Questionable practices?

  1. Hello everyone,

    So I accepted a job in a private pediatric office, and had my "orientation" yesterday. I put quotations marks in there because it wasn't an orientation at all. Instead, it was the office manager sitting around and gossiping while I was trying to pull information from her. When it came to billing, I asked her what information they would need for credentialing for insurance companies. She replied that I don't get credentialed, and that all the billing goes under the physician's name. When I said that doesn't sound correct, she stated that that's the way it's always been done. Apparently, I don't even get credentialed with Medicare and PA's Medicaid programs either, which I know for a fact that I need. I asked the billing coordinator if it's somehow under incident-to billing or how they bill the visits, and he had no idea what I was talking about. This practice also bills for 2 developmental tests at age 9 months, 18 months when they only do one, which is fraudulent.

    I'm also having difficulty obtaining my CRNP license through the state (submitted 6 weeks ago, no word on when I will get it, and I do not have my prescriptive authority, NPI or DEA either yet). I told the office manager about this, and she said I'll just practice under the physician's name. I replied that I would not, because it's illegal. She replied that that's what they did with NP's before. She also said that the physician will have a bunch of pre-signed scripts for me to fill out until I get my prescriptive authority. I also refused to do this, because I am not comfortable with this! She got frustrated and rolled her eyes.

    I honestly don't know what to do. I need to know if this is truly questionable activity or if I'm just green to the business aspect of medicine. I live in Pennsylvania. This is also my first position, and I'd hate to leave already but I do not want my name associated with fraudulent activity.

    Please help me. I'm grateful for any advice. Thank you so much for your time.
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  2. 5 Comments

  3. by   traumaRUs
    If billing practices are fraudulent and other practices are questionable, then your best option IMHO is to leave.

    I would never write a script on a pre-signed script pad - no way, no how. Billing for tests not done, sure fire way to lose the license you don't even have yet.

    Run fast, run far.
  4. by   TammyG
    The billing is an issue, unless the MD will also be seeing the patient. Private insurers all work slightly differently, but I don't think that any of them would be happy reimbursing him at MD rates if he never saw the patient.
  5. by   Melody48_MSNEd
    Run very far and fast! This sounds like my first NP job. I have a new job now and in less than 2 months, I am already creditionaled for all the insurance programs my practice accepts, and for the hosiptal as well. My last job kept telling me it takes a long time to get all that done. Ha, my new office manager looked up my name to see if any thing was started (Medicare, etc) and nope it wasn't! I was seeing 40 plus patients a day and the Dr. got paid his amt.....run....
  6. by   stickit34
    Thank you everyone. Unfortunately I still with this practice, but I was able to convince them to credential me through CAQHC. However, there are also numerous other problems with overall practice. They don't provide cleansing towlettes for urine specimens, use alcohol soaked cotton balls inside of prep pads, and refuse to provide diapers for patients who forgot/didn't grab one on the way out. By they, I mean the practice manager, and she and I butt heads constantly. She refuses to provide me a computer (even though my contract says I get one), refuses to change any of the practices despite me asking her to do so and even offering to buy diapers out of pocket, and she even gives my patients her opinions on vaccines! I tried talking to my doctor about it and the practices, and he sort of shrugged his shoulder about it and nothing changed. I want to quit so badly but my husband doesn't want me to. I could have my full time RN position back in a heartbeat, and could work until another position came up. I have a 60 probationary period, so I can terminate without any consequence.

    What should I do?? I'm so overwhelmed and lost. My entire gut is screaming to run.
  7. by   Jules A
    Quote from stickit34
    I want to quit so badly but my husband doesn't want me to. I could have my full time RN position back in a heartbeat, and could work until another position came up. I have a 60 probationary period, so I can terminate without any consequence.

    What should I do?? I'm so overwhelmed and lost. My entire gut is screaming to run.
    Personally I always follow my gut because it has been shown to be solid. I'd do soul searching to consider the validity and rationale of your husbands opinion, unless he's just an arse and in that case you might need to get out of that situation also.

    This isn't my area but the complaints you listed here sound a bit light, except the practice manager offering her opinion on treatments to patients which I wouldn't tolerate for once second. I don't recall anything other than the sink being available for urine collection and while it would be nice to supply diapers I don't think that is a negligent practice issue. Regardless I guess you sound unhappy and I believe we need to be happy going to work so I would give notice and attempt to find a better fit elsewhere.

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