Comments on: Pennsylvania NP’s

By: Cathy

Cathy — Sat, 09 Feb 2008 18:24:14 +0000

Lisa,
I have been in private practice for 19 years. I have seen many changes in PA, most recently Mr. Rendells. hough he did alot for NP, he did not address the problem about how we can become on the panel for HMO’s. You will be able to get into Medicare, Blue Cross without any problem. For some of the B/S PPO’s and Security Blue you will be admitted as a specialist. You will not be able to get into United, Health Assurance, Health America, or the HMO’s for Welfare.

By: Lisa Barba

Lisa Barba — Wed, 06 Feb 2008 00:44:52 +0000

Thanks ladies.

Sandy, who did you find to insure you? I currently have NSO but was under the impression that they do not cover nurse practitioner owned practice sites.

I am not looking to being until this summer but am busy getting my business plan together and looking for commercial space.

Have you come to an agreement with your collaborating physician regarding fees?

Thanks again

Lisa

By: Carla Anderson

Carla Anderson — Sat, 26 Jan 2008 20:26:12 +0000

Hi,

I am in Oregon, but welcome to private practice! I have been doing it for 6 mos, and love it. Congratulations on finding a biller who can help with credentialing and contracting with insurance payors. My biller “told” me she would, and turned out she did not even know what a credentialing packet looked like. I did it all myself, and needless to say, it was a long arduous process. I was the only one doing all the paperwork, and follow up calls, and packets were lost.. United HealthCare does it on Computer, and I STILL am not done with them, just because when you are doing it all alone things take time.. One piece of advice, when you are credentialing, realize that YOU also have negotiating power for your rates that they pay you. So check with surrounding providers, get at least 5 superbills from other providers, and start to set your most common code rates… then check with your biller and others to find out the RVU amounts for 2008 and make sure that your insurance companies are using those to calculate your reimbursements. They may sound like they are giving you a great “dollar amount per RVU” say “63.00 per RVU, but if they are using RVUs from 2006, the amount you get paid, could be less than what another insurance company pays you for a 99214 for example, at 60.00 per RVU… so dont let them just tell you the dollar amt, make sure they are following the most up to date CMS fee schedule.

Also, regarding your “verbal” contract with your physician, there has been a lot of discussion on this webblog about collaborating physician contracts, and how to re imburse.. In my state I don’t have to have a physician, but this will be so important. He/she may want a percentage, or a rate based on per patient, or a set amount per month just for collaborating. Good luck!
Carla/Oregon

By: Sandy

Sandy — Fri, 25 Jan 2008 23:22:30 +0000

I will be starting a Nurse Practitioner business this week. I bought a book on Barnes and Nobel, made a verbal contract with a physician to be my collaborating physician, and am meeting with him this week. I purchased malpractice insurance and identified a biller familiar with signing up providers for insurance payments. Next??????