podiatry to PA

[facetguy]

Thanks. An extra $40-60k per year in production bonuses? Hey, I guess you can't complain about that.

I would *think* that surgical PA's work under a similar arrangement, because if they actually got to keep the 85% and 14.5% they're eligible to bill/collect on, then that means there are surgical PA's out there making anywhere from $3k - $10k (or more?) per day in addition to their base salary. Maybe so, but it sounds too good to be true.

Are we talking about one of those 'first assist for hire' PAs or an employee of a surgical practice? Perhaps the 'for hire' PA gets to keep what s/he is reimbursed but I doubt the employee gets to keep that.

Where does that 14.5% come from? (note: I know nothing about surgical billing )

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[HenryH]

they probably get a per case fee, but I doubt it's as much as you were thinking. I have heard first assist fees for pa's in the range of 15% of the total provider payment(which is very different than the total bill).

Yeah, I think I read that the first assist fee for PA's is typically 14.5%. But is that what they'd actually get paid by the surgeon they work for, or is that the amount that the surgeon would actually be reimbursed for?

First assist fee or not, I would still MUCH rather work in surgery or EM than FP or in one of those doc-in-the-box clinics. I went to one of the latter for a sinus infection I had a few months ago, and even though that kind of practice setting might be the perfect fit for some folks, it just comes across to me as mind-numbing and repetitive... as if the days of the week would start to run together like one giant blur after a few months, LOL.

 

[deleted6669]

doc in a box retail medicine isn't for me either but I could see doing rural family medicine. many folks in those jobs follow their own inpts, work a bit in the er, etc

 

[HenryH]

Are we talking about one of those 'first assist for hire' PAs or an employee of a surgical practice? Perhaps the 'for hire' PA gets to keep what s/he is reimbursed but I doubt the employee gets to keep that.

Where does that 14.5% come from? (note: I know nothing about surgical billing )

I don't know much about surgical billing, either, but I believe that 14.5% is the standard reimbursement rate for a PA/NP who provides first-assist services during surgery; I might be wrong, though.

BTW, to answer your first question, I was asking about a PA who works as an employee of a surgical practice.

 

[deleted6669]

" I was asking about a PA who works as an employee of a surgical practice. "

I imagine those folks get a portion of that but the surgical group that employs them keeps most of it.

 

[facetguy]

Also, would the arrangement be similar for a surgical PA? I'm a bit confused about how it would be constructed for their employment scenario because I have heard people say, for example, that a PA working as a first assist can bill for up 85% of the reimbursement fee for something like a vein harvest, and that they can also bill for 14.5% of the surgeon's total fee for that particular surgery. Even if that is the case, does the PA actually keep the money that is reimbursed (the 85% and 14.5%) or is that money reimbursed instead to the surgeon, who would then pay the PA a production bonus based on whatever bonus system/scale their group has configured?

I don't know much about surgical billing, either, but I believe that 14.5% is the standard reimbursement rate for a PA/NP who provides first-assist services during surgery; I might be wrong, though.

Just to clarify, can a first assist PA bill BOTH the 85% AND the 14.5%?

 

[deleted6669]

Nope. Just the 14.5% in the o.r.
In clinic situations they can bill 85% of the physician rate. Most of this likely goes to the group they work for.

 

[HenryH]

Nope. Just the 14.5% in the o.r.
In clinic situations they can bill 85% of the physician rate. Most of this likely goes to the group they work for.

I have also been told that, during surgery, if a PA does a "mini" procedure such as harvesting a vein, they can actually bill for 85% of the fee the surgeon would receive from the insurance company if he/she had done the harvest -- I could be mixing this up with something else I heard/read, though.

 

[facetguy]

Nope. Just the 14.5% in the o.r.
In clinic situations they can bill 85% of the physician rate. Most of this likely goes to the group they work for.

Does the 85% apply to just Medicare, or do most carriers use this %?

 

[physasst]

Does the 85% apply to just Medicare, or do most carriers use this %?

Right now, Medicare/Medicaid and BC/BS all reimburse at 85%..

Aetna in Tennessee and 2 other states which are escaping me right now also reimburse at 85%...

ALL other insurers reimburse at 100% of the physician rate.

BTW, the entire 85% argument was based on flawed methodology, but that is an entirely separate argument.

 

[facetguy]

Right now, Medicare/Medicaid and BC/BS all reimburse at 85%..

Aetna in Tennessee and 2 other states which are escaping me right now also reimburse at 85%...

ALL other insurers reimburse at 100% of the physician rate.

BTW, the entire 85% argument was based on flawed methodology, but that is an entirely separate argument.

But it saves the insurance companies money, so how can it be flawed?

 

[HenryH]

Right now, Medicare/Medicaid and BC/BS all reimburse at 85%..

Aetna in Tennessee and 2 other states which are escaping me right now also reimburse at 85%...

ALL other insurers reimburse at 100% of the physician rate.

BTW, the entire 85% argument was based on flawed methodology, but that is an entirely separate argument.

Out of curiosity, do you know if surgical PA's are often paid a percentage of the 85% (as well as the 14.5% first assist fee) by the group they work for, or is it more common to just receive a flat percent bonus per surgery? Or even a production bonus awarded at the end of the year?

 

[deleted6669]

varies by group I would imagine.