Moonlighting questions

[goinverted]

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So I may be doing a year of some research prior to starting Derm residency. There is a dermatology group that I have worked with who have expressed interest in me working in their clinic under their supervision after I finish internship. The group is private and being Dermatology they don't need specific hospital privilages. Are there any reasons why this wouldn't work out? I would have taken step 3 and applied for a full medical license by the time I would moonlight. How does malpractice work for something like this?

 

[gutonc]

So I may be doing a year of some research prior to starting Derm residency. There is a dermatology group that I have worked with who have expressed interest in me working in their clinic under their supervision after I finish internship. The group is private and being Dermatology they don't need specific hospital privilages. Are there any reasons why this wouldn't work out? I would have taken step 3 and applied for a full medical license by the time I would moonlight. How does malpractice work for something like this?

You (or they) will have to pay for your malpractice. Even though they are supervising you, since you will be a fully licensed physician, you will be held to that standard. Billing will probably have to be done through one of the supervising docs since you won't be on the various insurance carriers lists, which means that (assuming they don't wish to commit insurance fraud), they will have to examine each patient and supervise any procedures just like they would if you were a resident.

 

[goinverted]

So when an individual works at an urgent care after their internship year how do they bill? I would think that the insurance companies would cover at least primary care codes which would also be used in a dermatology office for general skin checks and biopsies. It just seems strange to me that they would reimburse for work at an urgent care or outpatient family practice, but not a dermatology office.

 

[docB]

So when an individual works at an urgent care after their internship year how do they bill? I would think that the insurance companies would cover at least primary care codes which would also be used in a dermatology office for general skin checks and biopsies. It just seems strange to me that they would reimburse for work at an urgent care or outpatient family practice, but not a dermatology office.

If they're licensed they bill for their work. If they're not they don't. I think you're concentrating on the difference between working in a derm clinic vs. somewhere else instead of the really important difference which is being licensed vs. not.

Having applied for a license doesn't mean anything in terms of billing. You are either licensed or not.

 

[goinverted]

If they're licensed they bill for their work. If they're not they don't. I think you're concentrating on the difference between working in a derm clinic vs. somewhere else instead of the really important difference which is being licensed vs. not.

Having applied for a license doesn't mean anything in terms of billing. You are either licensed or not.

Thanks for the reply. I understand the issue of being fully licensed and the state in which I live requires that you have completed an internship year and step 3 to obtain full licensure. Someone had made a comment on another thread that an insurance company wouldn't reimburse unless you were board certified. It didn't make much sense to me. I would imagine that as long as I was able to acquire malpractice insurance then I would be fine working in the dermatology clinic and be able to bill for services rendered.

 

[Law2Doc]

... I would imagine that as long as I was able to acquire malpractice insurance then I would be fine working in the dermatology clinic and be able to bill for services rendered.

Malpractice and reimbursement are two independent questions (and often two separate insurance companies). Whether one can be reimbursed for a procedure is sometimes tied to qualifications/credentials. Not being able to become a board certified professional can impact what procedures insurance companies will be willing to reimburse you for, because in the eyes of reimbursers a procedure done by someone with board certification is worth X, while the same procedure done exactly the same way by someone without the same certification may be worth Y. So you may be rendering yourself worthless over time by not making yourself board eligible.

 

[gutonc]

Malpractice and reimbursement are two independent questions (and often two separate insurance companies). Whether one can be reimbursed for a procedure is sometimes tied to qualifications/credentials. Not being able to become a board certified professional can impact what procedures insurance companies will be willing to reimburse you for, because in the eyes of reimbursers a procedure done by someone with board certification is worth X, while the same procedure done exactly the same way by someone without the same certification may be worth Y. So you may be rendering yourself worthless over time by not making yourself board eligible.

^^^^ This is what "somebody" (me) was talking about in another thread.

In order to bill insurance companies you need to be "accredited" by them (there's another word for it that's escaping me at the moment). As you are not BC/BE, they may not accredit you at all or may do so at a lower reimbursement level.

Malpractice != reimbursement as L2D points out above.

 

[goinverted]

^^^^ This is what "somebody" (me) was talking about in another thread.

In order to bill insurance companies you need to be "accredited" by them (there's another word for it that's escaping me at the moment). As you are not BC/BE, they may not accredit you at all or may do so at a lower reimbursement level.

Malpractice != reimbursement as L2D points out above.

Right, I understand what you are saying and thank you for the input. I hope I didn't give the impression that I wasn't planning on completing residency, this was just to have some extra income during a research year. Do you know how the reimbursement issues are worked out when someone moonlights at an urgent care after intership? Are the billing codes for urgent care more likely to be reimbursed at a higher rate that those from an outpatient Derm clinic. Even if it was reimbursed at the rate of a mid-level it would still be fine. It is only a temporary endeavor and not a career.

 

[gutonc]

Right, I understand what you are saying and thank you for the input. I hope I didn't give the impression that I wasn't planning on completing residency, this was just to have some extra income during a research year. Do you know how the reimbursement issues are worked out when someone moonlights at an urgent care after intership? Are the billing codes for urgent care more likely to be reimbursed at a higher rate that those from an outpatient Derm clinic. Even if it was reimbursed at the rate of a mid-level it would still be fine. It is only a temporary endeavor and not a career.

No, I know it's just something to do for a year for you. I just think that the practice needs to figure out ahead of time if/how they're going to be able to bill for whatever it is that you do.

As for urgent care, a lot of that is cash up front with the patient getting reimbursement from their insurance so billing doesn't become an issue except for tests and procedures. If the derm office is working that way, then you'll be OK.

 

[DrMom]

In order to bill insurance companies you need to be "accredited" by them (there's another word for it that's escaping me at the moment). As you are not BC/BE, they may not accredit you at all or may do so at a lower reimbursement level.

The term is credentialed. Physicians are credentialed with insurance companies and healthcare facilities (hospitals, clinics).

 

[gutonc]

The term is credentialed. Physicians are credentialed with insurance companies and healthcare facilities (hospitals, clinics).

Thank you. Maybe I shouldn't start drinking so early in the day!