Hiring NP or PA for practice with insurance

[liquidshadow22]

Is it doable to hire an NP or PA for a practice and have them participate with insurance but you as supervising psychiatrist would not participate with insurance and continue to be cash only?

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[calvnandhobbs68]

Is it doable to hire an NP or PA for a practice and have them participate with insurance but you as supervising psychiatrist would not participate with insurance and continue to be cash only?

I'm not sure any of us would be able to answer this question. It likely depends on the individual contracts with the insurance companies. Similar to the "site specific" questions about insurance companies people always ask (ex. if I take BCBS at my main job, can I set up a cash only private practice down the road and charge BCBS patients cash).

 

[TexasPhysician]

Is it doable to hire an NP or PA for a practice and have them participate with insurance but you as supervising psychiatrist would not participate with insurance and continue to be cash only?

Assuming it doesn’t violate the insurance contracts being in the same suite and you use separate EIN’s, it would still be a logistical nightmare. The name/location will show up as in-network. Patients will assume you take insurance, superbills for OON charges will get denied, and plan for many negative reviews over this online.

 

[michaelrack]

Yes it's possible (in most states).. you would need to set up separate businesses and locations (give the midlevels a different suite number in the building).

 

[trophyhusband]

Assuming it doesn’t violate the insurance contracts being in the same suite and you use separate EIN’s, it would still be a logistical nightmare. The name/location will show up as in-network. Patients will assume you take insurance, superbills for OON charges will get denied, and plan for many negative reviews over this online.

Not to mention when the NP/PA inevitably leaves what happens then? All those patients are going to want to be seen but aren't gonna want to pay cash. NP's don't seem to care a whole lot about the whole patient abandonment thing based on what I see around here... can't imagine my wife tying herself to one of these folks without being able to fully cover whatever they're doing.

 

[Jules A]

Assuming it doesn’t violate the insurance contracts being in the same suite and you use separate EIN’s, it would still be a logistical nightmare. The name/location will show up as in-network. Patients will assume you take insurance, superbills for OON charges will get denied, and plan for many negative reviews over this online.

I have at least a couple per month who schedule an appointment despite me telling them, my advertising and intake documents that they sign clearly stating I don’t take insurance. Apparently they call their insurance and are told I take their insurance because I’m paneled for my hospital positions. So far only two have gotten nasty at the appointment phase. Two others actually attended the appointment thinking they could use insurance but paid without a problem so I guess they were hoping they found a work around but knew on some level that it was wishful thinking.

 

[whopper]

This is complicated and I even asked teaching faculty in NP programs about it and they didn't have an answer. Add to the complication that this could vary between states because the NP supervision requirements vary by state.

I have NPs under me. I specifically had a lawyer look into the state laws of Missouri and had my insurance company tell me their exact policy so I could follow it to the letter. They told me if NPs are in my payroll in my own practice then they had to have their names in the insurance coverage, but also told me if I happen to supervise the NP and in doing so work at an institution such as a clinic or hospital and they're not on my payroll then they aren't supposed to have their name in the coverage of my insurance.

Will this apply to you? I have no effing idea.

 

[robellis]

This is complicated and I even asked teaching faculty in NP programs about it and they didn't have an answer. Add to the complication that this could vary between states because the NP supervision requirements vary by state.

I have NPs under me. I specifically had a lawyer look into the state laws of Missouri and had my insurance company tell me their exact policy so I could follow it to the letter. They told me if NPs are in my payroll in my own practice then they had to have their names in the insurance coverage, but also told me if I happen to supervise the NP and in doing so work at an institution such as a clinic or hospital and they're not on my payroll then they aren't supposed to have their name in the coverage of my insurance.

Will this apply to you? I have no effing idea.

Why are you supervising NPs?

 

[whopper]

I became the medical director of an addiction clinic but still am able to retain my private practice.

Why? Each one working under me is very good. In fact better than a lot of doctors I've seen. They all are cooperative and follow the chain of command well. I get paid very well, but all clinical factors-good staff members, treatment, communication, and the area also is in high need of many more mental health providers.

Also I get my teaching itch scratched. Like a good resident good NPs want to learn and ask questions.

 

[liquidshadow22]

When you have an np see a patient, do they bill under a MD for the insurance or does the visit get billed as an NP or PA visit? Does it just depend on if you cosign, are the rules different depending on the insurance?

 

[Jules A]

When you have an np see a patient, do they bill under a MD for the insurance or does the visit get billed as an NP or PA visit? Does it just depend on if you cosign, are the rules different depending on the insurance?

