Question re critical care. Since critical care time provided by a PA/NP should not be attested/billed under collaborating physician but under the provider who did the work - what happens with critical care procedures at other places?
I have always billed my own critical care procedures, but now we have APP 'fellows' coming through and I was told to have them sent to the collaborating physician to bill ... is this permitted and it's just critical care time that can't be split/shared? I can't find any CMS guidance on the separately billable procedures done in critical care.
ghillbert replied to Apple2020's topic in Advanced
If I knew I wanted to work trauma/ED, even if I was a nurse, I would apply to PA school. As an NP, you are reliant on either being adult or pediatric, acute or primary care etc. There are some dual programs aimed at ED but PA would give you more clinical time. It really depends where you live and intend to work - some places prefer NPs and some prefer PAs. Know your market.
ghillbert replied to ghillbert's topic in Advanced
Is there any CMS/legal guidance as to the fact that licensed/credentialed NP/PAs cannot bill procedures under the collaborating doc? I think I will need cold facts to address this internally. I hate to just lose the revenue.
ghillbert replied to Aussienurse123's topic in Immigration
I am an Australian-trained BN RN who now works as a nurse practitioner in the US. I went to Deakin initially for my nursing degree. Deakin did offer standalone units for Paeds and OBGYN nursing but it is over ten years ago that I came over so I don't know if they still do. I applied for the CES from CGFNS and my education was found equivalent so I didn't end up having to do extra courses or clinicals.
On the good news front, once you have managed to pass the NCLEX exam and get licensed in the US, it is fairly easy now with the E3 work visa to get authorization to work once you find an employer.
UPenn is a well regarded program. This baffles me, because I am in Pittsburgh and I can't hire enough ACNPs. I have FNPs applying to my critical care jobs often. Are you getting interviews and not being hired? Or not getting interviewed? Are your salary expectations too high? Or not even getting to that point?
I hire ACNPs for critical care. HR controls the pay offer, based on experience, but I ALWAYS tell candidates to negotiate! Never accept the first offer! There is always a range, and room to move with hours etc. All bonuses and raises are based on salary so go for the highest you can. They can only say no and give you the change to accept or decline. Always ask about signing bonus - they won't offer if you don't ask! I have had candidates in same position with a $15K/yr pay difference, merely based on their negotiation, or not. It's also smart to go to the physician in charge and thank them for the interview opportunity and mention that you are interested in the position but may not be able to agree on terms. They can often put pressure on HR/admin if they really want you.
I probably would have told the patient, because I usually think about how it would feel to find out "accidentally" with a less-tactful clinician reading off a chart - because I have seen it happen. You don't need to get into the specifics, it's okay to say that you felt they should know so they can start to deal with it, and that the specialist will follow up with further information. It's good to reflect and learn for the future, so you're doing a good job.
ghillbert replied to ICUisLife's topic in Critical
- Inadequate paralytic dose or time
- Inadequate bagging/mask seal
- Need for jaw thrust
Multiple reasons it could be that you weren't able to oxygenate patient adequately with BVM. Was it an experienced provider attempting the intubation?
Probably could have grabbed the Glidescope or bougie with the first difficulty. Your best shot at intubating is the first one.
I work in a SICU which is primarily cardiothoracic. I am an ACNP. "Autonomy" is in the eye of the beholder, and is a limited thing when cardiac surgeons are involved; its an open ICU.
I have my own patient load (I see half the patients and the residents see the other half), then round with the ICU attending then multidisciplinary team and present my patients, my assessment and my plan. Attending may have input or agree with my plan. I do procedures independently such as limited bronchoscopy, intubation, central lines, arterial lines, pigtails. Attending is present on the unit for intubations. I bill for my own procedures and for my critical care time under my NPI.
This seems extremely impulsive and unprofessional to me. You didn't get a reply so quit without notice although you have no evidence of incorrect billing because... well... you didnt give them a chance to reply. Very odd.
Do not even consider accepting a job working for this person! If he's googling the FLSA now and working out ways to screw you over, do you really think he's going to do the right thing by you once you're hired? Run.
ghillbert replied to Overtime Mom's topic in Critical
We use them in the ICU. I am not a fan. It's decent for airway placement or quick issues but not too useful for significant pulmonary secretions or lavages/BALs. It gets stuck in the swivel adapter half the time and needs jammed down the tube super hard (yes even with adequate lubricant). I might not have used them enough yet, we've only had them a few months but so far I prefer the "real bronch".
My unit is called "SICU" but is mostly cardiothoracic surgical ICU. We get:
- cardiac surgery (VAD, ECMO, CABG, valves, aortic surgery)
- thoracic surgery (VATs, esophagectomies, bronchopleural fistulas)
- vascular surgery (EVAR, TEVAR, bypasses)
- organ transplant surgery: heart, liver, some kidney, pancreas
Consider surgical ICU if you have med/surg experience. I hate medical ICU but love cardiothoracic surgical ICU. I much prefer 3 x 12's than 5x8 schedule, and like having days off during the week to get things done.