Ins Reimburse for Psych from FNP?

[Spaciousness]

I am looking for some feedback/direction. I am a clinical psychologist in an FNP program. I chose the FNP track BTW because as an RN I did mostly psych and got "type-casted" there, i.e. couldn't get into other areas (e.g Med-surg,; ED) later on. I want my scope to go beyond psych assessment and prescribing psychotropics. That said, I learned that in my state, that non -PMHNP can work exclusively in psych if they have background to show familiarity (e.g. worked as a psych RN; in my case being a psychologist) with psych. In other words they are not considered to be working outside of their scope of practice. So far for me, Great. Now I learn that some insurance companies will not cover non-PMHNPs that provide psych services. So....finally my question/comment; Would this be something that a national NP organization could lobby and sue over? I mean if an internal med doc or a family doc (or an PA working in primary care practice) can prescribe psychotropics and get Ins. coverage, then why should FNPs be treated differently if they are " within their scope"-- even if they are not board certified as a PMHNP? On this note, I can't help but notice that PAs get hired into, and operate in just about any specialty without having to have the kind of background that is often required of FNPs that want to work in a specialty. As a profession, are we getting short-changed by our training and organizational hierarchy? In short if a PA or family/internal medicine doc can do it (i.e. psyc services) and get reimbursed, then why are FNPs settling for less?

[Jules A, MSN]

Sue them? I'd be careful about opening this can of worms. There are some states, such as Delaware, who supposedly will start requiring a board certification in psych to work primarily in psych in the near future and my guess is more states will follow suit. You did not get the same psych education as a PMH-NP and frankly as someone who spent the time and money to become dual certified as PMH-NP and FNP I find it offensive that others are attempting to scoot in the back door.

As long as there are no problems you might be fine but good luck when something goes amiss because my guess is any lawyer worth their salt would be all over someone practicing in a field where there is a standard of education and board certification available without having it.

[PG2018]

Actually, some insurers won't reimburse a physician who isn't board certified or board eligible in their field of practice. The same applies to NPs. Some insurers won't pay NPs at all. Some won't reimburse for SMI in non psych trained NPs. I don't know how the PAs bill, but I suspect their supervis physician has to be BC or BE in the PA's field of practice.

If your board will cover you, and your own, personal malpractice insurance will cover you then hey have at it. Diagnosing isn't the harder part of the PMHNP role so training in clinical psychology will cover that, but finding the right med is quite an art. I was just talking to my wife about this. Some people, psychiatrists or whatever, seem to have it, and others don't. I trained with a psychiatrist whose solution was Adderall for everything but mania and psychosis.

However, we have been short changed since the beginning. Yeah, we're nurse practitioners, but we're not functioning as nurses anymore. Too many NPs want to hold onto this because of their years of conditioning, and I think that's one of the drawbacks from being a RN for any length of time. I was a RN for three years and never in psychiatry. We have no uniform education process, no uniform scope of practice, and no uniform credentialing. Until these all become uniform we're never going to get anywhere. Reasons I've already mentioned and boards of nursing replete with LPNs and RNs who dictate our practice is equally stupid so we need our own board. It'll be a long time before we're sorted out. In the meantime, get trained, do your job, have fun with it, and move on with life.

I wanted to add I do admire the psych folks that have picked up the FNP. I'd like to do it or maybe just adult. I want to avoid genitals, butts, and feet in that order, but the major rub is that in my state, a collaborative practice state, I would have to work with a similarly trained physician to prescribe (not diagnose or test) in non psych instances. It's a load of hooey. My collaborating psychiatrists has dubbed me independent and doesn't care what I do so he'd be fine with it, and he covers all the somatic stuff at a rehab facility as well as the psych stuff with a residency and BC in only psychiatry. I still prescribe and not just refill a variety of non psych specific meds. This is another indicator of the short changing of advanced practice, i.e. we're so limited to a singular niche.

