NP making six figures?

ucmicurn · Jul 19, 2007

All that time, effort and education and only 70-80K as an NP....that really sucks.

As an agency Rn I make 95k/year working only 3 12's a week!!

`c

foxyhill21 · Jul 19, 2007

How long have you been an RN? What type of experience do you need to work for an agency?

NP4KIDS · Jul 19, 2007

I am a NP working in pediatric orthopedics. I have been working for a year, and this is my first job. I am in the low $70,ooo. We are an extremely busy ortho practice, hospital based. I work in clinic but also round on the in-patients, write all the orders, do discharges, etc.....the only thing I don't do is the surgery/OR. I was told that I would have the opportunity to do first assist when I was hired in, but have now found that that was false. NP's can do first assist, but they have to take the course. The one I was going to take was National Institute of First Assist (NIFA), and they will train RN's, NP's, etc for the position.

I am a family NP, but the peds hospital had no problem with it.

I agree that the payscales really need some modification!!! The amount of responsibility we hold does not match what we are paid.

I know of 1 FNP who started with a salary around $100,000/yr. He started in adult ortho and learned all kinds of injections and procedures, etc.....it's all about high billing!!

Trauma Columnist · Jul 20, 2007

Also - this thread is 3 years old - consider that too - maybe you would want to start another thread for more updated info?

core0 · Jul 20, 2007

I am a NP working in pediatric orthopedics. I have been working for a year, and this is my first job. I am in the low $70,ooo. We are an extremely busy ortho practice, hospital based. I work in clinic but also round on the in-patients, write all the orders, do discharges, etc.....the only thing I don't do is the surgery/OR. I was told that I would have the opportunity to do first assist when I was hired in, but have now found that that was false. NP's can do first assist, but they have to take the course. The one I was going to take was National Institute of First Assist (NIFA), and they will train RN's, NP's, etc for the position.
I am a family NP, but the peds hospital had no problem with it.
I agree that the payscales really need some modification!!! The amount of responsibility we hold does not match what we are paid.
I know of 1 FNP who started with a salary around $100,000/yr. He started in adult ortho and learned all kinds of injections and procedures, etc.....it's all about high billing!!

The problem that you have is that you are not bringing any income into the practice. The model for orthopedics is that your first assist fees cover your salary plus and the clinic time increases downstream revenue for the surgeon. Also remember that because of the amount of medicaid Pediatric specialties usually pay less than adult specialties depending on the state. In addition there are a less long and complex procedures in pediatrics that will reimburse for a first assist.

David Carpenter, PA-C

ucmicurn · Jul 20, 2007

How long have you been an RN? What type of experience do you need to work for an agency?

Foxyhill,

With two years experience you should be ok to do an agency gig. However, having said that..."let me aghhh say this aghhh about that"....it really depends on THE experience you have.

If you really want to be economically viable, you need ICU/ER experience. I started with 1 year experience out of a CVICU and have been agency for 13 years now. Currently I am contracted into a 25 bed high acuity MICU.

I would not trade it for any staff job in the world. I now own two agencies and sub-contract to hospitals, or through other agencies.

If you want to work your butt off (which I don't) you can pull over 130k per year.

~c

NP4KIDS · Jul 21, 2007

The problem that you have is that you are not bringing any income into the practice. The model for orthopedics is that your first assist fees cover your salary plus and the clinic time increases downstream revenue for the surgeon. Also remember that because of the amount of medicaid Pediatric specialties usually pay less than adult specialties depending on the state. In addition there are a less long and complex procedures in pediatrics that will reimburse for a first assist.
David Carpenter, PA-C

Actually, you are incorrect about the procedures/surgeries in peds being less revenue/shorter. My surgeon does very complex cases including spinal fusions, total hip replacements etc.... I believe he brought in (we only have the one doc right now and a resident in addition to myself) well over 3million $$ to the hospital last year. In addition to this he can bill for my in-patient consults and clinic patients more than if I were a PA and he does not ever have to see the patient.

caldje · Jul 21, 2007

In addition to this he can bill for my in-patient consults and clinic patients more than if I were a PA and he does not ever have to see the patient.

