Fair reimbursement for healthcare professionals is a controversial topic. Is the clinician’s degree or the type of care provided and overall clinician’s performance that should be rewarded? In actuality, most private insurance carriers pay standard fees for service. However, Medicare is the exception because it limits the reimbursement of services provided by physician assistants (PAs) to only 85% (Wilkens, 2012). Undoubtedly, productivity and economic reimbursement are integral components of the healthcare system. Therefore, it is crucial to understand the various aspects that have shaped the reimbursement for PA services, including the Balanced Budget Act (BBA) of 1997, current reimbursement terms, and the national provider identifier (NPI). …show more content…
Subsequently, under the changes of the BBA, both urban and rural-based PAs were able to practice in multiple settings without mandatory immediate supervising physician accessibility (Pryor, 1999). Furthermore, in 2002, through an expansion of the BBA, the Medicare program granted the ability of PAs to have an ownership interest in a practice. (McCall et al., 2001). Although the BBA historically influenced the reimbursement of PA services in a positive manner, it has currently left PAs behind at disadvantage being the exception to standard clinician …show more content…
“Incident to” billing refers to the ability to collect 100% reimbursement when billing PA services under the physicians name and provider number, only if the physician initially diagnose a patient with a specific medical condition and the PA provides subsequent care for the particular condition (Coldiron & Ratnarathorn, 2014). “Combined” or “shared billing” means the service rendered by a PA is billed “...under the physician's number instead of the nonphysician practitioner's number, and requires the physician to have had a personal encounter with the patient and to have provided some of the examination” (Self, 2007, p. 32). In today’s health care, the 85% reimbursement rate for nonphysician providers is obsolete because PAs have shifted away from physician-PA relationship of dependency and supervision to a relationship of collaboration and partnership. Currently, PAs spend more time with patients than physicians. Increasing reimbursement rate would not rise medical costs but rather represent a fair allocation of resources based on clinician performance especially with the recent implementation of unique numbers that tract the practices of