[Spaciousness]

Thanks for taking the time to respond to my query. To give it some context, I attended a grand rounds workshop sponsored in part my the local medical college and attended by a prominent member of the board of nursing in my state who is also an PMHNP and by 2 NPs who were trained as PNPs but now did psych after doing some training and continuing ed with psychiatrists. I was told that with my background, I would be within in my scope of practice to prescribe psychotropics just as the PNPs who were presenting their work at the grand-rounds. I would not presume to know how to do the work of a PMHNP as an FNP unless I received some additional training. Also, as an FNP, I would not want to get into treating serious mental illness such as thought disorders or unstable rapid cycling bi-polar; I would without a doubt refer that out. The gist of my question is that if a family doc or PA can prescribe the occasional anti-depressant or anxiolytic in primary care and get reimbursed for their services, than why not an FNP?

[Spaciousness]

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[Spaciousness]

"we're so limited to a singular niche." Thanks PsychGuy , appreciate your feedback. Your comment about the "singular niche" I see as being a real problems with the NP sphere. I believe that our training and professional structure should be such that regardless of specialty (an I see family medicine as a specialty), we have a base level of competence from which we can build, but some things should be a given (whether a psych NP or one specializing in cardiac, we should be counted on to be able to understand and treat some of the more common presentations showing up in a primary care office (be it a bacterial sinusitis or mild to moderate depression) without having to get board certification under the medical specialty that these disorders fall under.

[jer_sd]

A fnp can treat, bill and diagnose simple uncomplicated psych issues. But you need to be able to recognize and refer appropriately. Personally I do very little psych meds or diagnosis because even though my certification covered basics as a FNP my comfort level in this specialty is lacking. I could take ce classes, arrange a preceptor ship and build my skills but I would still be limited to simple ambulatory care.

not all insurance payers recognize NPs but that is another issue.

[PG2018]

Thanks for taking the time to respond to my query. To give it some context, I attended a grand rounds workshop sponsored in part my the local medical college and attended by a prominent member of the board of nursing in my state who is also an PMHNP and by 2 NPs who were trained as PNPs but now did psych after doing some training and continuing ed with psychiatrists. I was told that with my background, I would be within in my scope of practice to prescribe psychotropics just as the PNPs who were presenting their work at the grand-rounds. I would not presume to know how to do the work of a PMHNP as an FNP unless I received some additional training. Also, as an FNP, I would not want to get into treating serious mental illness such as thought disorders or unstable rapid cycling bi-polar; I would without a doubt refer that out. The gist of my question is that if a family doc or PA can prescribe the occasional anti-depressant or anxiolytic in primary care and get reimbursed for their services, than why not an FNP?

They most certainly can get reimbursed for it, and so can you. The vast majority of depressed and anxious persons are treated by PCPs, and plenty of people carry only a diagnosis of MDD and GAD. To the contrary, many people with MDD and GAD don't get well because there's another undiagnosed disorder that isn't being treated.

[Spaciousness]

Thanks jer_sd, DNP,NP, CNS for helping to separate out and clarify the issue.

[Spaciousness]

PsychGuy, Your comments are much appreciated. BTW, I note that you respond to a variety of people's questions/concerns in a very positive, upbeat, and informative manner--kudos to you! Patients in mental health (well, actually all patients in any area of healthcare) really need exposure to people with your energy and values. And, as a profession, we really need to be out there building each other up!

[AtomicWoman]

The gist of my question is that if a family doc or PA can prescribe the occasional anti-depressant or anxiolytic in primary care and get reimbursed for their services, than why not an FNP?

You should be able to get reimbursed as an FNP when you prescribe ADs or anxiolytics; that is within the scope of your FNP training/education. I definitely get reimbursed for those types of issues. The doc I work for (family practice) has told me never to bill the psych diagnosis as the primary (first) diagnosis, because that is a flag to certain insurers. He said even he risks getting dinged by insurers, who will say the visit then falls under their mental health coverage, blah, blah, blah. I don't know if the doc is correct, but he's been practicing a lot longer than I have, so I do what he says. If anyone else has insight into this, I'd love to hear it.

Anything more complicated, such as bipolar disorder, borderline, schizophrenia, etc. I refer out to psych, especially if there is no formal Dx yet.

[Spaciousness]

Hello Atomic Woman,

I haven't been back to this site for awhile. Thanks for responding to my question. Your response is similar to the conclusion that I came to after giving it some thought.

With Gratitude.