Please explain how he can bill more for you because you are an NP than he could for a PA...

p.s. for those who don't know, Im asking this because it is impossible.

core0 · Jul 21, 2007

Please explain how he can bill more for you because you are an NP than he could for a PA...
p.s. for those who don't know, Im asking this because it is impossible.

I would second this question. The billing rules for NPs and PAs are identical. Also if you are consulting on your own patients (ie. the MDs surgery patients) as inpatients then you are violating Medicare guidelines. Yes there are ways to make more money billing for NPs than PAs all of them illegal.

David Carpenter, PA-C

NP4KIDS · Jul 22, 2007

I would second this question. The billing rules for NPs and PAs are identical. Also if you are consulting on your own patients (ie. the MDs surgery patients) as inpatients then you are violating Medicare guidelines. Yes there are ways to make more money billing for NPs than PAs all of them illegal.
David Carpenter, PA-C

Not sure what state you are practicing in, but I have an independent billing number and when I see patients in the clinic and as in-patients we bill under my number. The PA's we previously had working for us were unable to do this, as they were not allowed an independent billing number, and I was told this both from my hospital administration and the PA's I worked with. It is absolutely NOT illegal! I thought this was a web group for nurses, not PA's.

I would never engage in fraudulent billing, and my hospital system/sponsoring physician would not either. This billing is why having me work with the physician is more beneficial than having a PA-in my state PA's do not have independent billing numbers.

core0 · Jul 22, 2007

Not sure what state you are practicing in, but I have an independent billing number and when I see patients in the clinic and as in-patients we bill under my number. The PA's we previously had working for us were unable to do this, as they were not allowed an independent billing number, and I was told this both from my hospital administration and the PA's I worked with. It is absolutely NOT illegal! I thought this was a web group for nurses, not PA's.
I would never engage in fraudulent billing, and my hospital system/sponsoring physician would not either. This billing is why having me work with the physician is more beneficial than having a PA-in my state PA's do not have independent billing numbers.

PAs have individual medicare billing numbers (UPIN and provider ID numbers). They also have individual NPIs. By federal law any provider that bills under medicare or medicaid must bill under their provider number unless they are billing incident to or co-billing. The reimbursement for NPPs (CNM, PA, NP, CNS) is the same, 85% of the physician fee.

In some states Insurers are required to credential and contract with NPs separately for services provided. However, in most cases insurance companies credential the physician and then the practice bills under the physicians provider number for both PAs and NPs.

While I am sure that your hospital means well, I can show you a number of cases where hospitals intentionally or unintentionally created cases of fraudulent billing - in one case to the tune of $600 million.

I am not sure exactly which "identification number" you are referring to that does not allow PAs to bill or that only NPs can get "independently". As I explained above, the process for PAs and NPs is identical. The only difference is that Medicare allows NPs to be paid directly without pass through from the physician.

Yes this is a nursing board. When you post false or misleading information then I feel compelled to answer. As always I am happy to help anyone with billing questions.

David Carpenter, PA-C

HealthyRN · Jul 22, 2007

PAs have individual medicare billing numbers (UPIN and provider ID numbers). They also have individual NPIs. By federal law any provider that bills under medicare or medicaid must bill under their provider number unless they are billing incident to or co-billing. The reimbursement for NPPs (CNM, PA, NP, CNS) is the same, 85% of the physician fee.
In some states Insurers are required to credential and contract with NPs separately for services provided. However, in most cases insurance companies credential the physician and then the practice bills under the physicians provider number for both PAs and NPs.
While I am sure that your hospital means well, I can show you a number of cases where hospitals intentionally or unintentionally created cases of fraudulent billing - in one case to the tune of $600 million.
I am not sure exactly which "identification number" you are referring to that does not allow PAs to bill or that only NPs can get "independently". As I explained above, the process for PAs and NPs is identical. The only difference is that Medicare allows NPs to be paid directly without pass through from the physician.
Yes this is a nursing board. When you post false or misleading information then I feel compelled to answer. As always I am happy to help anyone with billing questions.
David Carpenter, PA-C

As always, thank you for your informative post. Yes, this is a nursing board, but everyone is welcome and your contributions add a different perspective to the discussions. Please don't let a poster scare you off!

In regards to NP4Kids, having an "independent billing number" does not change the reimbursement amount. Coreo explained it quite well.