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The Rural Health Clinic Services Act of 1977 authorized the first Medicare coverage of PA services. Since 1977, a wealth of reform has revolutionized coverage of PA services. Medicaid currently reimburses all medical services rendered by PA’s at either an equal or slightly lower rate than that paid to physicians. Private insurers cover PA services for the most part, as long as they are part of the supervising physician’s bill or a part of a global surgery fee. Additionally, TRICARE reimburses all medically necessary services rendered by PA’s at 85% of the Physician rate and 65% of the physician’s fee when the PA is the first assist in surgery. When it comes to Medicare, the Balanced Budget Act of 1997 (BBA) has provided PA’s with the most expansive coverage to date (Third, 1). Over the past twenty years Congress expanded Medicare Part B payment to cover services rendered by PA’s only in hospitals, nursing facilities, rural Health Professional Shortage Areas (rHPSA), and surgery as first assist. Since the enactment of the BBA on January 1, 1998, PA coverage has been expanded even further. Some important changes to Medicare coverage resulting from the BBA involve the removal of practice location restrictions, increased reimbursement rates, independent contractor arrangements, and the issuance of provider numbers. The removal of the restrictions on the type of areas and settings in which PA’s can serve and still be covered by Medicare is one change authorized by the BBA that has made a large impact on the PA profession.
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