11/28/2023

OAPA Working for You: Reimbursement Committee

The OAPA Reimbursement Committee advocates for more favorable State and Federal reimbursement policy pertaining to the PA profession. It educates administrators, physicians, and other decision makers on the current regulatory environment in reimbursement. In short, this committee wants to help you get paid for the good work that you do!

Under the leadership of Clayton Rotuno, PA-C, an Inpatient Orthopedic Hospitalist PA for the Cleveland Clinic, the Reimbursement Committee represents OAPA at AAPA’s States Advocates for Reimbursement (STAR) meetings. In this forum, OAPA provides feedback and elevates Ohio’s voice to the national level, where AAPA works to affect change, such as in direct meetings with the Center for Medicare and Medicaid Services. New this year for AAPA was a Payer Summit where AAPA met with some of the top commercial insurers in the United States to brief on changes in PA legislation and provide perspective on PA coverage policies.

At the state level, the Reimbursement Committee represents Ohio PAs and comments on policy changes within the Ohio Department of Medicaid and the Ohio Bureau of Workers Compensation. It troubleshoots reimbursement issues related to enrolling PAs to bill as Primary Care Providers, educates Ohio PAs on current billing, coding, and reimbursement policies, and even advocates for reimbursement of state professional society dues for PAs. The committee has also presented to PA programs around the state to help prepare the next generation of PAs for addressing reimbursement issues in their practice.

Importantly, OAPA members can count on the Reimbursement Committee to help research and answer questions related to reimbursement. A few of the inquiries the committee has fielded in 2023 include:

• Two cases of CMS denying spine and shoulder x-ray interpretation by PAs citing this to be a "scope of practice" concern. This is an emerging issue and an example of the importance of OAPA’s continuous efforts to advocate for the profession and protect the ability for PAs to practice to the fullest extent of their education and training.
• A commercial insurer not allowing PAs to enroll as PCPs and instead billing them as specialists, which then bills the patient at a higher rate. It is critical that we set the record straight that PAs should be enrolled as PCPs when functioning in this role, and not overcharge patients with "specialist" charges.   

The Reimbursement Committee is critical for supporting OAPA members and all in the Ohio PA community to advance practice and ensure that PAs are valued for their work. If you would like to volunteer to serve on the committee, or if you have a question or concern pertaining to reimbursement, please submit your request here and it will be directed to the OAPA Reimbursement Committee. 

P.S. - Just as having a large membership base to show strength in numbers is valuable for general legislative activity, so is it for advocacy specifically targeted at reimbursement issues. Please invite your colleagues to join OAPA today and be sure to renew your membership before it expires to help keep our collective voice loud and clear!