mountainaireNP

Got my NPI number, but I understand I need numbers for Medicare and Medicaid as well. The office space I hope to get is in a fairly large town and is on the 3rd busiest street in the city, next to a chiropractor and across the street from a dentist.

I'm learning a bit here and there. From what I'm understanding,m I can get unemployment, which I think would help me buy some time while I get the clinic set up. I also hear that a lot of doctors contract their insurance claims out to companies that do the billing for them, so that might be an idea. I've got my accountant on board to take care of the bookkeeping. I'm looking at used office furniture and medical equipment. I'm feeling pretty optimistic right now. I guess I'll just have to play by ear and find out info. wherever I can.

I'm relieved, actually. I was fed up with the drama and poor oversight. I was assured it wasn't my fault, but the bottom line was they had a PA with a lot more experience. They assured me they loved me, I was great, I could always count on a stellar referral, blah blah blah. I want to open a small primary care clinic and any pain management will be done for a VERY select few. Since this was a cash clinic, I have no certifications to bill insurance. I am in touch with a supervising MD, and have found a prime location. I have been searching for a way to get an ID number so I can bill Medicare, Medicaid and other insurances. My question is, what steps do I take, who do I contact, so that I can start billing insurance? I know I need to hire someone to process the claims, what do I look for in an employee and what is the average pay? Thanks so much.

I've been there about a year. Day in and day out it's altered pee (we had started having someone go to the bathroom with them but we were losing too many people so the owners had us stop doing that.) A few weeks ago, I got a visit from an investigator at the board of health who collected 18 charts to study because a complaint came from an informant at the police department that I was misprescribing meds. It didn't take long for me to find out who it was, because patients were coming to me to let me know. Turns out, some lowlife crudburger bottom dweller who was caught buying narcs off the street after he was dismissed from my clinic for a number of actions breaching his contract, was willing to act as an informant in exchange for a lighter sentence. Oh, and we dismissed some weirdo for cocaine (no 2 week probation for illicit drugs here) and I don't know how but he got my cell phone number and he calls all the time. Now I have to change my number and you know what a pain in the rump that is. Is it like this everywhere???? Or am I just a magnet for scum? I told the investigator I try to be consciensious (sp?) about what I give people. I hope the chart shows this. I worked hard to make sure we have imaging, database, pill counts, notes, etc. on file. I don't know what else to do. I just figure I need out of this line of business but where do I go, with the glut of NPs? I really feel like I'm cracking up lately.

So...BostonFNP would you let it slide or tell her to pound sand? Yes, the old script should have been exchanged for the new script, but she knew full well she should not have filled that Percocet, especially considering the way she acted in the office when she got the Percocet (jumping up and down flailing arms and screaming "she can't do this to me!" over and over.) We do have a three page contract they initial beside each point, but most of them don't read it. I'm going with my gut on this and thinking her dismissal letter needs to be prepared and sent off. Yes, we should have gotten the old script back (I wasn't there when she came and got the script) but even if I had checked the database to be sure she hadn't filled it the Percocet would not have been there because she filled it 4 days after getting the Oxycodone. I just feel like she should hold some of the accountability because she got the script she wanted then still filled the Percocet...she took advantage of our mistake and even admitted as much. She is not a favorite at the clinic anyway, and this really broke the trust between patient and provider. I do not want to see her anymore. Her spouse is also a patient at the clinic but we have had no problems from him as of yet. And even without the Percocet, she was short several days on her Oxycodone, so...I guess we could cite her for that, too.

Just a background before my question...I am the only provider for this pain clinic where I work. One day I had to be out of town so they brought in a substitute who turned out to be absolutrely horrible. She was rude and nasty to the patients and was cutting their meds way down or stopping them altogether. Anyway, of the many patients (nearly all of them) who made complaints there was one who (I was told) threw a hissy fit in the office when she was given 90 Percocet 10mg tabs instead of her usual 120 oxycodone 30mg tabs. When I got back in town she was allowed to come get the prescription for her regular med. When the office staff gave her the script for the oxycodone they FAILED to collect the script for the percocet. So she came back for her monthly visit and I notice on the controlled substances database that not only did she fill the Oxycodone but 4 days later filled the Percocet as well. This really hacked me off and I told her. First, she said her husband took both of the scripts at the same time and she didn't realize he was getting them both. When I informed her that the percocet was filled 4 days AFTER she filled the Oxycodone she hemmed and hawed around and kind of mumbled that she realizes she shouldn't have done that, but assured me the percocet made her nauseated and she threw them out after taking a couple and then she pulled out the empty bottle of Percocet. She was also out of Oxycodone but was not due to get them filled for several more days. I know this is a flat out lie about the Percocet and what's worse, she had the NERVE to ask me to authorize an early refill on her Oxycodone. Am I making too big a deal out of this or should I let it go, since technically we messed up when we failed to collect the Percocet script when she came to get the script for Oxycodone? For some reason this bothers me a lot and maybe it shouldn't but the whole situation just makes me feel dirty.

