Supervisory ratios are the ONLY specification in most state AA regulations or state law. There is NO language that I'm aware as you state below:
2. In the case of the AA, the MDA MUST ...absolutely MUST do certain things to show he is supervising properly in order to bill.
You're confusing TEFRA requirements with language that you assume is in AA statutes, which it is not. When a group bills "medical direction", it does so regardless of whether or not the providers are AA's or CRNA's. I believe they can also bill it as "medical supervision". Groups generally don't mix trying to bill both "medical direction" and "medical supervision" as defined in CMS regs because the recordkeeping requirements would be onerous.
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