How does outpatient double boarded office visits go?

[MedicinalTofu]

Hello all. Curious about something.

How does the office set up work for a physician who is multiple boarded?

Specifically IM with subspecialty training. Whether it's one subspecialty or many.

Let's talk for the sake of argument the IM / Cardiologist physician.

Since a consultant must have a primary care physician refer in order to bill, would this mean this physician would primarily be practicing cardiology and occassionally dabble in primary care?

If this physician really liked primary care screening, prevention, and had a good grasp of non-cardiac issues, would this physician have to then have both board certifications maintained, buy two sets of malpractice, and essentially be labelled as an internist and bill for internal medicine visits (not that there's any different CPT codes I believe) and then just perform the cardiac procedures under the umbrella of this individuals cardiology certification?

Obviously this will have to be private practice as employers usually would not allow the reduced income/RVUs for a salaried employee to do the work of two physicians but only bill for the work of one.

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[IM2GI]

Nearly all specialists start out "double boarded" in internal medicine + their speciality. Most do not renew their internal medicine unless required for billing/privileges purposes.

Unless you are a nephrologist who can't find a job, no specialists want to be practicing primary care.

 

[bashwell]

Hello all. Curious about something.

How does the office set up work for a physician who is multiple boarded?

Specifically IM with subspecialty training. Whether it's one subspecialty or many.

Let's talk for the sake of argument the IM / Cardiologist physician.

Since a consultant must have a primary care physician refer in order to bill, would this mean this physician would primarily be practicing cardiology and occassionally dabble in primary care?

If this physician really liked primary care screening, prevention, and had a good grasp of non-cardiac issues, would this physician have to then have both board certifications maintained, buy two sets of malpractice, and essentially be labelled as an internist and bill for internal medicine visits (not that there's any different CPT codes I believe) and then just perform the cardiac procedures under the umbrella of this individuals cardiology certification?

Obviously this will have to be private practice as employers usually would not allow the reduced income/RVUs for a salaried employee to do the work of two physicians but only bill for the work of one.

In theory no reason a cardiologist can't maintain both, but all the cardiologists I know or know about are only practicing cardiology, not general IM.

If PCP is the goal (outpatient IM), unless they're independently wealthy or the opportunity cost isn't an issue or they're just a glutton for punishment, not sure why anyone would want to do a fellowship in cardiology which is 3 years.

And if someone is already a cardiologist, I can't see how they would want to go back, unless they can't find a job as a cardiologist for some reason.

 

[michaelrack]

Malpractice isn't an issue. I have had no problem getting malpractice policies covering the combination of psychiatry, sleep medicine, and Internal medicine. (I am only practing 1-2 of those at each location)

 

[michaelrack]

Since a consultant must have a primary care physician refer in order to bill, would this mean this physician would primarily be practicing cardiology and occassionally dabble in primary care?
.

A referral is usually only required to bill a consult code, which most insurers don't cover any more. No problem usually just billing a new patient code.

 

[IM2GI]

A referral is usually only required to bill a consult code, which most insurers don't cover any more. No problem usually just billing a new patient code.

You also have ot make sure you are not violating the Stark law

 

[michaelrack]

You also have ot make sure you are not violating the Stark law

I didn't mean to imply that the double-boarded doctor would refer a patient to himself, just trying that it made no difference whether a patient came to him for a primary care problem or a specialty problem. I don't bill consult codes any more, since insurers in general no longer pay them.

 

[DrSnips]

You also have ot make sure you are not violating the Stark law

I'm not a lawyer, but I don't think you can violate the anti-kickback statute by seeing a patient yourself as a specialist that you also see as a PCP. The wording of the law implies there must be a quid pro quo situation, which doesn't seem possible for a single person.

 

[MedicinalTofu]

Let's use a more real world scenario then:
The IM/Nephrologist who does not like to round in 4-5 hospitals/HD centers/call q3 as an attending...

Liked the renal physiology and disease processes, likes HTN, doesn't like the lifestyle...

Lucked out and got a private practice job in which no RVUs no partners no headaches..

Primarily wants to be a PMD, but can handle advanced CKD and will merely send HD patients to the centers and have the center's nephrologist take care of the HD...

Can this double boarded individual then see an existing patient for renal or HTN issues and do the things that a nephrologist would do during the IM visit.. bill the 99213 or 99396 and then just call it a day? As long as this physician has the specialty board certification and is not double billing, no one will make a big deal out of this? No need to "refer or self refer" then right?

 

[gutonc]

You don't even need the specialty certification. A board-certified interventional neuro-radiologist could do that if they were so inclined.

 

[Raryn]

Let's use a more real world scenario then:
The IM/Nephrologist who does not like to round in 4-5 hospitals/HD centers/call q3 as an attending...

Liked the renal physiology and disease processes, likes HTN, doesn't like the lifestyle...

Lucked out and got a private practice job in which no RVUs no partners no headaches..

Primarily wants to be a PMD, but can handle advanced CKD and will merely send HD patients to the centers and have the center's nephrologist take care of the HD...

Can this double boarded individual then see an existing patient for renal or HTN issues and do the things that a nephrologist would do during the IM visit.. bill the 99213 or 99396 and then just call it a day? As long as this physician has the specialty board certification and is not double billing, no one will make a big deal out of this? No need to "refer or self refer" then right?

The nephrologist bills the same codes as the primary care doctor. And gets paid the same for a visit. No big deal.