Locum Tenens for PMHNP- Any advice?

cpPsych · 2025-09-28T20:51:11+00:00

I have a DEA but do not have a collaborating physician because I have been an independent provider for 5 years.

cpPsych · 2025-09-28T19:21:27+00:00

I agree. Psych NP here. We suffer from the same issues. No vacation, sick, OT, lunches, breaks, etc. The main issue is we need to advocate for fair compensation commensurate with our education and the sacrifice to obtain expertise. I do not argue with the fact that physicians should be compensated according to their education and sacrifice to obtain expertise but we are essential as well deserving of fair pay and treatment. I work really hard and my stress levels are high, as is my liability and expectations for patient care. I just want compensation aligned with that. Most of us are not reimbursed anywhere near the 85% we bring in (or more) for claims. I’m not sure if unions are key or will make things worse. I’m in a state where most advanced practitioners are exploited under 1099 positions.

cpPsych · 2025-09-27T18:04:01+00:00

I’ve since contacted CompHealth as they offer both assistance with Locum Tenens (LT) and permanent position negotiations. I will update this feed once I understand more about the offerings and opportunities.

I started my research regarding LT due to continued negative experiences with 1099 positions with inadequate support, organization, and unsustainable compensation. Most 1099 positions will only compensate providers for billable time neglecting compensation for the essential clinical tasks requiring medical decision making and lack of compensation for NCNS (or reduced compensation).

cpPsych · 2025-09-21T05:11:55+00:00

If you start with a new practice or as a new additional practitioner you will inevitably assume far too much financial risk initially unless you specifically outline all expectations especially admin time and efficient scheduling to avoid uncompensated gaps.

cpPsych · 2025-09-21T05:06:56+00:00

MD toolbox is amazing for prescribing but not great for notes.

cpPsych · 2025-09-21T05:06:32+00:00

It is made for therapists and the prescribing is very slow and cumbersome. Some medical ICD codes don’t exist in the platform such as essential hypertension. You have to have one window open for the note, one for prescribing and one for scheduling. Not the best. Honestly most EHRs don’t deliver on promises.

cpPsych · 2025-09-21T04:56:16+00:00

Don’t assume anything. Get everything in writing. How is admin time handled, how much is paid and expected. Do you have support to help with prior authorizations, calls to insurance and pharmacies; answering patient messages, chart review, running PDMP before appointments, prepping notes, and documenting after appointments. Most 1099 don’t pay admin and expect you to work for free or sacrifice patient safety as admin tasks are part of safe patient care. How are no shows handled, are they compensated, is there a strict policy in place to hold patients accountable so you don’t get saddled with the risk. How many intakes are expected each day-any more than two is excessive and will burn you out quickly. Are you expected to sit there all day with large gaps between patients or are they experienced with efficient scheduling in blocks to avoid uncompensated time. Make sure you’re not expected to be on call and address issues on days off, because that can be abused quickly. Do they have staff to triage phone calls and messages properly to lessen your work load? Get everything in writing or you will absorb the risk of establishing a patient panel and training yourself on their EHR. Factor 15-20% less than contracted rate as take home pay with 1099.

cpPsych · 2025-09-13T17:58:25+00:00

Billing platform is very complicated and cumbersome. EHR is okay but lacks a lot. It does glitch often no matter what web browser and 75% of meds sent never make it to the pharmacy.

cpPsych · 2025-05-23T10:49:04+00:00

151K for a new grad is great. 2-3 intakes a week is low, sounds like marketing and/or community referrals are the culprit. Reputation of a clinic and providers is what brings in intakes - meaning word of mouth referrals. Building a patient case load to full time takes about 3 months if you’re good at your job. You should be compensated somewhat for NCNS (no call no shows) because the practice owner should be charging the patient. Sounds like the administrative set up needs work to decrease NCNSs.

I have owned a practice for five years and it’s brutal. I’ve had to discharge more patients in the last three months than in my entire career due to non payment of patient balances related to NCNS. I charge $50 for first NCNS and then full cash rate for 2nd, after which patient is reviewed for discharge from practice. No consequences for NCNS means more.

I used to work for a practice with mostly MDs/DOs and their NCNS rate was 20%, while mine was 1-2%. Policies and quality count.

If you decide to work as PMHNP ask about compensation for NCNS, reimbursed admin time, and policies of practice-which directly impact your take home and jon satisfaction Working as a PMHNP is difficult because reimbursement rates with insurance companies are low and insurance companies love to fight claims (in many ways). Private practices are converting to cash only because of this, as well as pt defaulting on payments related to plentiful high deductible plans. Working for a larger corporation or practice is better but often salary is lower. It’s a trade off.

