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Medicaid regulations and managed care issues affecting PAs.
18 May 2009
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If You're Coming to the Big Dance, Consider Attending
PAs are encouraged to attend any of a number of reimbursement-related continuing medical education (CME) sessions, a meeting on state reimbursement issues, and a coding and billing seminar that will be offered at the AAPA annual conference in San Diego. The list of activities includes CMEs on reimbursement and billing, PA practice ownership, the medical home concept, a two-hour meeting of state reimbursement coordinators and other interested parties discussing reimbursement concerns, and a full-day seminar that will focus on the details of proper billing, coding, productivity, and how to avoid fraud and abuse allegations.
The reimbursement seminar requires a separate registration fee ($250 if registered for the AAPA annual conference and $375 if not attending the conference) and includes breakfast, lunch, and a seminar workbook. If you did not pre-register for the reimbursement seminar, on-site registration is available.
Here's a quick look at the schedule of events:
Tues., May 26
11:00-11:45 AM Medicare & Private Payer Reimbursement Update, Room 31A-C, SDCC*
1:00-2:45 PM How to Navigate the Credentialing, Privileging, and Regulatory Maze, Room 23C, SDCC
Wed., May 27
8:00-10:00 AM Reimbursement Coordinators Meeting, Room 23C, SDCC
3:00-3:45 PM Patient-Centered Medical Home, Room 33A-C, SDCC
4:00-4:45 PM PA Practice Ownership-the Good, the Bad, and the Details, Room 30A-E, SDCC
Thurs., May 28
9:00 AM-5:00 PM Reimbursement, Coding & Billing Seminar, Room 23, SDCC
*SDCC = San Diego Convention Center
193 Million Enrollees and Counting
More than 69 percent of Americans with health insurance receive their coverage through a preferred provider organization (PPO). That translates into approximately 193 million individual enrollees. PPOs are a network of physicians, PAs, other health care professionals and hospitals that agree to offer health care services. PPOs negotiate with health care professionals and institutions to set fee schedules. Subscribers have the option of being treated by any of the network's health care professionals or in network hospitals. Most often, reduced fees and co-pays have been negotiated for patients. Seeing a health care professional who is not in the network often results in higher deductibles, co-pays, and other costs.
As part of the AAPA's reimbursement outreach efforts, Academy staff met with the president of the American Association of Preferred Provider Organizations (AAPPO), Karen Greenrose, to discuss the valuable role PAs play in the health care system. A secondary goal was to gather insight from the insurance industry side as to their views on the health care reform debate.
According to Greenrose, those who run PPOs understand how PAs deliver cost-effective care and appreciate that the profession is growing. The question is how that appreciation gets translated into favorable policies impacting PAs.
After a nearly 30-minute discussion, some of the ideas discussed for ongoing interaction include an AAPA presentation for the AAPPO's board of directors and the creation of written educational material that can be provided to the AAPPO member organizations that include Aetna, Cigna, and Medical Mutual.
Aloha to a Welcome Medicaid Policy Change
Certain health care policies just don't make sense. Especially when the policy hinders access to care in a state that has geographic challenges and a demonstrated shortage of health care professionals. For years, Hawaii's Medicaid program required the on site presence of the physician when PAs delivered care.
A few years back, two practices that employed PAs were audited by Hawaii Medicaid and asked to pay money back because the physician wasn't in the office when the PAs treated Medicaid patients. Hawaii state chapter leadership and the AAPA reimbursement staff made calls and sent letters to the Medicaid Department to protest the on site requirement.
Officials at the Medicaid office appeared to be somewhat sympathetic, but the official policy did not change.
In 2008, Dan Domizio, PA-C, became involved in a Governor's task force aimed at finding ways to increase access to care for Hawaiians. After working with a coalition as part of the task force, including a meeting with a physician member of the coalition that included AAPA reimbursement staff, Dan wrote another letter to the director of the Hawaii Department of Human Services. Shortly thereafter, the Hawaii Medicaid Department officially changed its policy and now allows state law (electronic communication) to determine physician supervision within the Medicaid program.
Reimbursement Watch is a bi-monthly newsletter written by Michael Powe, AAPA Vice President of Health Systems and Reimbursement Policy. You are more than welcome to reprint items, just credit American Academy of Physician Assistant's Reimbursement Watch. Your comments, questions, and suggestions are welcome. Phone 703-836-2272 ext. 3211,
Fax 703-684-1924 or Write: AAPA 950 North Washington Street, Alexandria, VA 22314-1552. E-mail address:
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