Last week we covered the benefits of adding a prescriber to your private practice. This week we want to focus on things you should and plan for before adding a prescriber on to your team.
Establish Realistic Goals with Clear Timelines
Is there a high need for medication prescribers in your area? Have you been referring out for this service? Do you have clients you could send to a prescriber? If this additional service could be beneficial to your practice, would it make sense for this prescriber to be in person or virtual?
Some considerations regarding the timeline would include:
- Preparation and Planning-determining the budget, role, and logistics
- Recruitment-posting the job, networking, and interviewing candidates
- Selection-checking references, extending an offer, and negotiating
- Credentialing and Onboarding-submitting credentialing applications, awaiting approval, and orienting to your practice
Become Familiar With Rules and Regulations
Research and familiarize yourself with the licensing boards rules and regulations in your state. Get clear on their scope of practice, determine if there are supervision or collaboration requirements for mid-level practitioners, license restrictions, and/or prescribing regulations. Familiarize yourself with credentialing and payer regulations, documentation and prescribing standards, and appropriate classification (employee or contractor).
Determine If This Service Will Be Covered By Insurance or Private Pay
When determining whether prescribers in your group practice will be covered by insurance or private pay, there are several critical financial, operational, and regulatory considerations. This decision affects billing, credentialing, patient access, and your overall business model. When comparing the two reimbursement models, consider the following:
- Is the prescriber type reimbursable by insurers, what will the reimbursement rates be, and what is the estimated timeline for credentialing?
- What is the impact of private pay versus insurance on patient access?
- Are the service types your prescriber will be offering billable to insurance?
- What are the liability and documentation requirements for insurance?
- How would each reimbursement model impact scalability and practice goals?
Create Workflow And Manage Operations
Adding a prescriber to your group practice is a major step that impacts nearly every aspect of your operations-from scheduling to billing, documentation, compliance, and team coordination. Some key considerations include:
- Scheduling Workflow-visit types and time blocks, provider availability, appointment times, and a no show/cancellation policy
- Documentation and Electronic Health Record-does your EHR support e-prescribing and have appropriate templates?
- Billing-ensuring the correct CPT codes are used
- Team Roles and Communication-who will be responsible for medication refill requests, urgent clinical concerns and safety issues, coordinating with therapists and how will the team communicate with each other?
- Medication management-protocols for refills, prior authorizations, land abs/vital monitoring will need to be established
- Client Onboarding and Communication-intake forms and consent forms will need to be created, clear expectations will need to be set regarding the scope of role, refill policies, and appointment frequency, and administrative staff will need to be trained to handle scheduling, triaging medication questions, and billing
Want To Know More?
Katelyn will be hosting a 5 week masterclass called the Prescriber Playbook from October 16th through November 13th. The classes will be held on Thursdays from 12-1pm EST. It includes everything you need: roadmap, templates, and real-world guidance.
The class is going to be live only, with no recordings available afterwards! So make sure you sign up through our form to get started.
