Changing Culture

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I'm a new NP and just accepted a position in a large and well-respected teaching institution in the midwest. There are NP's working there from both the hospital and also the medical school attached to the hospital, and the pay disparity is noticeable simply because NP's associated with the hospital cannot bill for procedures or time and the ones through the medical school can. I am going to be treated as a salaried employee overall. This job is a great teaching opportunity for me and worth the decreased pay because it will be the building block for the rest of my career, but I was wondering what are steps I can take to try and work for those billing priveledges. Thank you in advance.

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There's a good reason why the NP's are not billing in the hospital. The physicians are right there and can bill at a higher rate.

My suggestion is to learn as much as you can, and take this job for what it is. A building block position where you won't be able to bill.

NP's have made large strides in their ability to bill independently over the decades, but this is not something I would be looking to take on in my first job. They are not going to make an exception for you.

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Oldmanhubbard

I completely agree with your take as a building block. I'm not trying to scream "I'm special, pay me more." lol. I'm just trying to know why if I'm performing a procedure then why am I not being paid for it. I plan on this being a first career, not a final step. Thank you for your insight!

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I have always questioned the legality of these arrangements. Any reasonable person would.

But it is accepted for a very good political reason. Get your experience, don't rock the boat, and get out.

Unless you want to be a whistleblower about the fraud built into that system.

We certainly need more whistleblowers, but watch out, your tires may be slashed.

Or worse.

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This is falling out practice (for good reason) and will likely correct but I am not sure that increased pay will naturally follow. One thing I didn't know when I transitioned into this role was that pay is negotiable, so I would try to negotiate your pay to be a little more favorable with this job offer.

I was lucky as I gladly accepted the pay offered for my first NP job as it was more than the competing facility i had interviewed at. I found out later, that co-workers had successfully negotiated a higher hourly base (although were salary) when they were hired. luckily, there was a market adjustment a few months after I was hired and I received a 13% increase anyway ?

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Specializes in Vascular Neurology and Neurocritical Care.

Yeah, I would not worry about billing privileges unless it equates to more pay. For example, if reimbursement is RVU based, then it only makes sense to want to be able to track your work, ie via your billing record. But if you're salary, then it doesn't matter. If they don't want to bill appropriately for your services, or want to bill under the physician for incident to, then that's for them figure out. Just enjoy your career and the learning experience.

And do yourself a favor and read Carolyn Buppert's book about NP and business and mwdicolegal matters (or some other similar text) .

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