khbpac Posted November 14, 2011 Share Posted November 14, 2011 I am a PA-C in Virginia. I've have been practicing acute care psychiatry for 12 years. Just found out my renewal of my contract is in doubt because the hospital system feels that 'NP's can bill more". I've never had an issue with collections before, but the corporate machine has put the burden on me to prove my worth. Other than keeping a secure, safe, theraputic unit of 40 pt's with the lowest incident rate of all providers in the system. I guess it's about revenue. If anyone has a pointer or PEARL that I can find out about Virginia insurers and how to substaniate my income, please PM me, I will give you my andriod number. I'm not thrilled about throwing an NP or two under the bus, but I need to clear this up and get ready for PANRE. KBPAC Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 14, 2011 Moderator Share Posted November 14, 2011 involve AAPA - they have briefs of billing for all the states Link to comment Share on other sites More sharing options...
primadonna22274 Posted November 14, 2011 Share Posted November 14, 2011 Very first call: to the Reimbursement person at your local PA chapter. If you're not a member, join NOW and beg for help. Best of luck. Link to comment Share on other sites More sharing options...
burnpac Posted November 14, 2011 Share Posted November 14, 2011 Contact Michael Powe at AAPA. Link to comment Share on other sites More sharing options...
Contrarian Posted November 14, 2011 Share Posted November 14, 2011 Are you doing strictly Psychiatry or are you doing Internal Med and Psychiatry..???? I ask because your productivity numbers may be buried in the Psychiatrists/SPs numbers if its strictly Psychiatry. I'm doing both Internal Medicine and Psychiatry at both of the inpatient units I work for (Different Organizations) ... and this was also the same perception my employers had (thanks to a few malignant PNPs)... until I had the unit secretary print out a tally of all the Internal medicine ICD-9 codes I had generated over the past 3 yrs... When I first started... I seen that the unit clerk collated all psychiatric billable encounters weekly and submits them to admin for billing. I took this as my que, talked to the administrator and asked if she could have the clerks keep a running monthly list of my internal medicine encounters... and to submit them for billing to see if they will be paid. They did and started getting reimbursed for quite a few of them. The administrator also uses these numbers to support budget requests. To make it easy for them, I started writing ALL applicable ICD-9s in the Left margin next to all of my chart notes. At the end of the week, the clerk types them all into a spreadsheet on her computer and then sends them to admin. Since I am required (by law) to see every patient within 24hrs of admission... and the average patient has 3-5 ICD-9s (some 7-9 ... all excluding Psych issues)... and the average LOS is 9.5 days... then its easy to see that I generate lots of acute care codes. (Borderlines, Metabolic Syndrome-Diabetics, Thyroid and Hepatic, Lacerations from Suicidal Gestures) So after I set up this system in 2009... and they started getting paid for both my psych and internal medicine work... they then realized that not only were they getting excellent/billable psychiatry... but they were also being reimbursed $150k for my management of primary care and acute care issues that they used to send to the ED prior to my arrival. The look on the PNPs face, when they politely informed her of the difference in reimbursement was... well... priceless.:heheh: YMMV Contrarian btw... did we meet at a conference on Psychotic Disorders in April... in CHicago...??? Link to comment Share on other sites More sharing options...
foreveryoung Posted November 15, 2011 Share Posted November 15, 2011 Contrarian, Thanks for the info... I just sat through a thing on billing today and thanks to your post, I now understand the importance of making sure I bill all diagnoses... do you chart your internal medical treatment separately from your psychiatric care? Link to comment Share on other sites More sharing options...
Contrarian Posted November 15, 2011 Share Posted November 15, 2011 I now understand the importance of making sure I bill all diagnoses... Even if your employer doesn't get reimbursed for ALL of your submitted CPT/ICD-9 codes... you should list them all because this serves a concrete indication of your value/contribution to the practice/business/facility. At the end of the yr... you can say to Administration with confidence, " I provided $XXX,000 worth of quality medical care to this community over the last 12 months." ... do you chart your internal medical treatment separately from your psychiatric care? Yes... because on a typical day... there is a designated "psych" provider and a separate "medicine" provider. I never "wear both hats" at the same time. About 70% of my time is spent serving as the "Medicine/Addiction" consultant to the psychiatry staff. The other 30% of the time ( weekends, holidays, sick days, emergencies)... I am the psych staff. We made a conscience decision to use either "Psychiatry" or "Medicine" headings for each and every note... and to avoid making 2 notes under the same heading on the same day. Personally, I never write both a "psych" note... and a "medicine" note on the same patient on the same day. I never write a "medicine" note on the same patient, the same day that my psychiatist SP writes a "psych" note on that patient... since theoretically we are one in the same... and it could be seen as the same encounter. YMMV Contrarian Link to comment Share on other sites More sharing options...
khbpac Posted November 15, 2011 Author Share Posted November 15, 2011 i'm afraid we didn't meet, but I am in the same role as you, I do all the overnight admits and respond to IM calls and treatment for the unit. I have multiple medical and psychiatic codes, but admin is so NP focused, they simply dont document the medical findings and I get hammered on my eval for being " too medically oriented" Nevermind the fact I've "cleared to codes, caught two intracrainal bleeds, at least 10 DVT's etc. A atty boy would have been nice to Link to comment Share on other sites More sharing options...
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