Are you a licensed Physician Assistant from one of the 50 states or the District of Columbia?
Ever thought of owning a medical practice and having full control of the bank account?
Well, Now You Can!
Effective Jan 01, 2022, Medicare and several other insurance companies will make direct payments to Physician Assistants for their professional services.
On Nov 2, 2021, CMS has announced the following:
CMS is implementing a recent statutory change that authorizes Medicare to make direct Medicare payments to Physician Assistants (PAs) for professional services they furnish under Part B.
For the first time, beginning January 1, 2022, PAs will be able to bill Medicare directly.
As a result, more individuals with Medicare will have access to these services as PAs will have the same opportunity as certain other Medicare practitioners to bill Medicare for professional services.
You no longer need to re-assign your benefits to a physician-owned practice to receive payments for your professional services.
Like Nurse Practitioners, you will be paid directly for your professional services in your personal or business bank accounts.
Physician Assistants will be reimbursed at 85% of the MPFS.
You can start your private practice or do a partnership with other physician assistants (PAs).
Some states, such as California, do not allow physician assistants (PAs) to hold 100 percent of professional corporations.
If you live and are licensed in one of these states, you can find a friendly physician who can technically hold 51 percent of the shares while you own the remaining 49 percent.
You can still define the roles and powers in the agreement between you and the physician.
Regardless of your ownership interest in the business, you will still need to have a supervising physician to comply with the state and federal laws of Medicine.
Now let’s talk about how to set up a private practice (Tele-Medicine or Physical) being a physician assistant.
I will explain the entire flow in 2 different parts:
1 - Information and Documents Required.
You should have following.
- An active state license
- DEA certificate (if you choose to prescribe narcotics).
- Malpractice coverage with 1 million to 3 million limits.
- Your resume
- A physical or a virtual location (Home address can also work)
- A supervising physician agreement
- National Provider Identifiers
- EIN or SSN
- A bank account
The 1st step is to choose an appropriate business structure such as PC, PLLC, LLC, PA, etc.
Then look for a registered agent in the state you are planning to form your business.
The third step is to file your company article of organization with the Secretary of State (SOS).
Once it is filed and you have received the stamped documents from the secretary of state also referred as SOS.
The 4th step is to apply for an EIN with IRS.
The 5th step is to open a bank account in your business name, you will need your article of organization along with the IRS SS-4 letter to do that.
You can skip all of the above steps if you elect to practice as a sole proprietor or under your SSN.
The 6th step is to create a business NPI (If you decide to go as a business).
The 7th step is to setup a CAQH profile (If you don’t have one).
To this point you have just arranged everything that you will be needing along the way.
You may be able to arrange all of the above on your own and you will most likely already have some of these documents.
If you need help with any of the above steps, RxCredentialing can assist you !!
The next steps will most likely require the assistance of a professional service provider. There are many service providers out there who can handle everything for you from this point to onward.
RxCredentialing have been providing all of these services from a decade and is the first company to outline these steps for Physician Assistants and Nurse Practitioners.
RxCredentialing mission is to make it easy for healthcare practitioners to understand these steps so you can pick your service providers wisely.
2 - Administration & Services.
To run newly established medical practice, you will an affordable service on following.
After organizing everything you will then need to submit an enrollment application to Medicare. Medicare normally take 60 to 90 working days to process an application, currently due to Covid-19 they are processing applications within 7 to 30 days.
Once you received the Medicare approval, You will then need to submit an enrollment application to Medicaid, which will take 30 to 90 working days.
I strongly advise against submitting credentialing applications to any other insurance companies unless you are enrolled in Medicare and Medicaid.
That is because all of these insurance companies offer Medicare Advantage as well as Medicaid managed care programs to patients.
If you go to these insurance companies without Medicare & Medicaid, they will only contract you with their commercial lines of business and you will only be able to see a restricted number of patients.
Credentialing process take anywhere between 3 to 5 months, It is the base of your revenue cycle so choose your service provider wisely.
Once you are enrolled with Medicare, even if all other insurances are pending you can start seeing patients right away, and as you get credentialed with more and more insurances you can accept those insurances patients as well.
In order to see patient and bill the insurance companies you will need an EHR also known as EMR and billing company.
Who will submit your claims to all these insurances and keep your accounts up to date, an office manager (Physically in the office or Virtual) to assist you with day to day operations.
The day to day operations involve.
- Scheduling patient appointments,
- Running patient insurance eligibilities,
- Obtaining prior authorization (when needed),
- Sending superbills to the billing company,
- Keeping in touch with the billers for updates,
- Trying different marketing strategies,
- Keeping in touch with the credentialing company for updates etc.
Once you are credentialed, have billed and received reimbursements from some of the insurance companies you will learn everything yourself afterwards.
I hope this article will be helpful for you, if you have any questions about any of the steps, please feel free to reach out at email@example.com.