jer_sd

I prefer per encounter. As you gain familiarity with the patient population your speed will increase. As a 1099 you have your own business/practice and you should treat it as your practice not as an employee of someone else. Often NPs keep the staff nurse hourly pay mentality.

Lowest cost that provide clinical placement

Too many variables what type of practice, what cpt codes, cash, medicaid, medicare, PPO, cash only. Rent, expenses staff taxes.... You would need to focus this question a bit. Primary care, micro practice, group practice, specialty practice.....

Ct urogram could also be a good step rather than standard ct imaging better look at ureters image reconstruction

Another issue is many NPs have a clock in clock out mentality. They do not understand billing, payments and cost of practice. As more NPs own their own practices this will change as they learn the business of medicine/nursing. Understanding how to generate revenue and the cost of a practice are two huge issues to capture equity in practice. If a NP only sees post op patients in a global period they will generate zero dollars in reimbursement, however it will allow the physician to generate significant revenue by having more time to operate. This is indirect revenue. What codes are billed, what is the payer mix. Are clinic visits billed incident to are hospital visits billed as shared visits are the billing rules being followed? Both incident to and shared visits do not give credit to the NP. To get parity for work done it will require a more business related approach

Will it be a flat fee per pt or a % of collections? What cpt codes are billed the most frequently and what is the typical reimbursement? What support is provided (scheduling, assistants, ect). Once you understand the revenue you generate and the overhead it can allows you to have a better idea.

I was a certificate prepared NP. Eventually hit the point where I had less employment opportunities since I did not have a MSN. I eventually went back for a MSN.Ico p!etecmy DNP this year ad well. My opinion you have 10+ years of work left you may want to eventually get a DNP but go MSN first. If you have 15+ years of work left you should get a DNP but if you can get a MSN with APN credential firstif possible.

With this patient population you will primarily be seeing medicare patients. Look up the medicare reimbursement for RVUs in your area. Keep in mind you get 85% of the physicians fee schedule. Look up the E+M codes for nursing facilities and other cpt codes you will be billing for. Look at over all reimbursement and how much you will get. Personally I am a fan of "eat what you kill" for NPs. It is fair and rewards effort. However make sure your share is fair. Jeremy https://www.cms.gov/apps/physician-fee-schedule/overview.aspx 99308 is a follow up worth 1.16 RVU in my area physician reimbursement is 71.86 so collection from medicare is about 48.86 for a np assuming no secondary payer and pt does not pay obligation. So if you get 16.02 that would be 1/3 of collections. Keep in mind your reimbursement may be higher or lower so check the payment in your area.

A fnp can treat, bill and diagnose simple uncomplicated psych issues. But you need to be able to recognize and refer appropriately. Personally I do very little psych meds or diagnosis because even though my certification covered basics as a FNP my comfort level in this specialty is lacking. I could take ce classes, arrange a preceptor ship and build my skills but I would still be limited to simple ambulatory care. not all insurance payers recognize NPs but that is another issue.

Medicare a NP can boll 85% of physician fees. But medicare only pays 80% of billed. So say a procedure had a medicare fee schedule of $100.00. The MD would collect $80.00, a NP would collect $68 (85*.8). The rest of the amount is the patients or secondary insurance responsibility. Now if the patient has medi-cal as a secondary you will not receive additional funds since the medicare payment is already higher than medi-cal payments. Some PPO and HMO plans will contract with a NP, some will not. If a state has a any willing provider law passed it makes it much easier to receive payment. Jeremy

Having first assisting can add extra value to you as an APN. If you work in primary care type position it will not help. However some providers scrub in to assist in procedures and personally bill first assisting fees over and above traditional salary. Or if your contract includes bonuses for rvu production first assisting may add to that. Medicare does not require a NP complete a RNFA course to bill for first assisting. However this is not included in the NP program and obtaining credentialing is difficult without proof of training or competency. If you will be first assisting make an investment in your self and attend a structured course. Jeremy

