Rampant billing fraud with PAs and NPs

[Marinejiujitsu]

The vast majority of NP programs do not provide surgical training or rotations. Some do not have students rotate through inpatient services at all. 

But if they did.... lol. Jk.

Sent from my SM-N950U using Tapatalk

[lkth487]

I think, like anything else, it's about opportunity and experience. The pediatric CT surgeons at my institution have multiple NPs working for them, including in the OR and CICU. And with experience and motivation, you can get good. Whether you're a MD, PA, NP or whatever, the first time you take care of a single ventricle physiology post op from a Norwood, you're going to be scared shitless.  If you're not scared the first time, then you shouldn't be taking care of one because you don't know what you don't know.  But after taking care of 50 of these, now it's a little more routine.  Some of these NPs have taken care of hundreds and hundreds, and are fantastic.   They've taught me a lot.

That's why I don't care so much about titles when people ask me about who should get independance or OTP or whatever it is.  As long as someone is motivated, willing to learn, and manage to get the right experience - that's what it takes.  MDs (or PAs or NPs) don't have a monopoly on knowledge and skill.  The knowledge is freely available.  And skill just takes motivation and experience. 

[Gordon, PA-C]

On 5/2/2018 at 11:03 PM, jmj11 said:

This is somewhat billing 101. Surely most clinics are not doing this. When I owned my own clinic, I followed the rules to the letter (usually billing at the 85%, rarely meeting the 100% requirement).

You would be surprised.  Many PAs in this country have no clue how their clinic is billing for their services.  

Keeping to the billing rules is fairly complicated, considering you have to decide if the patient is being seen for a "new" problem or not.

Example:  if a patient comes in with an earache and hasn't been seen for an earache in the last few weeks, that's a "new" problem and therefore the PA cant bill under their own NPI unless the physician examined the patient.  I can guarantee you that many clinics will bill under the MD NPI in that scenario even though the MD never entered the room.  That's billing fraud.

[UGoLong]

I appreciate all of this discussion.

I took ethics as an undergrad more than 50 years ago and it ended up playing an important role in my life. Coupled with banging my head into countless wall along the way, it has led to some personal theories of life for me.

One of my theories (like all empirical theories, probably in error at times but still it lets me live) is that I am responsible for something less than everything that goes on in this world. Knowing where that boundary is day-to-day can be tough to discern. Still, I've learned that knowing where it is right now is often the difference between living a happy life and living one where there is always something out there beyond my control for me to be worrying about at 3:15 in the morning.

The corollary of my theory is that I should do all I do with integrity and honesty (tough enough on its own) and, when confronted with things that are outside of my responsibility that violate my code, I should do what I can to change them. If it's something important enough to me, I may choose to lobby intensely, become a whistle-blower, or choose to vote with my feet and leave. However, I see no duty for me to wander the world, looking for problems that are not my responsibility.

In summary, as an employee in a practice, I must feed accurate, honest stuff to the billing office, but I am not responsible for checking to see exactly what they do with it. They have their own supervisor and I am not an auditor. If I should happen to come across signs that they are doing something wrong, then and only then does my corollary come into play. 

In generaI therefore, I do not feel responsible for chasing my bill from my PC through our practice's systems and offices and out via EDI to a clearinghouse and the insurance company.  

[ventana]

On 5/4/2018 at 2:44 AM, EMEDPA said:

The vast majority of NP programs do not provide surgical training or rotations. Some do not have students rotate through inpatient services at all. 

 

and yet they get hired for inpatient jobs...

 

I think truly the NP's should not work outside their area of certification - ie acute care is inpatient, peds is peds, geri is geri, FNP is NOT ER or ICE or SICU

 

 

[lkth487]

But a typical med or PA student has a few months of surgical rotations, and many graduate with zero icu rotations.  Are those experiences really unteachable?  A month longer, MAYBE, to get up to speed. 

[lkth487]

I don't do any billing yet, being a resident, so this thread is very interesting to me.  How does this work in an inpatient setting?

[HmTwoPA]

22 hours ago, ventana said:

 

and yet they get hired for inpatient jobs...

 

I think truly the NP's should not work outside their area of certification - ie acute care is inpatient, peds is peds, geri is geri, FNP is NOT ER or ICE or SICU

 

 

Yet most NP have some type of inpatient experience such as med surg as an RN. While most people in my PA class have little to no experience at all. Im still not sure why so many PAs like to toot their own horn? My only inpatient experience was rounding post surgery and usually we admit them to hospital service to manage. 

[ventana]

29 minutes ago, HmTwoPA said:

Yet most NP have some type of inpatient experience such as med surg as an RN. While most people in my PA class have little to no experience at all. Im still not sure why so many PAs like to toot their own horn? My only inpatient experience was rounding post surgery and usually we admit them to hospital service to manage. 

 

not true at all

 

I see a lot of NP's coming from direct entry programs... never worked as RN....

 

You also have to understand that the NP are licensed in a certain specialty - they are not generalist like a PA 

 

 

PA education FAR exceeds that of NP .   Period...

[EMEDPA]

30 minutes ago, HmTwoPA said:

Yet most NP have some type of inpatient experience such as med surg as an RN. While most people in my PA class have little to no experience at all. Im still not sure why so many PAs like to toot their own horn? My only inpatient experience was rounding post surgery and usually we admit them to hospital service to manage. 

Didn't you do inpatient internal medicine? thought hospital medicine was required by all PA programs. I did 5 weeks of icu/infectious dz/nephrology. Many NPs today are direct entry and their inpt experience as an rn was starting a few ivs and foleys, passing meds, and handing out lunch trays as a student.

[GetMeOuttaThisMess]

7 minutes ago, EMEDPA said:

Didn't you do inpatient internal medicine? thought hospital medicine was required by all PA programs. I did 5 weeks of icu/infectious dz/nephrology. Many NPs today are direct entry and their inpt experience as an rn was starting a few ivs and foleys, passing meds, and handing out lunch trays as a student.

I did 8 weeks in-patient with two separate MS3/4 groups.  Only saw out-pt. clinic once since it was a “reward” by the res for being able to read an EKG that the med students couldn’t (yet).  Had to take call like the MS3/4 students and cover four sections of the floor each time.  THIS is why I think students benefit from a Med school affiliated program.

[EMEDPA]

4 hours ago, GetMeOuttaThisMess said:

I did 8 weeks in-patient with two separate MS3/4 groups.  Only saw out-pt. clinic once since it was a “reward” by the res for being able to read an EKG that the med students couldn’t (yet).  Had to take call like the MS3/4 students and cover four sections of the floor each time.  THIS is why I think students benefit from a Med school affiliated program.

yup, strongly agree. at my program slots were allotted as ms3/pa2 and we were expected to do everything the med students did. I have an em evaluation from an em residency director which says "emedpa was worth his weight in 4th yr med students. I wish he was a med student so I could give him a slot in our residency program next year". you can bet I kept that one.