[Limik]

OK, I need some advise. As some of you know, I am the only office nurse for an Orthopaedic Surgeon. I work with the Doctor and an office manager. The office manager is an older lady who has worked with a group of general surgeons in the past. Up till now it has been part of my job to schedule surgical cases and handle the insurance precertifications. Well, the office manager has decided that she would like to take over this task because she used to do it in her previous position. Now don't get me wrong, I am not territorial about this task at all. My concern is that this person has no medical training, is not familiar with the procedures that my doc routinely does, and knows nothing about the clinical history on any of our patients. She looks at this as just scheduling through the OR and talking to the insurance companies, but there is so much more involved. What do you think, should I just be thankful that she wants to take this over or should I make my concerns known? I do feel that this is a pattern of behavior with her. She is very threatened by the fact that the Doctor and I work well together, and she also likes to blur the line between nursing and non-nursing quite often. She has also taken it upon herself to call in a Rx to a pharmacy without even knowing the correct drug name, (an error I had to fix!) Sorry to continue to complain, but I really need some guidance here. Am I way off base or what??? As always , thanks for your input.

[canoehead]

Let her do it, and then grin as you reimbursement rates sink to the floor and they come back on bended knee to you. Be sure that when you get this task back that you get ABSOLUTE POWER and then delegate freely

[steelcityrn]

This job is usually done by a medical asst anyways. As far as her calling in the wrong medication, that would be surprising since you stated that she worked for years doing this type of work. Anyways, thats what a team is for. Have to be willing to help each other in a office setting.

[renerian]

I would let her do that. I agree with the previous posts.

renerian

[Limik]

Originally Posted by steelcityrn

This job is usually done by a medical asst anyways. As far as her calling in the wrong medication, that would be surprising since you stated that she worked for years doing this type of work. Anyways, thats what a team is for. Have to be willing to help each other in a office setting.

Just to clarify,I never said she worked for years doing this type of work. This is the first time she has ever worked in Orthopaedics in any capacity at all. She worked with general surgeons as an office manager. As anyone who has ever worked in a medical office knows, meds can be very different form one specialty to another. Calling in the wrong medication can be very harmful to a patient. Also it is not a question of teamwork. All of our office works well with each other. It is more a question of who is better suited to a task.

[renerian]

Unless she has prescriptive authority why is she calling in drugs, she can as an agent of the Dr/employee......What does the DR want done since it is his practice and liability?

renerian

[webblarsk]

If you are concerned I would bring my concerns to the doctor. Can't hurt to try!

[NRSKarenRN]

Precert in a surgeon's office = financial income.
You want to be able to maiximize income along with correctly having patients needs meet. "Sorry I can't take your gallbaldder as only approved for a bunionectomy" doesn't fly. You can make this a win-win situation for both of you. I'm assuming your present in the exam room during patient preop eval so know particular details of a case.

I'd develop a standard preop authorization form.

Practice name at the top with MD UPIN number and other required billing #'s/tax ID etc.
Space for patients name and insurance filled in by office staff.
List the top 20-30 surgical procedures that this doc performs along with corresponding ICD9/HCPCS code with check boxes.
Have a section for "Other" that you can fill in for rare procedures.

Clincial issue section for explanation of modifiers for procedure--repeat procedure, greater than usual length of time due to patients spinal deformity etc. (not done doc auths, only homecare, add your particulars.).

If you do I+D or other in office procedures requiring homecare followup, check box for homecare auth, circle, SN, PT, OT, HHA etc.
Those cases that you feel the need to get auth due to complicated surgical explanation, you should do so.

Have doc sign and hand form over to the office manager at end of visit for HER to spend time on the phones getting auth allowing YOU to focus on patient's preop teaching, exam room prep, doctors exam assistance, calling to the hospital OR to schedule/move case times etc.

Hope this helps you to focus on your NURSING abilites.

P.S.:This is how my surgeon's office handled my gallbladder surgery auth, so just stealing idea!

[passionate]

I am an RN in the state or ORegon. My husband is a RPh. The law states that a doctor or nurse must call in prescriptions. Pharmacists only take new prescriptions. Often pharmacists don't know what credentialing a person has so it is good if the office sends out a list of employees for the various pharmacies. Then the pharmacist can be the bad guy and ask for the doctor or nurse.

[jmgrn65]

In Ohio only an RN can call in a prescription. The other thing, I would let her have at it.