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Frequently Asked Physician Assistant Practice Questions
What is the Physician Assistant scope of practice in Wisconsin?
The scope of practice of physician assistants currently licensed in the state is defined under Chapter Med 8 of the Wisconsin Administrative Code governing the state’s Medical Examining Board.
In providing medical care, the entire practice of any physician assistant shall be under the supervision of a licensed physician. A physician assistant’s practice may not exceed his or her educational training or experience and may not exceed the scope of practice of the supervising physician. A medical care task assigned by the supervising physician to the physician assistant may not be delegated by the physician assistant to another person.
As our scope of responsibilities is determined by the practice of our supervising physician, we function as a medical team member who provides a broad range of services. These services may include: · patient histories and physical exams;
How do I get a DEA number?
To obtain a DEA number, apply online or download a form at http://www.deadiversion.usdoj.gov/drugreg/reg_apps/ The cost is currently $390 for 3 years. National phone (800) 882-9539
How do I update my state license?
PAs are required to inform the Department of Regulation and Licensing of any changes in their supervising physician status. Changing supervising physicians, adding alternate supervising physicians or updating your name or address information with the State of Wisconsin license information is very simple. You should list a primary supervising physician and also list as many alternate supervising physicians as seems practical for each employment position. If you moonlight, you should list a primary and alternate supervising physicians for each employer.
A letter sent to the state that simply informs them of your supervising physicians is all that is necessary.
These letters should be sent to: Physician Assistant Licensing State of Wisconsin Department
of Regulation and Licensing (608) 266-0627
Do all of my charts have to be co-signed by my supervising physician?
No, physician co-signature is not required on all patient charts. According to state law, the only charts requiring physician review are those encounters where new prescription orders are issued. Your supervising physician or employer may, as a matter of policy, require that all charts be co-signed. This is well with in their rights as your employer, as long as they do not interfere with the supervisory responsibilities of the physician. Charts must be countersigned within 72 hours, unless you work in a federally designated rural health clinic where the countersignature requirement is extended to 7 days.
What are the Physician supervision requirements in Wisconsin?
The supervising physician must be available for consultation by telephone or other means of telecommunication within 15 minutes of contact. The supervising physician is required to conduct an on-site review of facilities attended by the PA at least once a month.
How many supervising physicians can I have?
Unlimited, though each must be registered with the state as a supervising physician. You must report all your supervising physicians as noted above. Physicians may also supervise multiple PAs, but they may not supervise more than two PAs at the same time.
No physician may supervise more than two physician assistants concurrently unless that physician submits a written plan (to the state) and receives approval; however, more than one physician is allowed to supervise a PA. -Chapter Med 8
What must be in place for me to write prescriptions in Wisconsin?
Wisconsin Statute permits a physician assistant to issue a prescription order for a drug or device in accordance with guidelines established by a supervising physician and the PA. Physician assistants in Wisconsin are recognized as practitioners under state controlled substance law which permits them to distribute and dispense controlled substances including schedule II through schedule V medications. Wisconsin PAs are recognized as individual practitioners under federal controlled substance law and are eligible to apply for midlevel provider DEA registration numbers.
Chapter Med 8.08 of the Wisconsin Administrative Code requires that written guidelines for prescribing be kept on-site and reviewed at least annually by the PA as well as the supervising physician. The actual format of these guidelines is left up to the discretion of the physician and the PA. The supervising physician is required to review and countersign either the prescription order or the patient record prepared by the PA within 72 hours. The countersignature requirement only applies to patient records for which new prescriptions are written or new medications are ordered. WAPA has received clarification from the Department of Regulation and Licensing that refill prescriptions (prescription for medications the patient is already taking) do not need physician co-signature. Co-signature can be accomplished any number of ways. For example, the physician can sign a signature sheet in the front of the chart, sign the individual prescriptions or co-sign each individual clinic note. If a PA practices in a facility apart from the supervising physician, review by telephone within 72 hours and countersignature of the patient record within one week is required.
What about reimbursement for services provided by PAs?
Medicare pays the PAs’ employers for medical services provided by PAs in all settings at 85 percent of the physician’s fee schedule…. This includes hospitals (inpatient, outpatient, and emergency departments), nursing facilities, offices and clinics, and first assisting at surgery. Outpatient services provided in offices and clinics may still be billed under Medicare’s “incident-to” provisions if Medicare’s restrictive billing guidelines are met. This allows payment at 100 percent of the physician’s fee schedule if: (1) the physician is physically on-site when the PA provides care; (2) the physician treats all new Medicare patients (PAs may provide the subsequent care); and (3) established Medicare patients with new medical problems are personally treated by the physician (PAs may provide the subsequent care). State managed insurance programs such as Medicaid and Badgercare generally reimburse physician assistant services at 90% of the physician fee schedule. Private insurance companies reimburse through their own policies. They may follow Medicare and Medicaid guidelines or reimburse at 100%. Rarely, some may attempt to refuse reimbursement.
2/2005
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