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The numbers, crunched... Check my math and reasoning here and discuss where you see glaring holes. So the most common billing codes outpatient would be 99214 and 90833, can bill concurrently (same visit) , Med management + brief therapeutic intervention / followup / supportive therapy / CBT primer etc We will ignore new patient intakes for this brain storming session. Will also ignore medicaid because the payments are all over the place (and many states have lots of managed care options for these folks) OK so, a PMHNP can bill medicare 85 cents on the dollar for what medicare would pay an MD Psychiatrist. Technically you could do three of these appointments in an hour but for our purposes lets say half hour followups. 99214 2023 medicare rate is 128.48 (x0.85) = 109.21 for Psych NP 90833 2023 rate is 69.47 (x0.85) = 59.05 for psych NP. Now Per HCCI and some other sources , private insurance can sometimes pay out less than medicaid (5 to 14%) but is usually on par, up to 180%. this can vary widely and even widely within states (like 120 dollar difference in a states capital vs rural). So we are using Medicaid payments as a frame of reference in order to deduce some estimates for what outpatient insured clients pay / generate in revenue. reimbursement is also a function of negotiations, more experience meaning more renumeration. For the sake of my hypothetical I'll assume the "new grad" rate represents the lower end of the medicare billing payout and that private insurers would go up from here (but if you know different let me know, maybe new grads get 20% less traditionally, I couldn't find any legitimate dfata on this). So this gives us a range for billind code 99214 for a psych NP of 93.92 up to 196.68, and a range for billing code 90833 from 50.78 to 106.29. Let us presume you see on average two such clients an hour. This gives us on the low end $289.40 billable value and on the high end $605.94. Eight hours in a day, five days a week gives us 11,576 dollars a week (seeing 16 patients a day) on the low end up to 24,237.60. Monthly in then equals on the low end 46,304 and on the high end 96,950.40. You see 80 patients a week for this, 320 a month. Now, overhead costs. Estimates from some Google fu pin this at around 40 to 60% (although I don't think 30% or lower would be absurd, especially with more offices in an outpatient setting to centralize things and get quantity discounts on things) , Lets call it 50%. That's software, billing people, secretaries, off hour answering service, fax, internet, light, rent etc So our low end gets chopped in half to 144.70 an hour. High end 302.97. Heres the kicker though, if you walk in to some place to a full patient load, what have they really done? the patients already existed and had need so you could say they saved you marketing but is that "saved marketing" worth a pay cut in perpetuity (if you work an an independent practice state) You're a grown up, you couldn't find someone to make sure your billing correctly and get someone to answer phones? . You can get a website for pennies, and a nice one at that. Because if you were private practice, S-Corp/ LLC then that 50% overhead is your taxes. You won't owe any. Meaning that low end 144.70 is money in your pocket. If you are not in an independent practice state again, here is the amount of money your efforts are bringing in to the practice, does your pay reflect this? , in any other business, if the employees knew that their direct efforts paid X amount, would they except one fourth of X or less? Lets say you have some no shows and people who don't pay (and again were already not counting the new intakes which bill higher) , shave off another 20%. That's still $115.76 an hour, and that's if your average client has an insurance plan paying 14% below Medicaid (so at the base rate, with the 15% reduction for NP vs MD and we're back up to 134.60) So low end you should be making 18,521.60 a month (222,259.20 a year) to see 320 patients, a full case load (and remember , I dropped 20% for no shows and non-payment , which I pulled out of nowhere, feel free to play with the numbers if you do a 9 to 5 and only take a half hour lunch to get an extra 30 minutes of charting in and take a patient or two off per day for more admin work, still a pretty large amount of money coming in the door) So it would seem to me that any clinic or site paying in the 50 or 60 range is just taking advantage of people. Even 80 to 100 is pretty questionable (even if you're not in a full practice state, we already took out 50% of the income that is billed for to pay for office staff and rent and all of that). If they're forcing you to see 3 patients an hour? low end again, lowest possible ever studied or seen 14% below Medicaid you are now actually worth 173.64 after all expenses (and that's with 20% no shows or vacancies). Lets give the "owner" a healthy 10% profit margin because they so nobly googled "office space for rent" and "EHR software, price comparison" and did all that scary work. Oh and they "brought" the patients in! (the demand exists, you can get to 80% capacity in basically any area in 2-6 months with just networking and word of mouth). OK so fine, we give them 10%, which is a pretty healthy cut considering the actual office management was paid for in the 50% overhead that came from your work so this noble and much needed "owner" can actually do literally nothing. THATS STILL, at the lowest, 104.18 an hour if you see two clients an hour, with the worst paying insurance, bottom barrel, minimum, in your pocket, nationwide. 121.14 is closer to a realistic average. Now let me ask you board certified psych NP's. Do you make 120 dollars an hour? because if you don't, its because someone's stealing from you. I can assure you, shopping for an EHR and finding an office manager isn't such a huge mountain to climb that its worth you losing 30-50% or more of the money your value produced for the rest of your career, and if you are not in a full practice state y'all need to get together and figure it out. Don't let the new grads take chump change. Thoughts? critique? am I way off somewhere?
