New Ways MDs, NPs, and PAs Can Work Together

Harriet Edleson


December 21, 2011

In This Article

Billing, Malpractice, and Other Important Issues

Proper billing for NPs and PAs is critical. For example, Medicare will reimburse 100% if an NP sees a patient when the physician is on site, says Selway. If the physician is off site or the NP is in a satellite office, Medicare reimburses at 85%. Indemnity insurers typically reimburse healthcare providers on a fee-for-service basis, with each company having its own policy regarding reimbursement for NP-provided services.

Because payment for services provided by NPs can range from the same rate as physicians to payment at a reduced rate to denial of payment, someone in the medical practice has to track the insurers' policies. Some commercial insurers adopt Medicare rules and guidelines for billing NP services.

Similarly, each private insurance company determines how they reimburse for PA services. As private entities they can establish their own rules and procedures. PAs receive 85% of what physicians are reimbursed for services to Medicare patients. If the physician is on site, PAs are reimbursed at 100%.

What About Liability?

Liability coverage is another area to consider when working with NPs and PAs. While laws concerning how independently NPs can work vary from state to state, approximately 16 states allow NPs to own a private practice, according to the American Academy of Nurse Practitioners. Also, NPs can carry their own liability insurance, which Janet Selway recommends they do.

For the past 12 years, Eileen O'Connor, an NP, has been part of a collaborative team headed by Dr. Bob Morrow, a primary care physician with a private practice in New York. It enables me to work with a colleague who has a different background," Morrow says. "We cover for each other."

Morrow's insurance covers both himself and O'Connor, and he notes the cost savings: liability insurance for a nurse practitioner is $1000 per year while for another physician it would be $22,000 annually. "This was a major part of the decision," he says. O'Connor has her own panel of patients. "Patients always get a choice," says Morrow. To some degree, it depends on who is available. Yet, says Morrow, "I am responsible for what she does."

Physicians' malpractice insurance covers PAs who work with them as part of a team. However, the American Academy of Physicians Assistants recommends that PAs purchase their own personal insurance policy as well.

Seeing More Patients

Working with NPs and PAs in a practice setting can allow the practice to see more patients and can free up the doctor in a variety of ways. NPs and PAs can, for example, take the burden of nightly call off physicians. "I took call every other night," says Wooten. "The primary care physician had a life once again. He could expand his practice. It's all about access. He could get more patients into the office. We're part of the team. We complement them."

"The physician can concentrate on the patients with several medical problems or more complicated issues," says Wooten. "We divide up the work. It's like a marriage; every so often you have to sit down and have a discussion."

NPs' scope of practice varies as well. While NPs work as members of a healthcare team, not all states require NPs to have a legally defined relationship with a physician.

Rather than competition, collaboration is essential to good working relationships among NPs, PAs, primary care physicians, and specialists. "On the front lines, we're great partners," says Selway. "In a practice setting, look at the strengths of the person you are hiring, and maximize them."


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