Reimbursement expands for work performed by PAs

Most third-party payers cover their services

The services of physician assistants (PAs) are covered by Medicare, Medicaid, TRICARE (formerly CHAMPUS), and most third-party insurance companies, according to the American Academy of Physician Assistants (AAPA) in Alexandria, VA.

Reimbursement rates vary from state to state and insurer to insurer, says Diana McGill, PA-C, president of Pro-Search Medical Placement, a Houston firm specializing in placing physician assistants. In Texas, most insurance companies reimburse for PA care at 85% of what a physician is paid for the same services, McGill says. In the case of surgery, the reimbursement is 85% of the cost of an assisting surgeon. Medicare reimburses at 100% if the physician is on site, she adds.

Fort Collins (CO) Youth Clinic bills the same for a visit to a PA as for a visit to a physician, says Jeannette Perich, CPA, administrator. As managed care has increased, the practice has increased the number of physician extenders, she adds.

Harvard Vanguard Medical Associates, a fully capitated multispecialty group practice in Boston, uses more than 90 PAs who work with its 500 physicians, says Peter Dreyfus, practice spokesman.

"Physician assistants provide care at a lower cost and often enhance the care patients receive," he adds.

There are a number of ways to structure PA compensation. Some receive a straight annual salary; others receive a salary and a bonus based on productivity; still others are partners in the practice and are compensated based on revenues.

At Harvard Vanguard, the PAs, nurse practitioners, and other advance practice clinicians are all voting members of the practice. Barbara Kahwaty, PA-C, a physician assistant, also serves on the board of the practice.

"We had to put our salary at risk, but it aligns all of us on the same team," she says.

Some states allow PAs to work as independent contractors and receive an hourly wage for whatever time they spend in the office, McGill says. However, in all cases, the practice, and not the individual PA, is reimbursed by the third-party payer.

[Editor’s note: The AAPA sponsors a course on reimbursement for PAs and similar providers. The day-long course covers coding and documentation, credentialing, avoiding fraud and abuse pitfalls, and working with private insurance and the Health Care Financing Administration. Courses are scheduled for Aug. 9 in Boston and Oct. 29 in Chicago. More locations will be announced later. Information is available from the academy meetings department at (703) 836-2272, ext. 3405.]