The Importance for PAs to Know Billing and Reimbursement
A very important topic that gets little coverage in PA school is billing and reimbursement policy. I think we spent maybe two days in PA school talking about it and at the time it didn’t make any sense to me. There is a lot to learn in PA school and there is just not enough time to cover everything in depth. There are professionals who dedicate their careers to this, and as a PA you don’t need to know it as in-depth as the billing department; however it is important to have a working knowledge of the payment and coverage policies for the services you provide.
Most PAs did not become PAs because they wanted to know about billing and reimbursement, and you might say, “I have a billing department, so I don’t need to worry about know this stuff”. Actually, you do, as you are the one that is legally responsible. Fraud is the intentional misrepresentation of a service; abuse is negligence or the allowance of the activities, and if you allow improper billing under your name, even if you don’t know about it, that could count as abuse.
Understanding Billing for Negotiation of Your Next Salary
Beyond legal reasons for understanding billing and reimbursement it is also important to understand how this works, for better negotiating your salary. If you don’t know how much you’re bringing into a practice, it’s hard to put a number on your worth. This just comes down to profits and losses. How much is coming in and how much is going out.
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If you think you deserve $100,000 salary, but only brought in $100,000 in reimbursements, your salary is not viable to keep the business open. If you brought in $1,000,000 into the practice and are only paid a $100,000 salary, you’re probably underpaid and deserve a raise, and you can use that knowledge in your next negotiation.
This is also important in understanding what you can do to increase profits to the business. How much is it worth to see one extra patient a day? Is there something you can do to be more efficient during the day? Most PAs did not go into this career to worry about profits and losses, but the bottom line is that it allows you to have a job; and without profits businesses aren’t able to stay open.
Have a General Understanding of Billing and Reimbursement
As mentioned above, there are people who devote entire careers to billing, and as PA you don’t need to know it as well as them, but it is important to have a general understanding of how things work. There is a lot of terminology and acronyms that are very confusing; incident to, shared visits, RVU, MIPS, APMs, etc. You can learn more about all of these by attending the AAPA annual conference and going to a lecture on it, or you can get the AAPA Guide to PA Reimbursement for only $25 for AAPA members. (Disclaimer: I am not paid by the AAPA and all opinions are my own.)
It will probably help you fall asleep at night, but if you have any questions about billing and reimbursement for PAs, this really is a great resource. If you have any questions at all about how your practice is doing something, you need to make sure that they are doing it correctly, as you are ultimately responsible for what gets billed out under your name.
How well do you understand billing and reimbursement? How did you learn about these topics? Don’t forget to sign up to receive future posts by email, please comment below the original post and share with your friends!
