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- Jun 9, 2010
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I am here to request guidance and knowledge from the wise and experienced please.
A brand new PM&R and Pain attending in the private world here. I would like to diversity my practice by building outside consults. I have a psychiatrist friend who told me that he searched nursing homes, ALF’s and ILF’s in town on Google, just cold-called and/or showed up in person at those facilities to drop off his CV and requested to get credentialed to do psych consults. He said many of them credentialed him quickly and he was able to build his consult practice at multiple nursing homes, ALF’s and ILF’s, and his biller is able to bill for the consults… so I assume the residents’ insurance??. The friend said as a psychiatrist he doesn’t need referrals to do consults at those places and can just go do consults at ALF/ILF/nursing home after being credentialed with respective facilities.
(1) My question as a PM&R/Pain for nursing homes, ALF’s and ILF’s - can I also do the same and go without primary care referrals as long as the facilities credential me? I assumed even for nursing homes, ALF’s and ILF’s that I as a physiatrist (with Pain subspecialty) would need referrals from the facility primary doctors/MLP’s before being able to see their patients as consults - like doing consults at SNF’s.
(2) If I can go to nursing homes/ALF/ILF - what would be the points of emphasis to appeal to those facilities that I am worthy of their credentialing as a PM&R and Pain, and who would I “bill”? Because I would think the residents at ALF/ILF/nursing homes are likely self-pay, unless their insurances can be billed?
(3) For either PM&R or Pain (or both) consults at SNF’s, would these facilities like to have doctors with rehab backgrounds do consults for their patients to have rehab specific documentation to justify their patients to stay to continue therapy 1hr/day during their admission? For me obviously I could advocate that I can manage pain as a Pain-trained PM&R. Just trying to understand how I could better advocate for myself to build business with them. My understanding is that even as Pain fellowship trained, because my primary specialty is PM&R, I can’t be seeing a patient as a Pain if there is another PM&R doctor seeing the patient for regular non-pain rehab (to prevent double billing). This would mean that I would have to find a SNF who already doesn’t have a PM&R consultant available, convince the SNF administration to let me get credentialed as PM&R and Pain, and also “earn” the consults from the primary medicine team to do 3 consults/week. Would this be a correct assumption?
(4) If I “can” bill for the consults at ALF/ILF/nursing home, what codes for I use? or is it even possible?
(5) For PM&R and Pain consults at SNF, what codes do I use to bill?
Thank you very much in advance!
(posted after posting on PM&R Forum with a few changes made specific to Pain for more advice inputs since there was no comment yet :/ )
A brand new PM&R and Pain attending in the private world here. I would like to diversity my practice by building outside consults. I have a psychiatrist friend who told me that he searched nursing homes, ALF’s and ILF’s in town on Google, just cold-called and/or showed up in person at those facilities to drop off his CV and requested to get credentialed to do psych consults. He said many of them credentialed him quickly and he was able to build his consult practice at multiple nursing homes, ALF’s and ILF’s, and his biller is able to bill for the consults… so I assume the residents’ insurance??. The friend said as a psychiatrist he doesn’t need referrals to do consults at those places and can just go do consults at ALF/ILF/nursing home after being credentialed with respective facilities.
(1) My question as a PM&R/Pain for nursing homes, ALF’s and ILF’s - can I also do the same and go without primary care referrals as long as the facilities credential me? I assumed even for nursing homes, ALF’s and ILF’s that I as a physiatrist (with Pain subspecialty) would need referrals from the facility primary doctors/MLP’s before being able to see their patients as consults - like doing consults at SNF’s.
(2) If I can go to nursing homes/ALF/ILF - what would be the points of emphasis to appeal to those facilities that I am worthy of their credentialing as a PM&R and Pain, and who would I “bill”? Because I would think the residents at ALF/ILF/nursing homes are likely self-pay, unless their insurances can be billed?
(3) For either PM&R or Pain (or both) consults at SNF’s, would these facilities like to have doctors with rehab backgrounds do consults for their patients to have rehab specific documentation to justify their patients to stay to continue therapy 1hr/day during their admission? For me obviously I could advocate that I can manage pain as a Pain-trained PM&R. Just trying to understand how I could better advocate for myself to build business with them. My understanding is that even as Pain fellowship trained, because my primary specialty is PM&R, I can’t be seeing a patient as a Pain if there is another PM&R doctor seeing the patient for regular non-pain rehab (to prevent double billing). This would mean that I would have to find a SNF who already doesn’t have a PM&R consultant available, convince the SNF administration to let me get credentialed as PM&R and Pain, and also “earn” the consults from the primary medicine team to do 3 consults/week. Would this be a correct assumption?
(4) If I “can” bill for the consults at ALF/ILF/nursing home, what codes for I use? or is it even possible?
(5) For PM&R and Pain consults at SNF, what codes do I use to bill?
Thank you very much in advance!
(posted after posting on PM&R Forum with a few changes made specific to Pain for more advice inputs since there was no comment yet :/ )
