Where An Orthopedic PA Works Is Crucial to Reimbursement
Published on Wed Mar 01, 2000
Because the orthopedic physician assistant (PA) takes on roles in the office, hospital and operating room, billing can be confusing. When it comes to reimbursement, where the PA works (which state, which setting) is as important as how a PA works.
As for the how, Ron Nelson, PA-C, president of Health Services Associates in Freemont, Mich., says, It is important to distinguish between regulatory and employment issues. The employment issueswhether the PA is compensated as a W-2 (payroll employee) or 1099 (independent contractor)are separate from the legislative ones.
The compensation a PA receives always must be dispersed by (flow through) the physicianthe healthcare provider ultimately responsible for the activities of the PA. The sort of payment arrangement a PA negotiates with a physician is, under current federal and state guidelines for PA function, irrelevant to the role a PA plays in conjunction with a physician.
Regulatory Issues: A states legislation and licensure ultimately determine how a PA can function, which means to fully understand reimbursement for PA services you must have a thorough knowledge of the law of the state in which the PA is working. But Medicare sets the parameters for the minimum amounts of supervision and maximum amounts of reimbursement.
For example, although Medicare policy dictates a PA must always work under physician supervision, the statenot Medicaredetermines how close the physician supervisor must be. Within quick calling distance (immediately available) will do in some jurisdictions. In other states, the physician must be physically present when the PA renders a service.
A PA can provide many services in an office and hospital, including independent evaluation of a patients condition, setting casts and interpreting x-rays. But a PA cannot make a diagnosis; only a physician can do that.
There are complications beyond the state-by-state licensure. Medicare carriers in each state also set specific guidelines.
Since 1998, it has been possible for a PA to obtain his or her own non-physician provider Personal Identification Number (PIN) and, in certain and limited circumstances, to bill under it instead of under the Universal Physician Identification Number (UPIN) of the physician supervisor.
Incident To and Its Opposite: Incident to describes one way a PA works in an outpatient setting. A PA can never work incident to in an inpatient (hospital) setting.
To understand incident to, visualize a PA who is invisible to the payerthat is, when a bill is submitted, the UPIN of the physician is the one recorded. To meet the requirements of incident to, the PA services must be rendered in a way that is integral to the physicians activityfor example, when the PA helps the physician cast a patient. When a PA works incident to, the [...]
