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Category - Reimbursement

QUESTION – Do auto groups recognize physician assistant services?


ANSWER –
See MSMS Record (Sorry to make you click another link).

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QUESTION – What are BCBS of Michigan Reimbursement Policies on Mid-Level Providers ?


ANSWER –
Below are links of the official Blue Cross Blue Shield of Michigan publication, The Record, pertaining to the new policy for billing services rendered by Nonphysician Practitioners (PAs/NPs and CNMs). Also included below are some descriptive scenarios published by Blue Cross on their official website, “Web Denis.”
There have been many questions from MAPA members regarding this new policy and we are striving to share this important information to you in a timely fashion.
Please share this information with your supervising physician(s) and billing personnel.
Remember, this policy says that your practice can receive 100% reimbursement for services you provide when that service is discussed with your supervising physician before or after the visit. Documentation of that discussion is made by the PA; physician cosignature is no longer needed. If you provide autonomous services that do not require discussion with your supervising physician your bill to Blue Cross will be “direct” and your practice will receive 85% reimbursement.
MAPA strongly believes that this policy is still too restrictive and goes beyond the provisions outlined in our excellent state law. We are working on an appeal process to again register our dissatisfaction with this Blue Cross policy.

Support MAPA!  Help us keep Michigan PAs employed!

Blue Cross Clarifies New PA Billing Rules...more work still needed!
The Michigan Academy of Physician Assistants has been working inexhaustibly to oppose the recent reimbursement policy changes recently enacted by Blue Cross Blue Shield of Michigan. As of April 1, 2008 PAs are eligible for reimbursement for the services they provide to BCBSM beneficiaries. (All these policies effect Nurse Practitioners and Certified Nurse Midwives as well.)

MAPA works to Clarify Hospital Issue
Blue Cross will now pay for hospital employed PA services

January 2008 The Record
Physician assistant registration now under way; new billing guidelines take effect April 1

April 2008 The Record
Policy for billing services rendered by nonphysician practitioners effective April 1

Billing Scenarios
Billing scenarios for Direct and Indirect billing

June 2008 The Record
Physician assistant, certified nurse practioner services no payable for some auto group members.

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QUESTION – Can a PA do consults for Medicare patients?


ANSWER – 


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QUESTION – Can a PA perform Osteopathic Manipulative Therapy?


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QUESTION – Can PAs prescribe wheelchairs and other medical equipment?


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QUESTION – Do PAs get reimbursed for the procedures they do for an inpatient?


ANSWER – 

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QUESTION – Does Medicare and Blue Cross Blue Shield of Michigan reimburse PAs for outpatient services?


ANSWER – 

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QUESTION – How do I sign up for a Medicare?


ANSWER – 

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QUESTION – Can the PA perform a procedure in the office (e.g. flexible sigmoidoscopy, skin lesion biopsy, colposcopy) and bill it under the “incident to” provision?


ANSWER – 

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QUESTION – I have a PA that practices in my office without me being present. I am available by phone and review all charts. Other than for Medicare is this acceptable? How does Medicare differ?


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QUESTION – My administrator tells me PAs can no longer see new patients/ perform procedures/do consults/ bill for services, etc. What do I do?


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QUESTION – The PA sees an inpatient (admission, consult or subsequent day) and then performs or supervises a diagnostic test - can both be billed on the same date?


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QUESTION – Do you have information on Third Party Reimbursement for Physician Assistants in Michigan?


ANSWER – 

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QUESTION – What is the law regarding PA billing for inpatient and outpatient procedures such as ultrasound guided paracentesis, thoracentesis, various kidney & liver biopsies, vascular access for PICC line placement, "port" insertions, fluoroscopic guided lumbar puncture?


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QUESTION – What is the status of reimbursement for surgical first assisting for PA's and Blue Cross? I heard that the launch date of 1/1/07 was delayed.


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QUESTION – What procedures require a first assistant?


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