Quote from kevagonia
I want to inquire, from those who work in this field and have real business experience re: RNFA:
Can an NP work (in some states? all?) as an RNFA and what is the common practice for billing and employment?
Let me clarify. I am an FNP student, graduating this year and considering employment with a surgical group in a Southern state. I am interested in joining the NP and PA providers who work in this group and many or all of them also provide surgical assistance either as RNFA or otherwise (unsure). If I were to join a group like this where I do provide some surgical services or first-assisting, would I need to be certified as an RNFA, what are the pitfalls or advantages of this? Would I be able to seperately bill and gain income from this specific duty? It is billing specifically that I am interested in because frankly to work in surgery as well as my regular comfort zone of the hospital units, I would need some incentive.
First of all there are two different questions here. One is can an NP assist in surgery? The answer to this is yes within the boundaries of hospital credentialing and state scope of practice. The second question is can NPs work as RNFAs? The answer to this is yes, but technically there is no need. An NP can bill and be reimbursed for first assisting without being an RNFA. Notice I said technically. If you look at the nurse practice acts of various states, many of them require RNs to have an RNFA to first assist. Since the NP license is an extension of the RN license most of these states have held that NPs that first assist have to become RNFAs. Here is the AORN scope document:
Whether you can work in the hospital as an FNP has been discussed at length in other threads.
In addition even if not required by the state, many hospitals require RNFA for credentialing to assist in surgery. There is no real downside to getting your RNFA besides the time and money that it takes.
As far as practices, there are essentially three models. The most common is that the PAs or NPs are employees of the practice and all income from the first assist fees is assigned to the group. The first assist fees may be used for productivity bonuses. The second is that the PAs or NPs are employees of the hospital. The first assist fees are assigned to the hospital. The final is that the PA or NPs are either self employed or employed by a first assist group. If self employed as an NP you can bill directly if contracted with the insurance company or bill through the surgeon if not. As a group the group can bill for your services and collect first assist fees.
If you are in a surgical group and first assisting is part of your duties, it will be part of your compensation. As mentioned above it can be used to determine productivity or other bonuses. There are a number of other methods. One ortho group used the assist fee as a bonus for on call. For any case after 5pm the PA got 100% of the assist fee. For Ortho groups at least the assist fee is only about 1/3 of the income the group gets from the PA. Another 1/3 is from office visits and procedures and the final 1/3 is from down stream revenue.
As far as incentive, the incentive at least for PAs is a) the chance to do surgery and b) the fact that surgical PA salaries run 1-80% higher than medical PA salaries depending on the specialty.
David Carpenter, PA-C