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Well you can just go to your state board and get a list of accredited advanced practice programs. I think Wilkes & Chamberlain are considered the most "degree mill" of the lot, Herzing has never been cited or anything of that nature though which I feel like would be THE red flag to look at.
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Has anyone gone through the NMBI process recently? I'm seeing anecdotes online about the 2300 clinical hours (during school) requirement, so basically that would make it impossible for almost any BSN-RN from the US to meet criteria, but then I also hear people say floor experience is now being allowed? Has anyone attempted recently or completed this? What was the timeline? cost?
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oh, one thing I just thought of. You get the syllabus at the start of the course. What I've been doing is working a week ahead, meaning the first week I'm lining up my discussion posts for that week and week 2 and doing the readings for both weeks. So , having the syllabus upfront allows you to budget time better because you can see what portion of your final grade the assignments are vs the discussions. For example in my current course we have an assignment for week 6 (of the 8 week course) that's about 1/3rd of the total grade. So you won't have the knowledge base to start it early BUt because I'm running a week in advance I'm able to tackle that beginning week 5. I imagine this method of time budgeting and accountability would transfer to another program if you ended up doing it.
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Well I have my own network to draw from for clinicals and don't begin them until fall so I cant comment on that. So far I've just been doing the sort of...I guess MSN foundation stuff , twchnology for APRN's , research , roles od nurse practitioner etc I start advanced patho and assesment next term. Thus far its almost always 2 discussion posts per week per class per week with two responses to classmates for each discussion post. This is interspersed with assignments / essays / projects. It seems to be on average 2 per class of these major assignments. So far no exams , I think thats going to start eith the advanced patho / pharm / asseament portion. Outside of the reading theyll post extra powerpoints or videos weekly focused on the topic at hand. Its 100% online so , if you arent the aort to be able to self engage then I suppose it may be a struggle but I don't imagine a lot of folks got this far (a bachelora in nursing) without picking up the requisite time management and study skills so I don't think its going to be a pronlem. The proffesors are very accesible a lot will email weekly class updates and drop their personal cell telling you to text or call with quesrions. Try to find a local NP networking group. Thatll come in handy no matter where you end up.
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OK, so just began NU626 "Roles for Nurse Practitioners", which feels like the first real "meat & potatos" course. The one previous to this was something like "technology in nursing" and it was basically a rehash of my bachelors in that regards with bigger words. Not that it isn't important but I'm pretty comfortable with technology so a bit dry. No complaints about the school or teachers or anything thus far, if you go on the facebook group they have a lot of griping, maybe if you're upset about something you just tend to find others who share those concerns. So far the teachers have been fine, expectations laid out clearly etc
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So , it's keeping me busy. Doing nurse theory and research, each 3 credits. NU500 and NU560. So a lot of the negative chatter I saw on the facebook group seems to be one of three things, first disorganization which...well the program is new (June 2021, they only had the phmnp cert before that) and that's a moving target so we'll see (been fine for me so far) secondly "busy work" , I can feel you folks on that but I'm not buying that it wouldn't feel the same if you were doing a traditional on-campus type masters (of any sort), its gonna be a lot of work and some of it won't be interesting to yo and therefore will feel like filler. If we're doing a discussion post and I find a topic or article I'm curious about? not busy work. Something that bores me? busy work. See how that works? Third, and I feel like this maybe overlap with the others, it's an online program so you have to be organized. No two ways around it. If you're comfortable with technology and you've done online learning before it's a non-issue, if not, a masters level as your first rodeo might be a bit intense. I'm only 3 weeks in though so who knows how I'll feel in 6 months LOL
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Reach out to whoever your admission point of contact was and they should be able to get it straightened out rather quickly. Got mine showing in canvas I thin k3 days ago? so just trying to get organized now. Nu500 theoretical foundations and Nu560 research methods as well as the zero credit hour clinical readiness class.
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