Author Topic: billing nurse practitioners  (Read 4610 times)

RichardP

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Re: billing nurse practitioners
« Reply #15 on: March 06, 2014, 12:10:17 AM »
There is no such thing as "OBAMACARE"   EVERY practice has to take a look and review very carefully ALL plan contracts for the "All products clause".  THERE is no Obamacare.

Yup.  That is why I said that I was offering my idea with tongue only slightly in cheek.  But ...

Yes there is such a thing as Obamacare, or ACA if you prefer.  Note the following.  This is important for those who don't know about it.

In California, those Carriers participating in the Exchange sent notices to all physicians about accepting ACA patients.  I believe the requirement was to opt in, but I'm not absolutely certain of that.  At any rate, none of our clients opted in.  "Not gonna participate in Obamacare" they all proclaimed.  The majority of our clients are non-participating providers anyway, so this doesn't matter for them.  But we have a couple of clients who are participating providers for Commercial Carriers.

I have been seeing insurance cards with dental provisions on them recently, so I know that some folks who have been patients for years are switching to getting their insurance through the exchanges (or maybe all plans must now include dental??).  At any rate, for the couple of Par Providers, suddenly Blue Cross / Blue Shield has stopped paying for the ACA customers.  Inquiries as to why yielded the following answer:  you had a chance to sign up to be a Participating Provider for the ACA folks, and you didn't do that.  Therefore, while you are a Par Provider for our regular customers, you are Non-Par for our ACA folks.  Because you are Non-Par for them, we are sending payment to the patient, not to you the Provider.

I know this will not be true for all of these newly-minted Obamacare patients, but it will be true for some:  they will get the payment from the Insurance Carrier and won't pay the doctor.  It is for these patients I suggested a second office, staffed by a lower-cost Nurse Practitioner.  Let the NP see all the patients who get the check straight from the Insurance Carrier and won't pay the doctor / NP.  Sure-fire way for going out of business.

PMRNC

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Re: billing nurse practitioners
« Reply #16 on: March 06, 2014, 06:58:56 AM »
Quote
In California, those Carriers participating in the Exchange sent notices to all physicians about accepting ACA patients.  I believe the requirement was to opt in, but I'm not absolutely certain of that

Yes that's exactly what happened in many states. Those providers not par with that carrier or if they are and did NOT have an all payor clause (some states don't allow for all payor clauses), found themselves OUT of network unless they "opted in".

All product clauses are proprietary, in the case of BCBS in California, doctors were opting out not realizing that carriers were invoking the "all product clause". This only became news to doctors when patients started coming through the door, but in reality we were warned about this way ahead of time. Suddenly the credentialing department is overflowed now with reviewing contracts. In some states "all product clauses" can't be invoked. What we did was go through all of the contracts for each provider by the carriers participating in the exchange plans. Those plans that had all product clauses were noted and office was given a crash course in identifying exchange plan patients. Long before the ACA came into play, providers just wanted to "par with all BCBS plans" and did not give much thought to what that meant.  Now it matters.  Little tip if you do credentialing: This is a good time to review contracts and contract verbiage along with renewal terms.
Linda Walker
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