Phyllis
I appreciate you sharing this provider # info and issues of insurance fraud
(seems unfair, the services were provided). I had a conversation with a peds
office manager about some of this. Let's see what I can recall. She didn't
see how I could see pts unless I was an advanced practice nurse. Even though
I am an RN and have a master's degree in nursing I am not in a category to
be licensed as advanced practice. I am not a neonatal nurse practitioner,
nor a woman's health care nurse practitoner, nor a peds nurse practitioner,
nor even a clinical nurse specialist, legally. Then I asked her this: let's
say a child is diagnosed with cystic fibrosis. The doctor has his nurse see
the family for education about meds, diet, etc. The doctor pays the nurse a
salary, I suppose. How is the client billed for this service? The office mgr
really did not answer this. It is obvious to me that the client is billed
for a physician visit, or can't the client be billed for an
education/counseling visit? What if a child has diabetes and after the
doctor has his/her time with the family, then the nurse has some sessions
too. How is this billed? Can some peds offices answer this question?
I thought some visits are billed based on length of time or complexity of
the visit.

Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA


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