NYSSPA's Frequently Asked Questions

What is the organization that disciplines PAs?

Physician Assistants and physicians are disciplined by the NYS Department of Health's Office of Professional Medical Conduct (OPMC). If a complaint is made, the OPMC does a preliminary investigation to see if the accusations have merit or are within the DOH's jurisdiction. At that time the issue may be dismissed or brought to representative physicians, PAs or lay members of the Board of Professional Medical Conduct. This group decides whether the case goes to a formal hearing process or not.

For more information or to make a complaint call the OPMC at 1-800-663-6114

For your convenience, you can link to various New York State websites by clicking "Resources" on the NYSSPA website. Once you do (or if you are otherwise accessing them), the following will help you navigate the sites for the laws and rules and regulations:

For laws, go to the New York State Department of Education website www.nysed.gov, then under "Topics A-Z" choose "P". Then click on "Physician Assistants". Then click on the law or topic you need, or use www.op.nysed.gov or more specifically http://www.op.nysed.gov/med.htm.

For rules and regulations, go to the New York State Department of Health website www.health.state.ny.us. Click on "search". Then at the top upper right click on "Rules and Regs", then click on "Title 10-NYCRR", then click on "Search Title 10". Then enter the Rule and Regulation number you want (otherwise you have to scroll through the whole list to find what you want), or use http://www.health.state.ny.us/nysdoh/phforum/nycrr10.htm.
PA Part 94 (or choose 94.1 for Definition or 94.2 for Supervision and Scope of Duties) Prescribing 80.63, NP Services 85.43, Infection Control 92.2

We have been in contact with the AAPA on what to do about this. The origin of this comes from the Prescription Drug Marketing Act, which stipulates that samples can only be given to licensed providers with prescriptive privileges. While we are able to write prescriptions, the snag here is that our privilege to do so does not automatically come as part of our licensure. It is technically "assigned" to us by the physician. "Notwithstanding any other provision of law, a physician assistant may perform medical services, but only when under the supervision of a physician and only when such acts and duties as are assigned to him are within the scope of practice of such supervising physician." (see N.Y. State Dept. of Ed website, NYS Medical Education Law, Article 131-B). Since it is possible that not all PAs necessarily have this privilege delegated to them, the pharmaceutical companies want to have some type of proof that the PA with whom they are leaving samples has truly had the privilege delegated to him/her, hence the forms. While the companies expect you and your physician to comply and complete them, you don't necessarily have to.

The AAPA recommends that you simply give the representative a voided copy of a prescription blank that you use (including all the proper names, addresses, etc.). The premise here is that if the physician has allowed you to write prescriptions for his/her patients and approved a prescription pad with his/her name on it along with your name, then that should be proof enough that the privilege to prescribe has been delegated. If the representative refuses to accept your prescription, you have to make the choice between completing their form (which in your particular practice may not be a barrier), or not accepting samples (and discussing with the representative your future relationship).

Nurse practitioners are confronted with this as well, however, since they must register with the State for their prescriptive privilege, the pharmaceutical representatives can access who is or not privileged via the Internet. PAs do not have to register with the State.

According to the rules and regulations, one physician may supervise two PAs in an outpatient setting, four in a correctional facility, and six in a hospital setting. (see Article 131-B of the Law).

What this actually means is subject to who is interpreting it, i.e. for example, in the outpatient setting does it mean two PAs total, or two PAs working at one time? NYSSPA has a letter from the DOH favoring the latter interpretation. However, until this is more clearly defined, PAs may be subject to enforcement of this rule and regulation towards its strictest interpretation.

"A PA works under the supervision of a licensed physician who is responsible for the PA's performance as well as the overall care of the patient. The PA may have more than one supervising physician; however, there must be one clearly designated supervising physician who is available at any one time"

(Easy Reference Information Regarding the Registered Physician Assistant, N.Y. State Department of Health, 6/99).

No, but a PA may make a death pronouncement in lieu of the supervising physician.

Sections 4141, 4141-a, 4142, 4161, 4171, and 4175 of the Public Health Law govern the requirements for signing death certificates. The statutes do not exclude PAs, they authorize only a physician to sign death certificates.

Yes, but not in the behavioral health setting (psychiatric). Currently, the State Mental Health Law does not allow PAs to order restraints in the behavioral health setting.

Please note that the Joint Commission on Accreditation of Healthcare Organizations allows PAs to order restraints in the behavioral and non-behavioral health settings, but since the State does not allow PAs to issue behavioral health restraint orders, we must comply with the most restrictive rules.

For non-behavioral health settings, be sure to comply with your institution's policies and procedures. The AAPA has been very active promoting PAs with the JCAHO regarding restraints. For questions, please refer to the JCAHO website www.jcaho.org

No. There are currently only a small number of programs in the United States that train radiologist assistants or RAs. These individuals are radiologic technologists that have received supplemental training specific to the field of radiology only. RAs do provide medical imaging services, however, they are limited by law as to what services they can provide. For example, RAs can not legally order tests/procedures, diagnose, prescribe medication or bill for their services. PAs are permitted to provide these services and the supervising physician can bill for these procedures. Furthermore, PAs receive broad based medical education and training modeled after medical school programs prior to choosing a specialty.