We dismissed a couple more today. So, we should dismiss them after the first offense of having no metabolites? This is a new pan clinic with new staff and a medical director who isn't as involved as he should be, and we're still trying to figure things out. I can't up and quit as I waited two years to even get on with this job (glut of NPs in the area) and on top of that I have to drive 80 miles one way to have it. What do you do with them when a new patient comes in demanding "roxi 30'" because the 15's don't work (supposedly.)

I guess that's too bad for me, though, I can't afford to quit. The thing is, we do drug screens at each visit, and send the samples off for analysis. A large number of patients have no noroxycodone in their systems, which basically means they are selling their pills. The first time they are put on a 2 week program, the next time they are dismissed. They always want to argue the results, and insist they "don't do meth" or "they don't even know what suboxone is" and they will waste our time whining and arguing...I've gotten to where I don't listen to them. I hand them their test results and tell them to take it up with the drug testing company which they will own if they can prove that the results that test 96% positive for crystal meth are false. Any of you veterans, how do you deal with these people and keep your sanity? I end up getting flustered and angry. I'm sick of them trying to take advantage of me. The pill heads really know how much the law will allow a pain clinic to prescribe and feel they should get the maximum allowed. We have a few good patients but most of them are just junkies. One was overheard on her cell phone saying I'll have some this afternoon...FOR REAL??? Yes, she was dismissed over her drug test results but the nerve of some of these people is outrageous. One left sobbing today because not only was she nodding off and practically falling out of her chair in the waiting room but she failed for having absolutely no oxycodone or oxymorphone in her system but lots of crystal meth. She was so upset that we waited until she paid her money to send her away empty handed. Well, didn't she do it to herself? But we're the bad guys. I have to review new patient requests and have learned to not only check the database for what they have already been getting but criminal records as well. The managers of the clinic want us to give people a chance but should we really take on patients with numerous drug charges for controlled substances, etc.? I'm coming across a lot of these and have been saying no, citing their criminal history as the main reason. I'm losing faith in humanity. I started with the best of intentions but I was talking to the office manager and we both agreed this job is turning us into the "B" word... If anyone has any tips please share!

There would be a riot here if we started telling people to meditate for their pain or take Naprosyn. I agree the movement should be away from opioids, I just don't want to be around here to see it. It's so mentally draining to see these people. I had one just know who came in with his grandmother, who of course paid for it and no doubt babies him until you'd want to throw up. And I'm supposed to humor these people...

In the two weeks I've worked at the pain clinic I've come across a lot of dishonest patients, we've turned patients away after running criminal background checks that show recent trouble with the law over controlled substances. Jokers coming in trying to talk like they're in tight with the owner of the clinic so they should get special treatment. The MA is having a hard time not showing disdain and it's rubbing off on me. You can't tell me these big strapping young guys need opana and oxycodone around the clock. We have legitimate patients but we have as many I honestly believe are crooked, and they seem to run in packs. There's one guy bringing his friends in and paying for them to be seen, because we only take credit cards and these jokers don't have bank accounts (or they will go to Wal-Mart and get a prepaid card that doesn't even have their name on it.) This just screams diversion. What to do? I can't afford to quit but we need a new sherrif in town.

After two long years I finally found a job in a pain clinic. The pay is good but there is so much I'm ashamed to say I don't know. I'm constantly trying to look things up. We've had a few instances of strange events, such as a guy who is supposed to have given us a fake MRI, according to an anonymous caller (still under investigation). For the most part, I believe the patients have been genuine. I've gotten a lot of accolades since I've been there, but I feel like me and the medical assistant are like the blind leading the blind (we are both new.) The clinic is certified and has some very competent business people overseeing it, but this makes me feel even more inept because they emphasize the ultimate call in patient care is what I decide...me??? Are there any courses or certifications on pain management I can learn more about the meds? I didn't even know how to calculate a morphine equivalent. I feel so utterly stupid.

Never heard a peep out of the hospital in South Carolina, and it's been a week. I think I can safely assume it's a no go. I have two interviews tomorrow, both with the State of Tennessee in the health department. I'm wondering if someone can tell me anything about what to expect? If they like me, will they hire me on the spot? What can I expect there? I want this so badly but I feel like I'm banging my head against a wall, why won't anyone give me a chance???

Vaccines seem to be overused. Just because mainstream pharma company sponsored literature suggests turning children into pin cushions doesn''t necessarily mean it's the best way. The thing to do when someone challenges your knowledge is to delve a little deeper and see if maybe some of these parents have a point. Just playing devil's advocate. Not all parents who decline vaccines have unfound fears. Otherwise the adverse reaction database wouldn't exist.

I know how you feel about going back to school. As an adult NP myself with ridiculous student loan debt the thought of going back to school makes me cringe nut that's exactly what I'm having to do, as jobs are virtually nonexistent. Wish I had some advice for you, I just know I'm kind of in the same boat.

Thanks for the advice. No, I haven't done any mock interviews. It's too late for this one, maybe I could do it in the future. I have been getting professional help for many years and take medication. My husband is the one who compared us to Ma and Pa Kettle, he, he. I'd be perfectly fine with that if I could just land that dang job!