Question regarding Midlevel Oversight and Billing

[hopefulgasman]

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I am a soon to be new attending and had some questions regarding the utilization of midlevels.

The practice I will be joining requires that I see new patients, however, I will have at least one NP to see patients as well. I am in a bonus based off of collections model, so analyzing these details is obviously important.

If the NP sees all of the return visit patients including writing their notes and I am the MD in-house providing oversight -

1. Do I get paid at all for the patients they see?
2. Do I get any compensation for the patients they see, especially as they run ideas/plans by me?
3. After their note is written, does part of the process involve me reading their notes and signing them? Is there potential for me to get paid by doing this?
4. My concern is, as I begin to ramp up, I want to make sure my days are full and might want to see as many return visits as possible, especially if it means doing a much better job of identifying/recommending procedures than them.

 

[DOctorJay]

you get what you negotiate for.

I believe some of the docs here are in a model where they get credit for all their midlevel's wRVUs.

I'll be interested to see the responses. my group gets no additional value from the midlevels (aside from increasing our procedure volume), yet we have to co-sign all of their notes.

 

[GoBeers]

you are just starting out and the group's NP is going to take a substantial amount of your volume from under you?
bye bye bonus potential

good luck seeing 30 new patients a day lol

 

[Ducttape]

you should not be able to bill for the NP patients unless you directly see the patients themselves.

you can negotiate and get a percent of the billing that the NPs generate.

you should be seeing as many new patients as possible and setting up initial injections.

NPs should be for follow ups on MBB and when to go to MBB#2 or RFA, follow up on prior ESI and when to repeat if necessary, etc.



i get 5% of all the NP's wRVUs. i do not have to cosign any notes.

 

[Ronin1]

I get all the NPs wrvu but I send all meds and order all procedures etc and finish sign the notes. I negotiated this up front ( it makes no sense to give up the easy fu revenue)

In my old pp I did get all the np revenue but was paying for the np out of my collections.

So it depends

 

[clubdeac]

I think it all depends on what you negotiate. what I do know is that you get 100% of the liability regardless of your employer. Good luck and have fun!

 

[Ducttape]

thats extremely generous.

so the system is basically funding the NP...

 

[Ronin1]

thats extremely generous.

so the system is basically funding the NP...

Well I make them probably 3-4 million in facility fees alone per year so I think they can afford it. Don’t let them abuse you.

 

[SSdoc33]

a great way to never get an RFs is to let the NPs see the MBB f/u.

these are easy 99213/4 and you can steer them better to RF.

extenders are for the patients you dont really want to see, interpreter patients, patients you havent seen in a while but still want a shot and need to be evaluated, patients who have no imaging, ER referrals, etc.

 

[Tramadeezy]

Congrats to you guys getting midlevel RVUs. We get zilch and sign their notes 🙂

 

[bedrock]

a great way to never get an RFs is to let the NPs see the MBB f/u.

these are easy 99213/4 and you can steer them better to RF.

extenders are for the patients you dont really want to see, interpreter patients, patients you havent seen in a while but still want a shot and need to be evaluated, patients who have no imaging, ER referrals, etc.

Agree with this. Don’t have the NP see the MBB f/u.

Also agree the best use of mid levels is to see the patients you don’t want to see.

 

[clubdeac]

Agree with this. Don’t have the NP see the MBB f/u.

Also agree the best use of mid levels is to see the patients you don’t want to see.

I've heard some say, abuse them like they abuse the system...

 

[painisfear]

When you guys do an MBB follow up visit does it need to be outside of the global period for the MBB itself? Or can you setup a telemedicine visit for the next day and collect the information?

 

[SpineandWine]

So I pay for my APPS and get 100% of their collections.
Worth it. However, it does add more to the overhead in terms of MA hours


All practices are different. Even if you don’t get their billing, they help tee up procedures