Supervision Requirements for Incident-To Billing

I recently received the following question about incident-to billing: 

My compliance officer asked me to reach out to … seek direction on where we could find current information about [whether] it is permitted to bill incident to when a medical assistant is supervised and billed under a PA [physician assistant] as the supervising physician.

We read your 2016 article … about [Medicare’s Chronic Care Management] and [Transitional Care Management] billing. Oregon recently passed laws where PAs enter into a collaborative agreement with providers. [Does this change whether the Centers for Medicare & Medicaid Services] will now allow incident-to billing with PAs supervising [medical assistants]?

In the Medicare Benefit Policy Manual, the definition of physician includes physician assistants and nurse practitioners. As demonstrated in the 2016 Public Affairs article, medical assistants are classified as auxiliary personnel and clinical staff under Medicare law.

Therefore, medical assistants’ services performed incident to those of a PA may be billed incident to the services of the PA in the same way that they may be billed incident to the services of an MD or DO.

How Will Medical Assistants Be Impacted by the CMS COVID-19 Vaccination Rule?

In response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) issued its interim final rule with comment period titled “Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination” (CMS vaccination rule) in November 2021. This rule requires the staff of Medicare- or Medicaid-certified providers and suppliers to be vaccinated against COVID-19.

Medical assistants must be mindful of federal vaccination requirements. So, in order to combat confusion and misinformation about how this CMS vaccination rule—and other federal vaccination rules—affect medical assistants, my January/February 2022 Public Affairs article answers common questions about the rule.

This article—titled “How Will Medical Assistants Be Impacted by the CMS COVID-19 Vaccination Rule?”—covers many aspects of the CMS vaccination rule including its scope, who is and is not covered, and the effects on externing medical assisting students.

Find the article on the “Public Affairs Articles” webpage.

New AAMA Initiative Urges Private Payers to Adopt CMS Order Entry Requirements

The Medicaid Promoting Interoperability Program (formerly the Medicaid Electronic Health Record Incentive Program) will be ending December 31, 2021, because of the provisions of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act and the regulations of the Centers for Medicare & Medicaid Services (CMS). One notable requirement of the Medicaid Promoting Interoperability Program for participating licensed providers to receive an annual incentive payment is that they must attest that at least 60% of medication, 60% of laboratory, and 60% of diagnostic imaging orders have been entered into the computerized provider order entry (CPOE) system by either credentialed medical assistants or licensed health care professionals. 

Effective immediately, the Board of Trustees of the American Association of Medical Assistants® (AAMA) has authorized the AAMA to embark upon a nationwide initiative to persuade third-party payers to include the 60% order entry personnel provision in its reimbursement requirements. 

Further information will be forthcoming.

Medical Assistants’ Competence in Performing Diagnostic Tests: Comments to CMS

On August 14, 2020, I submitted comments to the Centers for Medicare & Medicaid Services (CMS) of the Department of Health and Human Services regarding proposed rule CMS-1734-P.

Read those comments in the September/October 2020 Public Affairs article, “Medical Assistants’ Competence in Performing Diagnostic Tests: Comments to the CMS,” on the AAMA website.

Testing Period Extension for the AUC Program

Note the recent update via the Centers for Medicare & Medicaid Services on the appropriate use criteria (AUC) program:

NOTICE: The EDUCATIONAL AND OPERATIONS TESTING PERIOD for the AUC Program has been extended through CY 2021. There are no payment consequences associated with the AUC program during CY 2020 and CY 2021. We encourage stakeholders to use this period to learn, test and prepare for the AUC program.

The following describes the intended AUC program timeline, according to the Centers for Medicare & Medicaid Services:

Program Timeline

Currently, the program is set to be fully implemented on January 1, 2022 which means AUC consultations with qualified CDSMs [clinical decision support mechanism] are required to occur along with reporting of consultation information on the furnishing professional and furnishing facility claim for the advanced diagnostic imaging service. Claims that fail to append this information will not be paid. Prior to this date the program will operate in an Education and Operations Testing Period starting January 1, 2020 during which claims will not be denied for failing to include proper AUC consultation information. Beginning July 1, 2018 the program is operating under a voluntary participation period during which time consultations with AUC may occur and may be reported on furnishing professional and facility claims using HCPCS [Healthcare Common Procedure Coding System] modifier QQ.

As a reminder, I provide supporting evidence for my position that CMAs (AAMA) are clinical staff according to the Centers for Medicare & Medicaid Services rule regarding the AUC program in my Public Affairs article of the September/October 2019 CMA Today. As a result of their clinical staff status, I assert that CMAs (AAMA) are permitted to do the following:

1. Consult a clinical decision support mechanism (CDSM) about the appropriateness of ordering a particular advanced diagnostic imaging service
2. Report findings to their overseeing or delegating licensed providers

Find the article, as well as all my other Public Affairs articles, on the AAMA website.