I believe NPs can either bill independently or incident to physician which results in full physician reimbursement. Regardless of full practice authority if NPs are working for your practice I would guess in the case of litigation the physician would be dragged in anyway so it might make sense to have them bill under your number to maximize income on the front end. If the NP isn't comfortable with that arrangement I'd take a pass on hiring them.

 

[liquidshadow22]

I believe NPs can either bill independently or incident to physician which results in full physician reimbursement. Regardless of full practice authority if NPs are working for your practice I would guess in the case of litigation the physician would be dragged in anyway so it might make sense to have them bill under your number to maximize income on the front end. If the NP isn't comfortable with that arrangement I'd take a pass on hiring them.

If an np or PA is billing incident to the physician, does the individual np or PA need to be separately credentialed with the insurance or can you get by with just the psychiatrist being credentialed?

 

[Jules A]

If an np or PA is billing incident to the physician, does the individual np or PA need to be separately credentialed with the insurance or can you get by with just the psychiatrist being credentialed?

I'm fairly certain both need to be credentialed.

 

[liquidshadow22]

I'm fairly certain both need to be credentialed.

Are you sure about this? I have heard this is not the case from a few docs but I am not sure if this an insurance specific issue

 

[liquidshadow22]

Are you sure about this? I have heard this is not the case from a few docs but I am not sure if this an insurance specific issue

Well looks like blue cross requires an SA modifier, so clearly looks like a separate credentialing for the mid level would be necessary for them

 

[Jules A]

Are you sure about this? I have heard this is not the case from a few docs but I am not sure if this an insurance specific issue

Not 100%, no but at the two clinics where I worked and this was done everyone was credentialed. I think there can be exceptions for temporary situations like locums in some instances. Curious, why you wouldn't just credential everyone anyway to cover all the bases?

 

[liquidshadow22]

Not 100%, no but at the two clinics where I worked and this was done everyone was credentialed. I think there can be exceptions for temporary situations like locums in some instances. Curious, why you wouldn't just credential everyone anyway to cover all the bases?

BC Billing under the NPPs will only pay 85% as you mentioned before. Also it's a lot of extra administrative work to deal with the credentialing process, will delay start dates etc. At least those would be my hesitations.


Not that they pay anything but I check optum and they appear to require the NPP credentialing as well.

 

[Jules A]

BC Billing under the NPPs will only pay 85% as you mentioned before. Also it's a lot of extra administrative work to deal with the credentialing process, will delay start dates etc. At least those would be my hesitations.


Not that they pay anything but I check optum and they appear to require the NPP credentialing as well.

It definitely takes time and effort to credential everyone but probably worth it in the long run.

 

[Sushirolls]

Some insurance companies have an easy add on for a business, where you simply update the NPI-I list.
Others require all the paperwork.
I've not yet personally had to test out the logistics of either method, as not yet hired anyone to join, but tried to pay attention to the contract details or the inner workings of their websites, admin sections.

 

[liquidshadow22]

Some insurance companies have an easy add on for a business, where you simply update the NPI-I list.
Others require all the paperwork.
I've not yet personally had to test out the logistics of either method, as not yet hired anyone to join, but tried to pay attention to the contract details or the inner workings of their websites, admin sections.

Which insurances off the top of your head allow an easy add on? I assume you must update it internally with them and via CAQH. That's it?

How does the malpractice work? I assume you add the mid-level to your malpractice? Do they need a separate insurance plan.

From previous interactions, I think I would feel more comfortable working with a PA over NP...

 

[dl2dp2]

I have a friend who does this, so it is technically possible. I'm not sure if it's optimal, since I do personally feel like my gig is way better, but his business is more sellable to private equity in 5-10 years if that's something you care about.

If I have to supervise NPs, I'd prefer to actually do it as a 1099 consultant with a completely separate entity, physical location, etc. because you don't want to contaminate your cash practice for business side reasons (i.e. marketing, style of practice, etc). It's not a good idea to try to sell Gucci and Gap under the same roof. I actually think this is one of the reasons many malls in the US are failing.

 

[whopper]

In the APA CMEs there's a video lecture on liability with working with an NP or PA. E.g. what if there's a bad outcome and the NP works directly with you but they never told you of the red-flags so you had no reason to suspect high risk and then the bad outcome happens?

Simply type in "risk management" in the APA CMEs and it'll be one of only a few so it should be easy to pick up.