=Email&utm_campaign=EMERGENCY+MED+CONF+CALL&_zs=GE5BB1&_zl=0uoE6

 

Short version:  Starting May 1, United is going to force NPs and PAs to bill under their own NPI.

That sounds good, right?

Well, it's not because under United NPs and PAs get paid 15% less than MDs do for the same billing codes.

If this goes through, other insurers are probably going to follow them, and when that happens clinics will slow down hiring PAs and hire MDs instead because they want to get the full 100% reimbursement.

The best long term solution is to force United to pay PAs 100% of what MDs get for the same billing codes, but until that happens PAs need to fight this decision by United.

 

[PAinPenna]

But NPs and PAs do not make 85% of what physicians make, so I believe this will all come out in the wash in a GOOD way . I for one am tired of my hard work being hidden under a Doc's NPI. 

[rev ronin]

1 hour ago, PAinPenna said:

But NPs and PAs do not make 85% of what physicians make, so I believe this will all come out in the wash in a GOOD way . I for one am tired of my hard work being hidden under a Doc's NPI. 

That, and much, probably most, quite possibly almost all incident-to billing is fraudulent.

[ohiovolffemtp]

Wonder what the implications will be for the EM staffing companies.  They've been billing the 100% doc rate by having the docs put "I was available for consultation but did not actually see the patient.  I reviewed the chart, labs, imaging, ... and agree with the treatment plan" notes in.

[rev ronin]

2 hours ago, ohiovolffemtp said:

Wonder what the implications will be for the EM staffing companies.  They've been billing the 100% doc rate by having the docs put "I was available for consultation but did not actually see the patient.  I reviewed the chart, labs, imaging, ... and agree with the treatment plan" notes in.

Now they have less reason to hire MDs, because they cost the same, but don't give a boost to PA/NP productivity.  Better to hire more PAs/NPs for 1/3 the cost and get 85% of the revenue.

[Kaepora]

I think this will only help APPs. We make considerably less than 85% of physician salaries in most specialties, so billing at 85% of their rate would still make us quite desirable to the bean counters. 

[VeryOldPA]

22 hours ago, TexasPA28 said:

If this goes through, other insurers are probably going to follow them, and when that happens clinics will slow down hiring PAs and hire MDs instead because they want to get the full 100% reimbursement.

Hate break this to you but most other insurers already do this and have for years

 

 

[ventana]

Lots more then simple arguments. 
 

can’t just use the “we don’t make 85% of physicians so it will help PA” argument 

overhead costs are the same for any provider   Pcp overhead running around 40-60%  300k in receipts is about 120-180 in overhead   Only leaves 120-180 for salary     Docs won’t work full time for this hence no pcp docs in private practice BUT established practices depend on this profit to support the docs still in pcp medicine     So in essence we support the docs pay while we don’t earn what we are worth  

 

also incident to is abused by practices to make more money then they are entitled to for the salary they pay  us  

 

finally incident to is truly evil in that it hides all the productivity of the PA   A few years I was generating north of 300k in receipts yet I was almost invisible to insurance companies as everything was under physicians   It was like I did not exist   
 

Apply this invisibility to the study and benefits of PAs and you can’t generate any real data because it we are hidden   No ability to prove and advocate for PAs because no real data   No data stops us from leveraging this data to advance our profession, and organized medicines wins by keeping us quietly working/producing/profiting for them   
 

I say enough   Eliminate incident to   Let us stand on our own   Get the real data to support us and demonstrate or contributions