KMKPA Posted April 24, 2016 Share Posted April 24, 2016 Hello, I was wondering if there is any way you can see what is billed to you as a PA under your NPI number? I have been in private practice for a large ortho multi-specialty group for about 3 1/2 yrs now and I have no idea what my collections are. I know it is good form to share the collections with the providers every month, however, my specific doc is very closed mouth about the numbers. Is there any way to utilize my NPI number to see what is billed to me in surgery or in office? Just a little background....I work with one doc who is part of a large group (although each doc has their own finances and they share a surgery center and profits from our own PT group and MRI), there are 2 PAs for one doc, and we usually try to run two ORs on our 2 surgery days where we first assist. The other 3 days are usually office days. The doc I work with does not utilize PAs very well in my opinion, especially in office. He has stated to me that when he decided to hire a second PA (me) he knew I wasn't going to be able to make a profit with me, he just wanted another provider to help him get home earlier. We don't have our own schedules, we see the patients first, work them up, then present to our doc. Sometimes post ops slip by without seeing the doc, but, usually they also see him, which I find unusually redundant for most follow ups and post ops. The practice bills under the docs name in office only (because they see him in addition to us almost every time), except in rare occasions when he is out of town, and then we just see post ops billed under a PA. I know the doc bills for a my services for every case I first assist...I just have no idea what I am producing, etc. This is important to me because I have had only one raise in 3 1/2 years despite only positive feedback from my doc. One year he stated that he 'wasn't able to give a raise or a bonus,' however, our practice is quite elite with a national baseball team as one of our patient groups and we certainly are quite busy...I can't understand how there wasn't enough for a bonus or raise. We take call when he takes call and stay late when he stays late....so, no scheduled hours, etc. I'm seriously considering leaving this practice for a number of reasons. any help would be appreciated. Thanks! Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 24, 2016 Moderator Share Posted April 24, 2016 no raise = doc wanted to keep all the money for himself Medicare data is available on the web - that is the only one very likely they are billing everything under the doc (might be questionable billing?) and you will not see any billings under you if the doc doesn't want to share - and tells the billing company to not share - you are out of luck - although I feel this is wrong and illegal as you could be held liable for fraud Only way to get it - is to make it part of your contract so they are bound to give it to you, but they will never sign that contract.... Link to comment Share on other sites More sharing options...
KMKPA Posted April 25, 2016 Author Share Posted April 25, 2016 Thanks, ventana! Link to comment Share on other sites More sharing options...
mgriffiths Posted May 12, 2016 Share Posted May 12, 2016 I'm looking to work in orthopedics upon graduating. I don't know if you were a new grad 3.5 years ago, but unless you got a very above average salary to start with I would have a major issue with only one raise. I would also have an issue with how you are being utilized. Everything seems redundant from your post, which is a waste of the patient's time and resources. Honestly it doesn't make sense. If it were me I would start looking for other jobs and test the market to see what I could make elsewhere. Since you think everything is billed under the physician you can't really use your productivity as a negotiating tool, so you need to use another one. For me it would be, "I don't feel that I am being valued appropriately for the work I do." Then based on his response I would immediately reply with, "I have another job offer that is going to pay me $$$ more than what I currently make. I am not looking to leave, but I am unable to accept that level of disparity in pay." This leaves the proverbial ball in the physician's court to decide how much you are worth to him. One word of caution...based on your post I wouldn't be surprised if he just tells you to take the other job. Too much of what you said tells me that you are not valued. Link to comment Share on other sites More sharing options...
PAS2014 Posted May 13, 2016 Share Posted May 13, 2016 I had an office manager for a large orthopedic group ask me as an interview question recently: "How much do you think PAs produce for a practice?" When I stated that 'I assume, based on their experience, they can produce quite a great deal for a practice', he stated "Nope. PAs actually produce $0. Everything is billed under the doctors." The PAOS salary report had just come out, which he mentioned he read, and he said he was "flabbergasted" by the high salaries of some PAs, because he couldn't figure out why any PA would make more than $75k/year since they bring absolutely no income into the practice. I was told I'd be utilized just as you said above "to help the doc get a better quality of life and to ensure his work flow is moving at such a speed that he produces as much as humanly possible". I think a lot of orthopedists work this way - it makes their productivity numbers skyrocket. Yet, his PAs scope of practice was AWESOME. She was doing tendon repairs independent of the doctor, and all outpatient injections/procedures (except of course he visited every patient in clinic after the PA). And she was doing all opening/closing (and a good chunk of the middle) of every other surgery. They offered me a job on site, and I thanked them for their time and declined. