HEALTHCARE NAVIGATOR

A New O.D.’s Dilemma

You’ve been hired to see a semi-retired doctor’s patients, but you’re not credentialed with the insurance plans. So, what can you do?

congratulations! You are now a doctor of optometry, licensed to practice in your home state. If you’re like many new O.D.s, though, there’s one problem: You have been hired to take over patients for a doctor who is looking to cut back. He needs you to take off some of his patient load, but there’s one rather large hiccup: You are not yet credentialed with any insurance plans.

Credentialing can have a huge impact on the bottom line of any practice. It takes time, effort, organizational skills, and a “squeaky wheel” persona to get this part of medicine handled.

NEWBIE CONUNDRUM

It’s what is called The Newbie Conundrum. And the big question is: Can you see this other doctor’s patients on his behalf? Can you bill the insurance companies for services you are providing under the credentialed doctor’s identification? Sadly, the short answer is no.

• CONTRACTS. First, the contracts issued to the seasoned doctor need to be reviewed for language regarding other doctors using their credentialing. Most contracts state that they are nontransferable and thus, not allowed to be used by anybody but the credentialed physician.

• BILLING. Second, what about billing? Is billing as a locum tenens replacement doctor allowed? Remember, as an employed doctor, you are not allowed to bill for services as though you were a contracted locum doctor seeing patients on behalf of a vacationing doctor.

OTHER OPTIONS

So, does all this mean that you cannot work until you have been credentialed? Of course not!

• PRIVATE PAY. Many patients do not have any insurance considerations, and you can see those patients without reserve.

• ‘INCIDENT TO…’ You are also allowed see insured patients ‘incident-to’ a current treatment plan as laid out by their doctor, as long as the supervising physician is in the building. Incident-to rules are specific and do not allow for any treatment plan changes, medication changes, or new issues to be addressed with the patient. But if they are coming in just to follow up, to review testing results, or to discuss current medications or issues, you can see those patients on behalf the supervising doctor, document the encounter, and bill for those services provided. Revenue can be had if these criteria are met!

Starting a new career is always a bit bumpy, but don’t let that stop you from moving forward. There are many ways that you can help your new employer as you work through credentialing with the long list of insurance plans that are prevalent in your area.

All this will require some additional time on the premises for the retiring doctor, but with planning, bringing in a new practitioner fresh from school can be an advantageous experience for any practice needing to add patients—and revenue—to its daily mix.

— Krystin Keller, CPC

Krystin Keller is an instructor and consultant with Cleinman Performance Partners, a business consultancy specializing in the development of high-performance optometry practices. © Cleinman Performance Partners, Inc.