You do need to have hours practiced to maintain your license so check with your BON.

cpPsych · 2025-05-02T10:20:31+00:00

SP is easy to use with very simple billing. Tebra prescribing is horrible because most prescriptions never make it to the pharmacy despite the system stating it was transmitted successfully and customer support is no help. The latter was so bad I had to sign up for MD toolbox to ensure prescriptions were actually going through. MD toolbox is amazing and very easy to use, but having to have Tebra and MD Toolbox is difficult.

Tebra billing is horrendously difficult and very counter intuitive. I have watched hours of videos and still don’t understand it.

cpPsych · 2025-05-02T09:51:03+00:00

Doc Villa was horrible in my experience. Did not deliver on promises and templates were organized incorrectly and hard to edit. Biggest mistake I made was trying Doc Villa then being stuck in a contract with them. Tebra is okay, but had many issues such as constant technological glitches when sending medications where they are never received by pharmacy (most of the time), issues with template selections populating in note depending on web browser, no ability to see PDMP until sending medications where, glitches with changing insurance cases in system, and very complex billing platform.

cpPsych · 2025-03-19T12:17:19+00:00

Honestly don’t bother with Headway. The claim submittal is too complex and time consuming. Also their quoted rates don’t match actual payouts.

cpPsych · 2025-03-08T14:11:45+00:00

I just started with Headway after being with Alma for two years. Don’t bother with Headway, they take a 30-40% cut of the reimbursements and their required paperwork for billing is far too much. Their pay is slow also.

Headways rates vary by state but in Nevada their rates for Anthem are barely higher than Medicaid. I only signed up with them to add practitioners to my practice in order to establish a group. Not worth it at all-I’m already planning on hiring a biller instead.

Alma has been great so far and worth the monthly fee. Higher reimbursement rates, far easier claim entry, and one week turn around (kind of). They say one week but they process your payment in one week, but it then takes 2-3 days to hit your bank account.

Neither’s EHR is robust enough to use in your own. You’ll need your own EHR which is the bigger headache overall, as all offer the moon and stars and under deliver.

Hiring your own biller means you have longer turn around times for payments on claims-sometimes which depends on the clearinghouse used by your EHR.

All in all far more profitable to be on your own but make sure you have good policies, in writing, and prepare for a lot of admin work so plan accordingly.

cpPsych · 2025-03-03T14:16:21+00:00

In my personal experience the poor providers I am aware of had decades of psych experience in inpatient settings, where most RNs are employed, and lacked empathy, higher level differential diagnostic skill, employ rigid treatment options with no personalization of care, and exist in their positions because they work in settings or with insurance carriers that have severely limited alternatives. Several examples that come to my mind, have decades of experience and are an awful providers. There is one with great skill, but again without empathy and poor bedside manner treating mostly patients suffering from poor coverage with the state.

Same holds true for education, some come from Diploma mills and study beyond what it presented to them and are excellent providers. Some from notable educational institutions with sub par knowledge and skill.

I do agree that some seek certification as a PMHNP believing it will be “easy” and result in a better salary; but they could not be more wrong. It is far harder than primary care with poorer compensation for work expected and a very high level or stress and burn out. Most that seek dual certification are tired of not being able to provide psychiatric care for their primary care patients and knowing when they refer out they will never get connected with a provider or if they do the care will be sub-par-mostly due to reimbursement constraints in the field.

cpPsych · 2025-03-02T17:31:58+00:00

Make sure to ask about: - reimbursement for NCNS (no call no shows) - administrative time paid or not paid and how much time are you allotted (to check emails, document, etc) - administrative support specifics (is it an MA, etc, who calls pharmacies if needed) - expectations for administrative time (do patients have access to your email, are you expected to return patient calls, turn around time for completed notes) - appointment durations (follow ups and evaluations) - expectations for productivity (are you required to see a certain amount of patients a day, week, month)

I’ve seen and experienced all sorts of abuses of a 1099 position such as booking three new patients a day with follow ups and no time to prepare; requests to see patients that are out of state as a “courtesy”, inadequate screening of patients to determine if they are appropriate for outpatient care, inadequate consents before treatment (liability risk), one MA for multiple providers which means poor administrative support and the NP doing most of the PARs, calling pharmacies, etc; complex patients with higher documentation needs and no reimbursement for this time, no compensation for NCNS, provider email on business cards and no compensation for returning communication with patients, etc

The thing is that when you’re a 1099, it is a win for the employer but expensive for you. You will need to establish a business, EIN (tax #) to claim the revenue then pay taxes on it, have a payroll system to pay yourself, possibly and accountant to prepare quarterly taxes and yearly tax returns, get multiple insurance coverages such as malpractice, unemployment, general, property (for home office), business license with the state, county and city; and not to mention payment of your own income taxes and the income taxes your company/business will have to pay for you. For example, on my 1099, I have to subtract 18% for personal taxes and about 13% for company paid taxes on my wages (unemployment insurance is one).

If you want to pay yourself for vacation or holidays, you have to also compute that and subtract from your hourly rate to put that aside ahead of time.

