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does being only BOARD ELIGIBLE and not certified affect reimbursement in private practice?

Discussion in 'Pathology' started by pathology2020, Jun 22, 2016.

  1. pathology2020


    May 5, 2016
    I have a question.
    Does being only board eligible affect reimbursement when working in private practice. Please let me know.
    Thank you
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  3. Alteran

    Alteran 10+ Year Member

    Feb 9, 2008
    Border war zone
    I think that's a mute point as I don't think a board eligible only pathologist could clear credentialing to be able to even work.
  4. pathology2020


    May 5, 2016
    Yes you can. I know a number of board eligible pathologists in major hospital
  5. LADoc00

    LADoc00 There is no substitute for victory. 10+ Year Member

    Sep 9, 2004
    I want to respond to this because personally a long time ago I had senior pathologists outright LIE to my face about this.

    I had pathologists tell me:
    1. Not being board certified prevented them from billing CMS. Verdict lie
    2. Not being BC equaled lower reimbursement from private insurance. Verdict lie
    3. Not being subspeciality BC prevents you from billing for subspeciality technologies like flow. Verdict lie

    There are only 2 things not having BC status can affect:
    1. Ability to get onto certain hospital medical staffs
    2. Malpractice insurance tier
  6. AZpath

    AZpath 5+ Year Member

    Nov 1, 2012
    If I was taking on a BE physician.
    My offer would likely be the same but the contract would stipulate that you have 2-3 to pass your boards.
    Mainly this is for hospital privileges .
  7. Torsed

    Torsed Deo Vindice. 7+ Year Member

    Apr 11, 2008
    You can't be a medical director of a hospital lab with AP/CP.
  8. Dokta Sam

    Dokta Sam 5+ Year Member

    Jan 27, 2012
    What a great question! It's one that I had back in '03 but never found an answer to so I just trailblazed it! I am a DO psychiatrist in private practice since 2003. I am didn't waste my money on taking the boards. My plan was just to take self-pay patients only but as it turns out the insurance companies do not require board cert (or eligibility for that matter). My reimbursement rates are the same as those of my practice partner who is board cert (and MD). I think they're just happy to use us as vehicles to help keep the american healthcare economy running for them. When I was in training I was warned left and right that I should take the boards , but not once did anyone give me any convincing explanation of consequences that would befall me if I didn't take the boards, and I'm glad I trusted my gut.
    Last edited: Apr 27, 2017
  9. yaah

    yaah Boring Administrator Physician 10+ Year Member

    No, it doesn't. But it may effect your ability to get hired. Some hospitals won't put you on staff unless you're board certified (or eligible and in the process of becoming certified).
    mikesheree likes this.
  10. mikesheree

    mikesheree Physician Gold Donor Classifieds Approved 7+ Year Member

    Feb 27, 2010
    NOT behind a scope.
    As others have said, reimbursement is not generally or significantly affected.
    However, not being boarded within an appropriate time frame, in the
    field of pathology, is (almost) the kiss of death. Getting a job is hard enough as it is in path.
  11. Mordak

    Mordak 5+ Year Member

    Jun 2, 2011
    I have a follow-up concern that perhaps some of you may be better able to explain. Under the UnitedHealthcare Laboratory Benefit Management Program Administrative Protocol which applies to laboratory services for fully insured Commercial members who live in Florida, it specifically reads:

    If you perform and bill for any laboratory services, you must demonstrate the following:

     CLIA certification

     Accreditation from the College of American Pathologists (CAP) or The Joint Commission for

    certain complex pathology tests

     Secondary review for certain complex pathology tests

     Sub-specialist review for certain complex pathology tests

     Capability to process test orders and results electronically"

    It goes on to cite specific accreditation for "sub-specialist review" and that includes numerous board certifications.

    I do not know how common place this is.

    Is this type of arrangement becoming more common?
  12. AZpath

    AZpath 5+ Year Member

    Nov 1, 2012

    UHC would like to do
    Designed to promote the use of a Narrow network.
    They would like 100% of the work to be done by Lab Corp.

    UHC does plan to do this in other states.
  13. LADoc00

    LADoc00 There is no substitute for victory. 10+ Year Member

    Sep 9, 2004
    I would never ever ever tell someone NOT be BC in both AP and CP. YOU SHOULD, not exceptions. But even CLIA88 and knock on rules interp allows someone to be grandfathered in who was medical director prior or has significant related experience without BC in Pathology.

    But that doesnt matter, STUDY AND GET YOUR BOARDS DONE FOLKS!

    that is all, carry on.

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