Ann A. Lewis, FNP-C Owner and FNP Provider Sampson Medical Services, P.A, Surf City, NC

What are your 3rd party payer issues?

The major third party payer issue is with Blue Cross & Blue Shield of North Carolina: They refuse to contract with her individually. To receive payment from BCBS, she had to form a Professional Limited Liability Corp (PLLC) with her supervising physician. The state Dept of Insurance has approved BCBS’s requirement. Even though none of her physician’s monies and her monies from BCBS will mix, the legal association is acceptable to BCBS and they will now recognize claims from her. Finding this solution was not easy. Ann called Governor Mike Easley’s office in Raleigh, NC to complain about BCBS’s actions. BCBS agreed to the arrangement only following a call from the Governor’s office. (Note that BCBS is not the only organization refusing individual credentialing.)

Billing is the #1 issue in office management. This is associated with insurance companies that will not recognize and credential nurse practitioners in private practice.