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06/01/2009

Medicaid Rules Revised in 2009

 

Medicaid Rules Revised in 2009

The Ohio Department of Jobs and Family Services revised the Medicaid rules and the new rules went into effect on February 16, 2009.

Of note in the new rules:

Elimination of the prohibition against PAs billing for seeing new patients, seeing existing patients with a new condition, or admitting and discharging patients to a hospital without a physician also seeing the patient. (Note: This is a correct statement of the change in the reimbursement rule. However, under Ohio law the actual admission to the hospital must still be done by a physician, dentist, or podiatrist, not a PA. The reimbursement rule does not affect this requirement.)

Reimbursement for approved services will be at the lesser of the provider's billed charge or eighty-five percent of the Medicaid maximum

Reimbursements for PA services are not payable to the PA directly, but can only be paid to the physician, physician group practice, or clinic employing or contracting with the PA.

The new rule excludes the following services from PA reimbursement:

  • Assistant at surgery services
  • Visits and/or procedures provided on the same date of service by a PA and the PA's employing physician, physician group, or clinic that are billed as separate services
  • Consultations and critical/intensive care services (though the rule does recognize that services provided by PAs in such circumstances are highly valuable to the physician and the patient)
  • Services prohibited by the requirements of the PA supervision rule


The employing physician, physician group practice, or clinic may be directly reimbursed for PA services performed in a nursing facility or an intermediate care facility for the mentally retarded.

The new rules clarify that there is no separate reimbursement for services provided to a hospital-employed PA. The reimbursement for such services is bundled into the facility payment made to the hospital.


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