Beginning September 1, 2018, all physician assistants (PAs) must now enroll both with Indiana Medicaid and all Indiana Medicaid Managed Care Entities and can no longer be billed under a supervising physician’s NPI.
This change, which we previously reported as affecting Indiana Medicaid only, brings billing for PAs into alignment with billing for other Mid-Level, or Non-Physician Providers (NPP), and reduces reimbursement for PA services to 75 percent of the Medicaid allowed amount for dates of service on or after September 1, 2018.
Since our earlier articles, Denise O’Brien, CIPROMS Director of Provider Enrollment, has confirmed with all of IHCP’s managed care entities (MCEs) that after enrolling as a provider with Indiana Medicaid, PAs must apply directly with each MCE to participate as a provider in all of IHCP’s managed care programs―Healthy Indiana Plan (HIP), Hoosier Healthwise, or Hoosier Care Connect.
As we noted 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.)
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 Beginning September 1, 2018” from August 2, 2018
- CIPROMS article “Indiana Medicaid Now Fully Enrolling All PAs, Reimbursing at 75%” from July 6, 2018
- IHCP bulletin BT201839 from July 31, 2018
- IHCP bulletin BT201743 from June 29, 2017
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