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Credentialing for Physician Assistants and Nurse Practitioners – Navigating the Rules

Physician Assistants (PAs) and Nurse Practitioners (NPs) are found in every medical specialty and in every health care setting.  When you incorporate a PA or NP into your team and utilize them effectively, your practice will accommodate more patients. In addition, you will reduce patient waiting time, increase patient satisfaction levels, and improve overall practice efficiency. All of this adds up to more potential revenue for your practice. Proper credentialing is an important and necessary requirement and a key to proper compliance.

USA map vector outline with states names in gray backgroundRules For PAs And NPs Vary By State

Medical board rules vary slightly from state to state, but for the most part, PAs and NPs can perform many tasks traditionally reserved for physicians. These services often include:

  • Physical exams
  • Patient histories
  • Health screenings and preventive care
  • Assisting with surgeries, ER, and long-term care
  • Issuing prescription orders
  • Chronic disease management
  • And much more…

Consider these statistics:

  • The typical PA brings in revenue of $231,000 with an average salary of $84,000
  • An average PA or NP can boost a practice’s bottom line by $30,000 or more
  • Training costs for PAs are one-fifth of an allopathic physician

files-featuredCredentialing Can Take A Long Time

The most common credentialing pitfall is that the process is not started early enough.  Often, paperwork can be initiated up to 30 days before starting work and it is common for some hospitals and health systems to take up to 90 days for full credentialing.  PAs and NPs need to be organized and have copies of their educational background and certifications handy. Forms and paperwork must be completed in a timely manner.

Practice managers and health care administrators also need to be familiar with state regulations and licensing requirements. Regulations are different state by state, and payer by payer.  Some states require a certain percentage of charts to have a co-signature, while others have no such requirement. Some states limit the number of PAs or NPs that can work with a single physician, and some have no such requirement. All states require some level of documentation to be kept to show compliance with the rules.

PAs And NPs Help Workflow

Utilization of PAs and NPs is common across all medical specialties. Changes in medical resident workforce requirements as well as changing third party payer reimbursement models have encouraged the exploration of new ways of achieving high quality patient care across all specialties. In 2003, the Accreditation Council for Graduate Medical Education (ACGME) instituted limitations on total hours worked by residents in both inpatient and outpatient settings.  This mandate to limit work by training residents has created a need to fill patient care hours. PAs and NPs have no such work restrictions and since these new regulations took effect, have been utilized in greater numbers, especially in the inpatient setting.

Team-Based Care

As hospitals and healthcare systems continue to address quality patient care and improve access for patients, team-based care is becoming more the norm.  It is cost effective and efficient to hire a PA or NP to perform 85% or more of the clinical tasks that were traditionally performed by physicians, and to leverage support staff to engage patients for improved health outcomes.

Operationally, PAs and NPs can be added to teams in a number of ways. Fall flu season is a great way to use a locum’s provider to expand capacity and add on a flu clinic or incorporate evening or weekend hours as a trial to a more permanent hire.  Some practices may appreciate that return on investment analysis before making a long term commitment, full or part time.

References:

http://www.physicianspractice.com/blog/ten-things-physicians-should-know-about-pas-part-one

https://www.aapa.org/career/state-licensing-requirements/

About the author

Avatar

Lisa Shock

Lisa P. Shock, MHS, PA-C, is a seasoned PA who is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs and NPs in the health care system. Contact her at lisa@pushpa.biz

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