Beginning September 1, 2018, all physician assistants (PAs) must now enroll as Indiana Medicaid Providers and can no longer be billed under a supervising physician’s NPI.
When CIPROMS previously reported this new Indiana Health Coverage Programs (IHCP) policy, the effective date was unclear as IHCP had published it as August 1, 2017. That would have made the policy retroactive, with uncertain implications. In a July 31, 2018, IHCP bulletin, the agency announced the new effective date as September 1, 2018, and offered an explanation:
In Indiana Health Coverage Programs (IHCP) Bulletin BT201743, the IHCP announced expansion of its eligible providers to include physician assistants. The bulletin further stated this policy change allowed professionally licensed physician assistants to independently enroll with the IHCP beginning August 1, 2017. The IHCP’s intentions were to require the independent enrollment of physician assistants. Accordingly, effective September 1, 2018, the IHCP is updating its policy to require physician assistants to independently enroll with the IHCP to be eligible for reimbursement.
This change, which brings billing for PAs into alignment with billing for other Mid-Level, or Non-Physician Providers (NPP), also reduces reimbursement for PA services to 75 percent of the Medicaid allowed amount for dates of service on or after September 1, 2018. However, as we reported earlier, when both the physician and the PA provide any face-to-face portion of an evaluation and management (E/M) encounter, the service may continue to be billed under the physician’s NPI based on split/shared visit rules. (Refer to page 39 of the Medicare Claims Processing Manual: Chapter 12 – Physicians/Nonphysician Practitioners for more information on split/shared visits.)
How this policy change affects PA enrollment with managed care programs is still uncertain. According to IHCP, after enrolling as a provider with Indiana Medicaid, PAs “may contract as a provider” with the IHCP’s managed care programs – Healthy Indiana Plan (HIP), Hoosier Healthwise, or Hoosier Care Connect – by applying directly with one or more of the managed care entities (MCEs) offering health plans for those programs. But whether PAs are allowed or required to enroll with the MCEs is unclear. CIPROMS has inquired about PA enrollment with all of Indiana’s MCEs, and we will report any additional information as soon as it’s available.
For more information about how the new policy will affect PA enrollment and billing with Indiana Medicaid, review the following:
- CIPROMS article “Indiana Medicaid Now Fully Enrolling All PAs, Reimbursing at 75%”
- IHCP bulletin BT201839 from July 31, 2018
- IHCP bulletin BT201743 from June 29, 2017
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