How will your practice be set up under your name!e and number or corporation. This will determine if you use your SSN and npi or an alternate number. Register for a NPI number, free and fast. Hold onto conformation number. Apply for medicare such as cms855i, apply for medicaide in your state Insurance credentialing with ppo and HMO plans can be painful but worth it. Malpractice, general liability, how will you do billing in my area billing companies take 6-9% of collections. Create a superbil for easier use. What supplies will you need. Clia license for point of care testing. Marketing, how will you capture patients and referrals. There are a lot of little steps you will need to take but good luck Jeremy

Many procedures done by a np are considered minor surgery. So my guess is as long as your state does not say no, and you have documented training not just on the job experience you can probably do the procedure. Jeremy

I have opened two practices as a np. It is possible but a lot of work. You need to have a good understanding of billing coding and some business sense. What services do you want to offer, family practice, specialty care? What payers are you looking to use cash only, medicaid, medicare ppo, HMO. Are you credentialed on any provider panels? You will need to have a billing company, clia license. What capital equipment will you want to use, supplies, pharmaceuticals, there are a lot of unanticipated costs associated with opening a practice. Will you have employees? What set up will you have sole proprietor, c corp, s corp, llc It is doable but requires effort and planning. Jeremy

I keep my cnor. One hospital I was credentialed at required APN to have cnor or crnfa to get first assisting privileges.

Physical therapists are now dry needing which they claim is not acupuncture and they can do it with appropriate training in many states. A few states have limited acupuncture license for ariculotherapy for detox. I have not seen guidelines for licensure for other reasons. Battle field acupuncture is also interesting seminar description. You might reachout to that group and see if they have any info to help you Battlefield Acupuncture » Battlefield Acupuncture Seminars | Battlefield acupuncture, Advanced battlefield acupuncture, battlefield acupuncture seminars,acupuncture, auricular therapy, auriculothrapy, ear acupuncture

I have had several 1099 positions over the years. They have a greater flexibility but quarterly taxes are not fun. Some people claim there are tax benefits to this position but check with your CPA first. Also there have been a lot of employers treating IC as employees the IRS has very narrow interpretation of the role and can result in significant fines for employers who violate this ruling.

And for billing insurance especially medicare you would need to be nationally certified.

Look into incident to billing. There are specific rules and regulations through medicare but if you are seeing patients in follow up only, and acting within your scope of practice there is potential to have billable services. This will also depend on your payer mix. Jeremy

Ce will have minimal overlap. You will need to maintain ce, competency, practice in both. It is possible but it is more work than only having one np cert. For increased scope you have additional responsibilities. Some states give general np license, others license by speciality areas do you may have double payment there as well.

There are actually a lot, depending on how you want to progress your career; Some are NP other are advanced practice nurisng. Urology- Society of Urologic Nurses and Associates (SUNA) Derm- DCNP Certification | The Dermatology Nurses' Association Ortho- Orthopaedic Nursing Certification Board Nephrology- NNCC Oncology- Oncology Nursing Certification Corporation Hospice- http://www.nbchpn.org/ Addiction- Addictions Nursing Certification Board - IntNSA Child psych Welcome to The PNCB Web Site Then there are certifications that are not NP specific but relate to the NP role: Lipid management Accreditation Council for Clinical Lipidology anticoagulation NCBAP: About the CACP Exam There is almost a certification in anything..... So depending on how you want your career to develop there is probably a test you can take to support it.

You need your furnishing number prior to DEA registration. You may also need to complete a specific course to get scheduale 2 authority.

i am a male and a whnp (one of my np certs) i do not work as a whnp but use the skills and knowledge frequently. great education, can do a lot of health promotion and preventive care job market is limited, male obs tend to prefer female support staff, many women prefer a female provider special fields such as gyn onc may not have as much limitation as general ob/gyn great training gook skill set to develop but you will be at a disadvantage for employment in private practice. but i do not regret this as part of my education. jeremy

Good question. I keep my CNOR since some facilities require this for NPs to first assisst. If you are working in a specilty area having certification in that area as a RN can not hurt, except for CE requirements and the $$$. My bias would be to keep it since holding onto it is harder than taking the exam again. I did let my CRN lapse and I keep thinking about retaking that exam. But I hate alphabet soup after a nurses name and never list all my credentials.

Check out http://www.narm.org/ as a good starting point. It covers the examination.