Lessons Learned From Nurse Practitioner Independent Practice

A Conversation With a Nurse Practitioner Entrepreneur

Joyce A. Hahn, PhD, RN, NEA-BC, FNAP; Wesley Cook, APRN, FNP-BC, CPSN


Nurs Econ. 2018;36(1):18-22. 

In This Article

Lesson 4: Obtain Written Confirmation of Payment Guarantee Before Seeing Patients

The most painful lesson learned was to not work until the contract was signed. My credentialing firm did not request retroactive dating for claims generated prior to contract finalization, but, more importantly, I failed to supervise adequately, falsely believing my time was best spent in income-producing activity. When addressed, the credentialing firm asserted that retroactive dating for claims could not be negotiated after the contract. I rejected this wholesale because everything is negotiable until it is not. So, I pursued retroactive dating approval from all payers.

While the start dates for retroactive claims with public payers and some commercial payers were successfully appealed, DPC did suffer financial loss due to unpaid claims generated on inactive dates. Given the impoverished financial situation of many of DPC's patients, the unreimbursed claims were written off as bad debt.

You can realistically expect credentialing to take 3 to 6 months, depending on payer. It is what it is. Avail yourself to the written policies for retroactively submitting claims prior to the contractual start date; do not accept the word of any contractor without written documentation of the policy. Do not begin to see patients until you are officially credentialed unless you have in writing that claims will be paid retroactive to the date of the contract. Without that written documentation of the exact date, you will not be paid or will endure a painful and avoidable appeals process.