When PAs and NPs bill, does the practice get reimbursed as if a physician saw the patient?

[mainetrout]

Hello everyone,

When NPs and PAs bill, does the practice they work for get reimbursed as if it was a physician who saw the patient?

For example, if a physician owns a family practice and hires an NP - when the practice gets reimbursed from the insurance company for the NPs services (seeing patients), does the practice receive reimbursement as if a family doctor saw the patient, and therefore the practice can pay the NP his/her salary and profit the rest?

Thanks.

---

Members don't see this ad.

 

[Merely]

Someone please answer this question as it's an interesting one and important for someone that wants to open up their own practice to know.

 

[deleted87716]

If you're talking about commercial payers, you would need to examine each payer contract and fee schedule to see if they credential NPs or PAs (most do nowadays), and whether or not they reimburse the same as for physician services.

If you're talking about Medicare (CMS), they typically pay 85% of the physician fee for services provided by NPs or PAs. However, there's something called "incident to" billing that may allow you to bill at the physician rate if you meet all of the requirements. You can read more about that here: http://www.physicianspractice.com/blog/medical-practices-guide-incident-billing

 

[Merely]

So by hiring NPs and PAs, one can earn physician level money from them then pay them a lot less and that difference is all profit? Sounds like a good deal to me...

 

[deleted87716]

If you hire an NP or PA and pay them a salary+benefits, they're just part of your overhead. If their collections exceed the costs of employing them, you make a profit. As you can imagine, there are lots of variables. However, most physicians who employ NPs or PAs profit from doing so, else they wouldn't be doing it.

 

[hallowmann]

In my limited familiarity with a handful of practices, according to the docs involved adding on a PA/NP adds ~$80k or a bit more in profit to those practices. In terms of gross its closer to ~$200k.