July 30, 2021
Reimbursement Guide Offers Valuable Information on PA Payment
By Max Linder
Reimbursement policy can be incredibly complex for a PA to navigate. Billing experts themselves spend countless hours clarifying and reclarifying nuances that determine what services a PA can be reimbursed for, by which payers, and at what rate. Beyond those permutations, the jargon contained in regulations and provider manuals make them nearly incomprehensible without considerable experience in reimbursement policy. PAs don’t need to gain fluency in all reimbursement policy, but a working knowledge of the basics and a reference guide for the specifics they may encounter is essential. Understanding the framework for reimbursement can help a PA stay on the right side of the law and maximize their value in their practice setting.
The Essential Guide to PA Reimbursement is designed to help PAs, physicians, employers, and billing and coding professionals understand the terms, issues, concepts, and policies regarding payment for PA-provided services. The information provides an overview of PA coverage and payment policy. It also provides insight into the courses of action that can be taken to maximize legitimate reimbursement, help resolve problems, and maintain a positive reimbursement environment. The Essential Guide contains nearly 100 pages of analysis and summaries from AAPA’s Reimbursement team covering a wide range of topics that a PA will encounter throughout their career in the realm of reimbursement policy from both private and public payers. This analysis is supported by more than 300 pages of appendices that provide PAs with a convenient reference for statues, regulations, and policies. Concluding with a comprehensive glossary of acronyms and terms that are omnipresent in provider manuals and reimbursement discussions, the Essential Guide is an aptly named tool for understanding and navigating reimbursement issues a PA faces day-to-day.
Each year, AAPA updates the Essential Guide to reflect changes to regulatory, statutory, and private payer policies that affect the PA profession, including adding new sections to the Essential Guide where necessary as PA practice evolves. This year significant updates were made to the Essential Guide covering topics such as:
In the Medical Record Documentation section, the Essential Guide breaks down Medicare policy changes made to medical record documentation requirements that took effect this year. These changes may impact documentation practices for PAs, physicians, students, and other members of the care team. As practices catch up to the new, as well as upcoming changes in 2021, the Essential Guide can help a PA navigate these changes and maximize the benefits now available to them.
The Essential Guide also dives deep into topics that are especially complex, and at times misunderstood, as well as topics that have the largest impact on the day-to-day lives of PAs such as:
For example, the Essential Guide defines the rules and regulations that govern “incident to” billing, and then breaks down each element that is required to satisfy Medicare. The Essential Guide explains in detail exactly when “incident to” can and cannot be used as well as demonstrating instances where it may not be worth the administrative hassle for a PA, physician, or to bill “incident to”. Beyond that, the Essential Guide explores the unintended consequences, beyond the financial, that may arise from the overuse of “incident to” billing. This analysis is critically valuable in providing a PA with a succinct summary of the rules and regulations necessary to practice efficiently and in compliance with Medicare policy.
Finally, the Essential Guide provides general overviews of policies that vary by state or payer. For PAs that deal with various entities when seeking reimbursement, or who are considering changes to their practice, the Essential Guide includes charts of common policies among top commercial payers, overviews of state policy regarding workers’ compensation, and more. These charts are kept as topline guides designed to help a PA get a sense of how their practice may be affected by a policy or regulation, helping them to determine where to look for the policies that matter most to their practice.
The Essential Guide to PA Reimbursement provides a detailed summary and explanation of the key aspects of coverage and regulatory policies related to reimbursement for medical and surgical services performed by PAs. In a rapidly changing healthcare environment, a thorough understanding of the PA payment policies of public and private payers is essential for demonstrating PA value, maximizing the collection of appropriate reimbursement and avoiding potential fraud and abuse.
Max Linder is health policy manager for AAPA’s Reimbursement team. Contact him at [email protected]