Independent Clinic as NP

[coco3299]

I have heard that NPs are allowed to open their own clinic with an MD overseeing, but not necessarily there all the time dependant on states. I would like to know if NPs are usually expected work under a doctor full time for some time, prior to starting their own clinic? Or can an NP start a clinic immediately amoung licensure? Also how can I find out what states allow NPs to work independently? Anyone with experience?

CC

[core0]

I have worked at a psych facility in the past and the aging population usually are paid for through Medicare which requires billing. Also, I am not sure how insurance coverage would be waived just because there was no billing. Insurance would not only be for employees as general, liability and professional are needed, even for one. I am also confused as to what this psychs basis for practice was with an office and no employees. Was he like an independent that saw one patient an hour type thing? If so,then I sort of see this, but is this likely for a Psych NP?

There is no requirement that a practitioner takes insurance. Its only a recent development that practices billed for insurance at all. Outside of the hospital the norm 20 years ago was to pay (the much smaller) bill and then get reimbursed. The one rule is that if you bill even one medicare patient you have to accept the assigned payment for all of them (medicaid also). Other you can technically pick and choose but mostly its one way or another. With Medicare the only way that you can get more reimbursement than the usual and customary is to not accept Medicare assignment (direct payment from Medicare) and have the patient pay you directly. The patient can then file for reimbursement with Medicare and will be reimbursed the usual and customary payment. They are responsible for any other charges.

I'm not sure if I understand the rest of your post but yes you need professional liability insurace. The issue is that the major cost of running a medical practice is the clinic. For the last practice I worked at (which was relatively lean) there were 36 staff members for 12 providers. Some FP practices have as many as six employees for each provider. In my previous practice one physicians entire collections was needed to pay for the health insurance of the entire practice.

The issue with psychiatry that makes it different is that there are really no tests or labs that need to be done. Not a lot of prior auths. The billing is relatively straight forward. All of this makes it possible to run a cash only clinic that is very lean. Say that you charge $100/hr and schedule 30 hours a week. With 2 weeks of vacation thats $150k per year. An office would be around $3-5000 per year. Liability phone etc another $5k. No billing costs (normally up to 5% of collections). No MA to do teahcing or check the BP. No scheduling department (paper schedule and cell phone). No reception (let yourself in and wait outside the office until its your turn). Net $135k for 30 hours work isn't bad. If you charge more you make more (to a certain extent).

The only issue from a societal point is that the poor and the elderly (without disposable income) can't access this system. They end up in the few overloaded providers that take insurance or in county mental health programs that are also overloaded.

David Carpenter, PA-C