Physician extenders granted more flexibility
Physician extenders granted more flexibility
Medicare act brings good and bad news for PAs
If your practice utilizes physician assistants and other physician extenders, get ready for some good news involving changes resulting from the Balanced Budget Act of 1997. But before you start celebrating too elaborately, prepare yourself for some not-so-good news: The changes also will affect your pocketbook.
The bottom line: Practices will have more flexibility in how and where they can use physician assistants (PAs) and other extenders to provide Medicare-related medical services. However, in exchange for this increased flexibility, Medicare is lowering its PA payment rate from 100% to 85% of fees paid if the service had been provided by a physician.
Currently, Medicare’s "incident to" rule lets practices bill for services performed by a PA at 100% of the regular physician’s fee schedule, provided a supervising physician was on site when the PA saw patients.
Achieving this new status has been a long-time goal of the American Academy of Physician Assistants (AAPA), says spokeswoman Kelly Dunn. She explains that up until now, a physician assistant could not see a patient until after the patient had been examined by a physician. The new regulations mean that as of Jan. 1, PAs will be free to perform any Medicare-eligible services in any setting that’s been approved by the program, provided they conform to state guidelines. As such, a supervising physician no longer has to be physically present in the building when a PA sees a Medicare patient.
"Now that PAs have covered provider status, this means practices will have much more flexibility in how they use PAs, plus their ability to schedule and treat patients," Dunn says.
The new 85% rule also affects services provided by physician assistants outside the practice setting. This means the other present physician-based PA payment rates of 65% for assisting during surgery and 75% for services provided in the hospital setting will also be raised to 85% in January which will, in effect, make it more expensive for PAs to provide care in these settings to Medicare patients. As a result, the AAPA estimates surgery-related payments for PA first assistants will jump 20% as a result of the new rules.
Also, Congress recommended that the newly created Medicare Advisory Commission consider using graduate medical education (GME) funds to train PAs as well as future physicians.
While Medicare still will pay PAs through their employer, Congress also added language permitting PAs to enter into independent contractor relationships with practices, an action intended to help clarify the legal and tax-related nature of the employment relationship.
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