Practice Economics

HM16 Session Analysis: Maximizing Collaboration With PAs & NPs: Rules, Realities, Reimbursement


Presenter: Tricia Marriott, PA-C, MPAS, MJ Health Law

Summary: Ms. Marriott brought humor to a detailed #HospMed16 presentation on the rules of reimbursement and Medicare requirements for physician assistants (PAs) and nurse practitioners (NPs). The session was packed with information regarding the Medicare regulations relating to PAs and NPs, as well as information from state Medicaid programs and commercial payors. The presentation continued with focusing on myth busters and misperceptions about PAs and NPs. These topics were reviewed in depth:

  • PAs and NPs have been recognized as providers by Medicare since 1998, as demonstrated by Medicare citations provided to the audience.
  • Supervision/collaboration, as defined by Medicare requirements.
  • Medicare payment policy: “incident to” vs. “split/shared visit,” reviewing unacceptable shared visit documentation and unintended consequences of fewer shared visits.

The discussion provided detailed insight into how to address the question, “What about the 15% reduced Medicare reimbursement for PAs and NPs?” An analytical approach to answering this question was provided as it relates to inpatient services, observation services, critical care services, and consultations. At the end of the talk, the audience was very engaged, and a lively Q&A ensued past the scheduled time. TH

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