Nurse duties at dr office

[sungrl01]

I just started working at busy doctors office and they have one nurse(me) to be responsible for scheduling all the patient tests, doing the insurance coding, answering voicemails,setting up the rooms, scheduling their appointments with us, and trying to help Doctor. Feeling overwhelmed thus far..is this normal for office nursing? I've always worked in hospital but haven't ever had to schedule every patient tests and handle insurance billing. But of course I'm new and found out this week they have gone through nurses pretty quick. I love that area of nursing and the people I work with.

[cayenne06, MSN, CNM]

Insurance billing?! Good lord. If they want you to be responsible for coding and billing, then they should provide comprehensive, paid training. That is a monumental task.

Do you have MAs? I am assuming so. What tasks are they responsible for? Are you doing follow up and case management? Patient education? When I was a clinic RN I did new patient intakes, case management for our high risk patients, follow up, chart audits, scheduling surgeries and consults, pt education, and of course giving meds etc. I would always help out with rooming patients, vitals, blood draws etc, but that was the MAs job usually. I never did anything with billing, and I didn't even know how to schedule appointments.

The nurse in my office, however, functions more like an MA plus. She is an LPN and does everything the other assistants do, but also does med administration, pt histories, education, etc. We do not utilize her full skill set and it drives me nuts! I am hoping to get her her own schedule so she can see patients that don't need a provider directly (depo injections, birth control counseling, smoking cessation, vaccines etc). I also want to get her more involved in follow up and protocol development.

[HouTx, BSN, MSN, EdD]

Based on my own experience, ambulatory staff are generally divided into two functional areas: Front office & Back office. Front folks handle the operational stuff - reception, registration, appointments, billing, records management, etc. The clinical folks are Back office - all of the patient contact stuff, including clinical documentation. This usually works very well because of the distinct skill sets required to function in each area. It's also a good arrangement because it prevents the patient from getting the impression that their care is going to be based upon their ability to pay. If the 'nurse' is handling financial/billing functions, this separation is eliminated. Actually, in EDs, there are Federal laws that prohibit any discussion of finance prior to assessing/triaging the patient - violations can have very severe consequences for the organization and providers.... but I digress.

If your doc wants you to manage processes that are completely outside your skill set, you will need to request training. Inaccurate billing (even if it's accidental) has consequences. It could result in your provider being 'flagged' by auditors & possible loss of revenue if due to being dropped off the "approved providers" list of insurance companies.

I would recommend getting your ducks in a row first - do your homework on all the background issues and talking to some other MD offices to see if you can identify some 'best practices'. THEN, present your ideas to your doc. Good luck.

[nrsang97, BSN, RN]

Why aren't they hiring medical assistants to room patients? They can easily room patients and do VS and why the patient is there. They need a medical biller/coder. You cannot do all of this work. It is insane. I have never seen an office with only one nurse like this. I can see why they went through nurses.

[ScrappytheCoco]

My current agency contract is in an urgent care that shares an office with family practice. The FP office has 7 providers always 3-4 front desk staff, 6 medical assistants, 4 RNs, and 4-5 administrative type staff that handle referrals and such. There is also an office manager and nursing supervisor. How on earth does your provider expect you to do all of that by yourself?

[sungrl01]

Okay yeah it seems like a lot to me. But I do admit I'm new to this. So most offices don't run like this? No offense if offices run like this it makes me appreciate hospitals a bit more.