Reimbursement Team Provides Update on Interactions with Public and Private Insurers

Will Continue Meetings to Advocate for More Inclusive Policies

By Trevor Simon, MPP

AAPA’s Reimbursement Team pursues an eclectic set of outreach methods to both public and commercial insurers, in order to promote policy enhancements that will benefit and advance the PA profession. Here’s a summary of AAPA’s recent interactions with both public and commercial insurers on behalf of PAs.

Public Insurers
AAPA seeks to influence the policy of various public payers, most prominently Medicare and Medicaid.

Over the past year, AAPA has submitted comment letters to the Centers for Medicare and Medicaid Services (CMS) on various topics, including the Physician Fee Schedule, the Hospital Outpatient Prospective Payment System, the Quality Payment Program, the Center for Medicare and Medicaid Innovation, and more. These letters can be found on the AAPA website. Through direct outreach, AAPA has successfully secured favorable interpretations from Medicare, such as a clarification that a physician’s co-signature is no longer required on discharge summaries for patients discharged by PAs. AAPA has also been able to further elevate the voice of individual PAs in policy making by arranging for the inclusion of volunteer PAs to participate in select CMS subcommittees. Finally, AAPA recently met with CMS regarding three current issues of interest to PAs: state use of alternatives to the term “supervision,” transparency of PA-provided services, and AAPA congressional advocacy on the issue of direct reimbursement.

AAPA, through its daily tracking and analyzing of state legislation and regulations of potential interest to chapters, frequently sends Medicaid bills and rules that, if responded to, have the ability to improve policy on the state level. In addition, AAPA has continued to see success in its ongoing efforts to assist state chapters in reaching out to Medicaid regarding enrollment under the program as rendering providers. Select recent successes include Hawaii, Indiana, Massachusetts, and Washington DC, bringing the total now to 43 states and DC who identify PAs as rendering providers under their Medicaid programs.

Commercial Insurers
Much like with public payers, AAPA frequently communicates with commercial insurers regarding their policies relating to PAs. We regularly conduct outreach through emails and telephone conversations to both clarify existing policy and advocate for policy changes that are PA-friendly. Through this work, AAPA seeks to remedy the concerns of individual PAs who reach out to us for assistance, as well as pursue large organization-wide policy modifications. In addition, AAPA is in the process of surveying over ten behavioral health organizations to determine which identify services provided by PAs, and which need to be followed up with for advocacy. AAPA plans to visit three behavioral health payers that do not respond favorably regarding their PA policies.

Looking Forward
AAPA anticipates that, in addition to our standard interactions with insurers through tracking and casework, we will continue to meet with major commercial insurers to advocate for more inclusive policies regarding PAs. AAPA will further engage our allies that possess similar interests, as well as organizations that heavily influence future health policies, to help advance our reforms to improve the transparency of PA services. Finally, AAPA will explore additional opportunities for increased direct interaction between insurers and PAs.

AAPA Reimbursement’s interactions and successes with both public and commercial insurers have allowed us to update the information we relay to PAs through direct casework, STAR network calls, online announcements and resources, presentations, and The Essential Guide to PA Reimbursement book. These communications have also helped lay the groundwork to achieve further victories in the coming year in advancing the PA profession.

Trevor Simon, MPP, is director of regulatory policy at AAPA. Contact him @ [email protected].