Show me the Money. Homework 10/27/2014. Things to know before you go. Types of Employment Salary Types How Billing Effects you Benefits

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1 The Business of Being a Nurse Practitioner: How to negotiate a contract and get paid what you are worth Nena Tucker, DNP, MBA, FNP Drexel University Show me the Money Nurse Practitioner vs. Physician Assistant Salaries Full Time Nurse Practitioner in 2013-Avg. $98,817 Full Time Physician Assistant in 2013-Avg. $107, Nurse Practitioner Salaries by State Pennsylvania- $86,000 (12% lower than the national average) New Jersey- $103,000 (6% higher than the national average) New York- $114,000 (17% higher than the national average) Massachusetts- $111,000 (14% higher than the national average) Homework Things to know before you go Types of Employment Salary Types How Billing Effects you Benefits 1

2 Employment Types Two main types: Employee and Independent Contractor Employee Part of an organization, practice or group. Benefits should be provided including sick leave, paid time off, health insurance, etc. Wages are reported on a W-2. The employee and employer pay equal shares of Social Security and Medicare taxes. Federal taxes are deducted from the employee's payroll by employer each pay period. Employment Types Independent Contractor "Self Employed" Salaries are traditionally greater Must meet IRS definition of "Independent Contractor" Training and benefits are usually not provided Can deduct many of your professional expenses Taxes are not deducted each pay period. Independent contractor must pay federal taxes quarterly. Also must pay "Self-Employment Tax" of 15.3% Employment Types 2

3 Employment Types The salary for an independent contractor MUST be at least 7.65% more than an employed position in order to break even. Best practice is to establish an LLC for clear separation between business and personal Salary Types Hourly: Payment is made for hours worked Straight Salary: Fixed amount per year. Does not increase or decrease with productivity/hours worked. Percentage of Collections: NP receives a percentage of the amount billed and/or collected Based Pay Plus Incentive: Base pay can be hourly or salary. NP receives additional compensation once benchmarks are met or exceeded. Ex: Collections, Billing, RUVs, Patients Seen, etc A Quick Word on Billing Ask the potential employer how they Plan to bill for your services AND Plan to evaluate your performance. Be SURE you are able to prove your worth (and hard work). Claims should be submitted under the NP's name and provider number. 3

4 A Quick Word on Billing Example: NP sees a patient and bills using his/her Medicare number. Medicare pays 85% of the physician fee schedule. NP sees a different patient under the physician's "direct, personal supervision" and bills under his Medicare number as "incident to" services. Medicare pays 100% of the physician fee schedule but amount collection usually comes as revenue generated by the physician, not the NP. A Quick Word on Billing Also, monitor the number of post-operative and follow-up patients that you are seeing. Many of these visits fall under the "bundle" that is included in the fee that has already been paid, meaning the NP is not generating any revenue during these visits. PA services bill differently because of their practice regulations.. Benefits Malpractice Who is paying for it? Who is it through? What does it cover? Also important to know how your physician is covered. Continuing Education Continuing education not optional. The only question is who is going to pay for it. Consider both the cost of the activity as well as time off work 4

5 Benefits Medical, Dental & Vision Insurance Need I say more? Licensure Reimbursement More expensive than you think. Cost of DEA license just increased to $731 for 3 years (from $551) Vacation and Sick Time Set number of paid vacation and sick days per year. Ask if sick days can be used for immediate family. Benefits Worker's Compensation Covers an injury sustained while on duty. Required by most state laws for employees. Not provided to independent contractors. Retirement (401k, IRA, etc) Usually has some contribution from the employer. Independent contractors must fund 100% of their retirements Short and Long Term Disability Varies greatly amongst employees and Independent Contractors Time to Interview 5

6 Interview Basics Dress professionally (leave the scrubs at home) Bring an updated copy of your resume Research the company as well as the person interviewing you Highlight any nursing or clinical experience that compliments the position you are interviewing for If you don t know, it s OK.. Be sure to let them know you are willing to learn Be prepared to discuss long term plans REMEMBER Interviews are a Two Way Street! Important Questions to Ask Describe the patient population Number of patients seen per provider per day Types of procedures Inpatient/outside facility rounds Call Physician Availability If not clear, ask about the physician's credentials Employment type Longevity of position/role Orientation Salary and Benefits 6

7 Let the Negotiations Begin If YOU are asked to provide an acceptable salary: Answer Carefully Quote local, regional and state averages Use being a new graduate as an excuse and put the ball back in their court If YOU are asked to provide a minimum salary: Consider your previous nursing salary If you have a mandatory minimum salary in mind, tell them!! Let the Negotiations Begin If the EMPLOYER provides a salary that is too low, ask About benefits If salary is negotiable About performance measures If the EMPLOYER provides a salary that is expected, ask About benefits About performance measures If the EMPLOYER providers a salary that is too high, ask A LOT MORE QUESTIONS!!!! Let the Negotiations Begin What if the EMPLOYER says there is no negotiation 1) It s not true. Anything can be negotiated 2) Most employers are referring to salary only 3) The easiest points to negotiate are licensure and continuing education 4) You can always negotiate for later 5) Know what s a deal breaker for your 6) Be prepared to provide a rationale for all negotiations 7

8 Post Interview Recap and make notes if interviewing at multiple facilities Send a thank you . Be patient and do not harass the potential employer If an unusual amount of time has passed, follow up with the employer. Making a Decision Consider all factors including hours, pay, commute, flexibility, short & long term goals, family obligations, longevity, etc Talk to other NPs about their experience Shadowing a provider should always be an option Be sure about your position before you talk to the potential employer If you are unsure, find out what you need to be sure Selected for a Position? Recap position including salary, benefits, expectations, etc Require a contract. Get everything in writing Expected start date Be prepared on your first day. First impressions mean a lot 8

9 Turning Down a Position? Best done via telephone or in person Remember to thank them for their time and use positive terminology to deliver the news Provide honest reasons for turning down the position Be prepared for a counter-offer Stick to your guns. Do not allow yourself to be guilted into taking a position Not Selected for a Position? Review the job description Perform a self assessment Reflect on the interview If notified via telephone, remain pleasant and respectful. Thank them for their time and ask that they keep you in mind for future positions Keep your head up and continue trying. If you are looking for your first job, remember it can be the most difficult to find. Take Home Points Do your homework before ANY interviews Look and act like a professional. Remember your role has changed Interviews are a two way street. Ask questions! Avoid making on the spot decisions Consider ALL factors before making a final decision Happiness is paramount! Be sure it is the right fit. Get everything in writing 9

10 Questions/ Discussion Contact Information Nena Tucker Phone: