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Do any of you work in Rural Health? I work in an RHC in Georgia.

For those of you who don't know me I've been a PA 8 yrs now. I switched from surgery to a RHC IM (pedis/adults) last fall and have been very happy.

Today I went back to work after vacation and was told that I can no longer be in the clinic alone. This has nothing to do with my ability. The practice manager wasn't clear but said something about it having to do with WellCare (Ga Medicaid) & BCBS. She then said it has something to do with the physician having to sign 100% of those notes due to reimbursement. She said they aren't comfortable having him sign if he isn't working in clinic that day. He never sees my patients unless I have someone come in that I need a second set of eyes or I need him to admit as I don't go to the hospital.

Our practice admin is on vacation so I can't ask her. This isn't such a big deal for me as I am pretty much independent in my practice. BUT, It effects my day off. I work 4 days. No weekends or holidays. I have had flexibility with my day off which was a draw to this job. Example. I normally have Wednesday off. Today I told the office manager I was switching Wed for Friday in a few weeks. She had switched me to Thursday off that same week without telling me, then told me because I needed Friday off I would be off Thursday and Friday because of having to have a doc in clinic. 2 days off would not be an issue but I will have to use my time off. Normally I move my day around and it isn't a big deal.

This makes no sense to me. RHC do have different guidelines though and I'm still learning. Georgia law states I do not have to have a Dr present 100% of the time.

Do any of you have a clue what she is talking about? Can you direct me to where I can find information on this?

I will ask the admin next week. But would like to have ammunition to back myself up if needed.

Thanks Kim


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Guest Paula

It sounds like they are billing everything incident to, meaning everything is billed under the physician, not under your own NPI number.  It could be different in a RHC.  Call Ga medicaid and BCBS and ask them what the rules are for billing.


Maybe the RHC has been billing incident to when the physician is not present, and that is illegal, thus they got caught and are now following the rules?


IDK.....RHC and FQHC are two different animals of similar stripes and the FQHC I worked in billed under my own NPI and my reimbursement was the same as the physician.  We got an annual wrap-around payment at the end of the year that made up the 85% reimbursement for PA/NP.

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