Are you listed as a PCP?

[amalay, MSN, RN]

I've been having quite a struggle (well, internally - I've only voiced it to my administrators and upper-levels twice) with the organization that I work at. I am currently employed with Dignity Health (kind of like a Kaiser or Sutter Health) in California as an NP in a pediatric practice.

My question to other NPs working in primary care - are you able to be listed as a PCP? Do you have your own panel of patients? I have been told I cannot be listed as a PCP. I did my training in CT, where NPs COULD be listed as a PCP but I'm not very familiar with how far we've gotten in California. Any advice anyone can give me either from experience or from an insurance/legal stand point? Thank you!

[IsabelK]

I work in NYS. I'm listed as the PCP for all of my PCP patients and I have my own panel. Not sure what to tell you about California, but check the state nursing practice act or as your board of nursing...I'd also ask where you work (or try to find out) if it's billing issue.

[amalay, MSN, RN]

I work in NYS. I'm listed as the PCP for all of my PCP patients and I have my own panel. Not sure what to tell you about California, but check the state nursing practice act or as your board of nursing...I'd also ask where you work (or try to find out) if it's billing issue.

I've raised the question twice to the medical director and interim chief clinic operations officer or whatever it is, but I've aways gotten a "we'll look into it and get back to you asap". But their version of "asap" is more like "8 months into the job and still no answer".

I do bill under my supervising physician though, and not under my own name. Does this have anything to do with it?

[IsabelK]

I'm not sure...I'd ask. Every place I've ever worked I billed under my own name. I have refused to be billed under a physician's name and one place offered me a job where I'd be "incident to billing" so I said no thanks.

[automotiveRN67]

I guess the first question: Does it make a difference?

[automotiveRN67]

I'm not sure...I'd ask. Every place I've ever worked I billed under my own name. I have refused to be billed under a physician's name and one place offered me a job where I'd be "incident to billing" so I said no thanks.

Why? You don't want the company to pick up the extra 15% revenue (assuming it is medicare you are billing).

[lhflanurseNP, APRN]

I do bill under my supervising physician though, and not under my own name. Does this have anything to do with it?

If that is how you are billing, than you are NOT the PCP, you are an extension of the PCP. By billing "incident to", the PCP sees the patient and sets the plan of care. As long as you do not deviate from that plan of care (see the patient for something new), you are just following the PCP's plan and seeing the patient on their behalf. If you were to see the patient for something entirely new and different, some PCPs will "sign-off" the note and still do incident to billing but if not, you can bill that directly as a PCP...depends on your company's policy.

[AnnaN5]

I am in Michigan. Have my own panel of patients, am listed in the chart as the PCP. We do not do incident to billing in our office.

[Corey Narry, MSN, RN, NP]

Since you work with Peds patients, your payer mix is likely a combination of Medi-Cal (California's Medicaid Program) and private insurance. Medi-Cal allows you to bill directly. In fact Medi-Cal even goes as far as to empanel California primary care NP's (FNP and PNP) as primary care providers either in a solo practice or a group practice. You have to apply to get that designation. The forms are explained here: Medi-Cal Enrollment of Non-Physician Medical Practitioners. Private insurances vary as far as ability to bill directly.

If you're asking whether the institution you work for should list you as a provider then that depends on the by-laws of the institution. Where I work (Northern California academic practice with a hospital and clinics), NP's who have a clinic (primary care and specialty clinics) are listed in their "Find a Doctor" web page with links to appointment scheduling. NP's who solely work in the in-patient areas (such as ICU like myself) aren't listed.

[amalay, MSN, RN]

Thanks for all of the input everybody! Yes, our patient population is mainly a mix of Medi-Cal. I know I do bill incident to under my supervising physician, so now at least it makes sense for me to technically not have my own patient panel or be listed as a PCP. Now, whether the institution itself advertises me as a PCP is I guess, another issue. I think to have me be listed as a PCP on the company website and on the EMR may cause insurance billing issues or confusion for the billing department, so that may be why. Either way - thank you for everyone who has helped explain this a little more to me!

[IsabelK]

Why? You don't want the company to pick up the extra 15% revenue (assuming it is medicare you are billing).

I'm doing the work--all of it. The only things I can't do in NYS yet are sign a DNR/DNI and whatever the federal government restricts. The physicians get payment for signing the home care orders, etc, but they never see my patients except if I ask them to or its an urgent visit and I'm not in the office. And even then, usually another NP will see my patients in the urgent and I'm not in the office scenario. If I do the work, including initiating the care plan, and the physician does not ever see them, it's not incident to. So no, they should be billing me as a provider, not as an extension of a physician.