For more information regarding this please refer to http://www.aapa.org/gandp/rpas.html or you may contact Sharon Kulesz , PA -C, AAPA Professional Affairs Department, 950 North Washington Street, Alexandria, VA 22314-1552

Contact the NYSSPA Executive Office at 877-769-7722 or info@nysspa.org

NYSSPA Thanks Peter Schuman, RPA-C, RT(R), RDMS, RVT, CCD, CD, Chief PA, St. Peter's Hospital & Northeast Medical Imaging, PC for his assistance in the formulation of these FAQ's.

Medical services provided by a PA may be reimbursable through Medicare, Medicaid, TRICARE, and most private third party insurance providers. PAs do not deliver PA services, they provide medical and surgical services within the scope of their supervising physician's practice. It is best to avoid the term PA services.

The AAPA recommends using the following question when dealing with insurance companies: Do you cover medical services provided in the physician's office by a Physician Assistant when billed by the physician?

This will have no impact on your Tax ID, DEA, or State License.

To apply online or for more information please go to: https://nppes.cms.hhs.gov

Small health plans have until May 23, 2008. After those dates, PAs and other providers may use only their NPIs to identify themselves in standard transactions.

There are two options available regarding billing Medicare for medical services provided by a PA in an office setting. The Balanced Budget Act of 1997 stipulates that a PA may be reimbursed at 85% of the physician's fee schedule or at 100% of the physician's fee schedule if the "incident-to" provision is utilized.

All services that a PA is legally authorized to provide that would have been provided personally by a physician are reimbursed at 85% of the physician's fee schedule. State law determines the level of supervision.  The supervision must be continuous, but not direct. The physician (or designee) must not be physically present in the office suite when the PA delivers the service. The physician (or designee) is responsible for the overall direction and management of the PA's professional activities and for assuring that the services provided are medically appropriate for the patient. The level of general supervision is determined as part of the physician-PA relationship.

"Incident-to" services, which may be reimbursed at 100% of the physician's fee schedule, are defined as an integral, although incidental, part of the physician's professional activities services in the course of diagnosis and treatment of an injury or illness. It is extremely difficult to meet the all of the requirements to bill "incident-to". The following requirements must be met:

• The physician must provide DIRECT supervision. The physician must be on-site and immediately available to provide direction and assistance during the time the service is provided.

• The physician must provide the initial care of any new patient during their first visit 

• The physician must provide the initial care for any new problem of an established patient.

The "incident-to" provision is confusing and subject to allegations of fraud. This provision has received significant attention from the Department of Justice since 2002. Many problems arise when an established patient who is being seen for a routine follow-up presents with a new complaint. This new complaint must be evaluated by the physician or incident-to is violated. If the physician routinely arrives late to office hours after rounding at the hospital, the PA cannot bill incident-to for the patients seen in the physician's absence.

When both the PA and the physician provide part of the patient's evaluation and management services on the same day in the hospital setting (inpatient and emergency department), they may usually bill Medicare using the physician's PIN at 100% of the physician's fee schedule if both the PA and the physician are employed by the same employer and a portion of the care provided by the physician was face-to-face. The amount of work provided does not matter, only that the documentation clearly and accurately demonstrates that the physician provided some portion of the face-to-face care. A countersignature on the patient's record does not suffice. The record must reflect the service provided by the PA and the physician. This provision does not apply to procedures, only evaluation and management.

If the physician does not see the patient face-to-face, then the evaluation and management services should be billed under the PA's PIN at 85% of the physician's fee schedule.  "Incident-to" does not apply to the hospital setting.

Medicare's policies have not changed.  The physician still has to personally perform the comprehensive exam/visit, but the PA can perform every other visit in the nursing facility.

Medicare has been trying to clarify its policy over the last year or so.  It seems that every time they issue a clarification, it causes more confusion.  One change is that PAs and NPs can perform the first visit for the SNF patient, but the physician still must perform the comprehensive visit.  The change seems somewhat meaningless in terms of actual practice.

We contacted New York Medicaid and were told by Mary Rondeau that PAs (and NPs) are not covered separately when they work for the facility.  Ms. Rondeau's number is 518/474-9219.

Allegations of fraud and abuse do apply to PAs even if the care they provide is higher than average. PAs are subject to state and federal scrutiny of their practices in providing and billing for services rendered. State and federal authorities have targeted all health care providers, including PAs, for investigation and enforcement leading to criminal, civil, and administrative sanctions. PAs are at risk, even if they have no knowledge of and did not personally participate in the wrong doing.

NYSSPA thanks Michael Powe, Director, Health System & Reimbursement Policy for the American Academy of Physician Assistants, for his assistance with these issue.