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted May 13, 2016 Share Posted May 13, 2016 NOT OK. You should have reconciliation monthly or quarterly that shows your billing, number of patients seen, procedures billed as assist and how much was collected due to insurance contracts, etc. Anything less is highway robbery. Ortho pays a base salary usually - not much more than $80K mostly around my town. However, the main ortho group (for whom I worked in the past) charged us overhead just like the docs and we had an "eat what you kill" policy. I could make $130K without a problem and got extra checks every 3 months with a full excel spread sheet thing showing everything I did. You need info and a lot of it. Someone is making an enormous amount of money off of you without your knowledge. Find the CFO, call a meeting and GET NUMBERS. Ortho PAs will likely never get much of a raise in base salary - it is all about the reconciliation...... You, my friend, are getting screwed Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 14, 2016 Moderator Share Posted May 14, 2016 I had an office manager for a large orthopedic group ask me as an interview question recently: "How much do you think PAs produce for a practice?" When I stated that 'I assume, based on their experience, they can produce quite a great deal for a practice', he stated "Nope. PAs actually produce $0. Everything is billed under the doctors." The PAOS salary report had just come out, which he mentioned he read, and he said he was "flabbergasted" by the high salaries of some PAs, because he couldn't figure out why any PA would make more than $75k/year since they bring absolutely no income into the practice. I was told I'd be utilized just as you said above "to help the doc get a better quality of life and to ensure his work flow is moving at such a speed that he produces as much as humanly possible". I think a lot of orthopedists work this way - it makes their productivity numbers skyrocket. Yet, his PAs scope of practice was AWESOME. She was doing tendon repairs independent of the doctor, and all outpatient injections/procedures (except of course he visited every patient in clinic after the PA). And she was doing all opening/closing (and a good chunk of the middle) of every other surgery. They offered me a job on site, and I thanked them for their time and declined. what you describe is most definetly insurance fraud this is not acceptable and exactly why PAs should always ask to see the billing data, and follow it. This practice manager obviously has bee feed a line of lies, and the doc really doesn't understand the true value and use of PAs. This is what I refer to as the dirty little secret of employing a PA - if you bill it all under the doc (which is just driven by greed - nothing more) then the doc essentially gets the INCOME of having another doc in the practice, with the expense of a PA. Then on top of that they start to force PAs to do more call, to improve their own quality of life, and you have a receipe for doc's taking advantage of PAs for pure greed. The solution is simple Get rid of incident to billing, reimburse at 100% for everything a PA does, and mandate that a PA MUST bill under their own pin, and make it criminal to purposefully bill under a doc's pin, with the exception for locums/per diem/short term..... I have crazy dreams about the insurance companies realizing this little scheme and cracking down on it, but not sure that will ever happen.. Link to comment Share on other sites More sharing options...
Maverick87 Posted May 15, 2016 Share Posted May 15, 2016 no raise = doc wanted to keep all the money for himself Medicare data is available on the web - that is the only one very likely they are billing everything under the doc (might be questionable billing?) and you will not see any billings under you if the doc doesn't want to share - and tells the billing company to not share - you are out of luck - although I feel this is wrong and illegal as you could be held liable for fraud Only way to get it - is to make it part of your contract so they are bound to give it to you, but they will never sign that contract.... If they are billing all of the PA's work under the doc, wouldn't that constitute as fraud? Wouldn't that be reportable to Medicare? I would think that the doctor would be held liable as well for this. Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 15, 2016 Moderator Share Posted May 15, 2016 If they are billing all of the PA's work under the doc, wouldn't that constitute as fraud? Wouldn't that be reportable to Medicare? I would think that the doctor would be held liable as well for this. yes, but who is going to do that?? Link to comment Share on other sites More sharing options...
Reality Check 2 Posted May 16, 2016 Share Posted May 16, 2016 The PA will get shafted on this. My opinion - the PA reports the office to Medicare/Medicaid/State Board BEFORE anyone else does and claims to have discovered this procedure and KNOWING it is wrong. Otherwise, when it does get figured out - the PA will get the ultimately short end of the stick. Protect yourself - always. Link to comment Share on other sites More sharing options...
SedRate Posted July 9, 2016 Share Posted July 9, 2016 no raise = doc wanted to keep all the money for himself Medicare data is available on the web - that is the only one very likely they are billing everything under the doc (might be questionable billing?) and you will not see any billings under you if the doc doesn't want to share - and tells the billing company to not share - you are out of luck - although I feel this is wrong and illegal as you could be held liable for fraud Only way to get it - is to make it part of your contract so they are bound to give it to you, but they will never sign that contract.... How do we find that Medicare data? https://www.cms.gov/ but where? Link to comment Share on other sites More sharing options...
NeoTrion Posted December 19, 2016 Share Posted December 19, 2016 Not to resurrect a to old of a thread but I have found something that might help. Mind you right now they are only publishing 2014 values, but this will give you a ball park estimate of what was going through your NPI. We have had almost the exact situation at the practice I work at as well. If anyone has any other way I would be open to exploring this further. data.cms.gov/utilization-and-payment-explorer Link to comment Share on other sites More sharing options...
jmj11 Posted December 23, 2016 Share Posted December 23, 2016 I think someone above has said this, but I have had it in all my recent (past 15 year) contracts that I receive a monthly statement on my billings and collections. As a previous owner, I did the same for my SP-employee. I can't think of any reason this could not be done unless someone is trying to hide something. Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted January 7, 2017 Share Posted January 7, 2017 Very interesting. Amazing how little showed up under my NPI. I do EM, so I bet as much as possible was billed on under a doc's NPI, courtesy of the "I was available for consultation & reviewed all labs and imaging" note. Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.