Private Practice PMHNP Question

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Hi - I have been reading these posts for years and have learned so much! I will be starting my program next year and have a question. I have a friend in private practice - she does both medication management and therapy. Most patients have BCBS and she is paid about $240 for 45 mins. which includes medication and therapy. I know that it all depends on insurance and that many people don't want therapy, but it seems that based on these numbers she could work 5 hours a day, 3 days a week and still make almost $200,000 a year (I'm not taking out for insurance, sick pay, vacation, retirement etc.) Does this sound right? It almost sounds too good to be true to me.

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Anyone? í ½í¹

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Specializes in Psychiatric Nursing.

She may not be billing correctly! I think you could charge that for some private pay. Depends on location .

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Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.

Is the $240 what she is billing or what she collects (2 different things) also, income tax if she is self employed will take a big bit out of what she collects. (1099 vs W2). Not to mention all the overhead.

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She billed $300 and netted $220 and got a $20 co-pay. I understand that she has lots of expenses that she's responsible for because she has a private practice, but even so - to make $200,000 working 15 hours per week? So if she worked 40 hours it would be about $500,000. Is that really what PMHNPs make?

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Specializes in Outpatient Psychiatry.
She billed $300 and netted $220 and got a $20 co-pay. I understand that she has lots of expenses that she's responsible for because she has a private practice, but even so - to make $200,000 working 15 hours per week? So if she worked 40 hours it would be about $500,000. Is that really what PMHNPs make?

Based on the numbers you provide, that's possible, yes. However, there are a lot of "ifs" involved. If she's paying others, admiistering her own business, etc. then there is a bit of overhead. Generally, when you have an organization, somewhere around 60% of the revenue will go out to salaries and matching, i.e. insurance, retirement, gov't tax, etc. The rest is somewhat dependent. I'm not sure how she is billing 45 minutes of therapy under BCBS. Although PMHNPs can "do" therapy most do not so I have no idea what psychotherapy plus med mgmt produces. If you contact with an insurer, then you get what they'll pay. You can charge all you want, but BCBS, and others, will only pay what you've agreed to take. The difference is sometimes quite glaring.

Do PMHNPs make a lot of money? It depends. I know PMHNPs over at the community mental health making about 70k running 16 30 minute med checks a day. Sounds boring, and there's no room to make more money. I'm the only guy with a prescription pad in my shop, and I typically schedule 20-25 per day. My no show rate is a bit less than the national average which generally hoves around 50%. I'm paid a salary plus bonus, i.e. once I have seen enough patients and earned enough revenue to pay my salary I get 80% of what's leftover. That incentivizes my work, and I work four 10 hour days by choice. Notwithstanding the once a month moonlighting gig I have, my current work regimen puts about 180k/yr on my check. If I chose to work Fridays then I'd probably see 250k/yr. Not bad for a southern boy with a master's degree. I don't care who knows my income either because, as a NP, other NPs need to realize that there are dollars to be had if they just put forth the effort and drive themselves to have an efficient, profitable practice. My practice is somewhat "private," but most of my patients are Medicaid at about 80%. The rest are BCBS, QC, Amb., pvt pay, Medicare and some others. Actually, I'm not sure what the breakdown on Medicare is. Some have -care and -caid, and I'm remiss at not knowing the percentage.

I do know you've got to stay on top of your numbers. Know how many you schedule, what types of appointments you schedule, your no show rate, and what types of insurers you have. An amibitious clinician would know what reminder calls and other reminders do to attenuate the no show rate.

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Thank you for your response PsychGuy!

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Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.

How many staff does she employ? Does she hire a billing company that also maintains credentialing? How much is office rent? Then there are utilities (one clinic I work at the electric bill in summer is $800 a month. Take your friend to lunch and ask about all the details involved in her practice as far as financials.

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If BCBS is now paying 240 dollars for 45 minutes, I will eat Donald Trump's shorts. Please don't take me up on it.

A few years back, when I was in the private practice, BCBS was paying half that, at most, and also refuses to accept NP's without a collaborator, even in states where no collaborator is required.

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