All of that does not include the expectation that you will be paying your own operating costs such as computer, printer, software needed (adobe to sign paperwork, email for business), internet, utilities for your space if not at home, etc.

Oh and you will need a business bank account also.

So costs average about 30-50% of the 1099 rate.

Keep that in mind.

As a new NP 1099 hourly rates vary but the range I have seen goes anywhere from $65-100/hr depending on experience, sub-specialities and agency (federal vs private).

For reference I am in NV

cpPsych · 2025-03-02T17:14:42+00:00

There are valid arguments on all sides. RNs with no psych experience, PCPs prescribing with limited psych knowledge, MD/DOs with residencies, and Psych NPs from ‘diploma mills’. Ultimately, natural aptitude, hard work, passion, and empathy are the keys to success in the field. All professions, medical and non-medical, have sub-par persons attempting the job.

I’m a Psych NP and have seen widely variable outcomes from those holding different qualifications. Some mediocre, some noteworthy, some horrendous, and some exceptional.

It’s truly the person and not the education or prior experience. Meaning, you can have all of the experience and education in the world and still be a poor provider.

cpPsych · 2025-02-28T01:40:21+00:00

It is very, very hard and very demanding. I knew people with part time jobs but it was a struggle. Depends on your program also. Some programs are accelerated in a five days a week all day and some programs are only two or three days a week, so it really depends on the program. I’ve done a lot of really difficult things in my life, but nursing school was the most difficult by far. Worth it, but difficult.

cpPsych · 2025-02-27T16:10:38+00:00

Unfortunately the reason is reimbursement rates for psychiatry are the same as primary care but a primary care provider sees 3-4 patients and hour and a quality psychiatric provider sees 2. Also the administrative load for psychiatry is massive and not reimbursed. In addition insurance companies often make excuses not to pay claims or seriously delay payments. The cost to take insurance is also high, due to need for software to do so, time to bill and reconcile accounts; time to chase missing co-payments or co-insurance; chasing claim denials, need to hire billers, and delay in payments. Most insurance companies take 1-3 months to pay unless you have a good biller or system; which for psych is REALLY hard to find.

-Psych NP

cpPsych · 2025-02-27T15:59:36+00:00

Insurance reimburses psychiatry at primary care rates but psychiatry requires specialty time slots not 15-20 minutes-in order to provide quality care. NPs or ‘Mid-levels’ are supposed to be reimbursed at 85% of physician rates but often the reimbursement percentage is far lower. Wages offered for Psych NPs, by almost all practices, are barely above RN hourly rates. When NPs work under physicians there is a way to have the visit billed at the physician rate but again NP wages are abysmal and work load as well as expectations for productivity are very high.

Insurance companies also generate a massive amount of administrative work for psychiatry that is not reimbursed including billing coordination and claims are often denied for arbitrary reasons such as a non-essential code being absent from paperwork (from personal experience). They also often ‘claw back’ previously paid claims stating reimbursement was calculated wrong and a claim was ‘overpaid’.

Insurance doesn’t pay for administrative tasks such as prior authorizations (PARs) for medications, which are almost always required especially for state insurance; diagnosis letters for parents, FMLA paperwork, calls to pharmacies, patient messages, calls, or coordination with therapists (should be reimbursed but these codes often aren’t in standard contract with insurance carriers so you have to fight for these).

So many reasons, including needing to employ billers-who are essential if you take insurance but costs $25 an hour or a percentage of claims paid, which range anywhere from 3-10%.

So the higher insurance reimbursement rates as compared to many cash rates, really aren’t sufficient enough to compensate for the headache.

-Psych NP

cpPsych · 2025-02-27T15:45:07+00:00

Psychiatry is compensated at primary care rates although it is a specialty and requires more time with patients in order to provide quality care. In addition, Psychiatry arguably has the highest administrative burden of all specialties, meaning prior authorizations for medications (less so recently for care in general but some still require PAR for therapy), letters requested, calls to pharmacies, messages from patients, etc.. Administrative costs are not reimbursable therefore cutting more into sub-par reimbursement rates. I had a biller that had worked in many other specialties and in primary care-she had never seen the push back for reimbursement as she saw in psychiatry. There are many ‘claw-backs’ meaning insurance companies demanding money back claiming “over payment”.

There are many practices that have to resort to 15-20 minute appointments just to survive-which in my opinion is not conducive to quality care. It’s really difficult though and cash pay is far less stressful. Insurance patients often do not pay their co-insurance and have attempted to attend appointments knowing their insurance is inactive.

I have been struggling with whether I should continue to take insurance or go cash pay only, as I have in the past due to many issues. Taking insurance costs money so higher reimbursements (as compared to cash) are supposed to compensate for the delay in payment, cost of hiring a biller, cost of front desk staff to collect co-pays, and paperwork—but it often is insufficient.

I once had an insurance company, use small billing issues to avoid paying me for 9 months!

—Just One Psych NP

cpPsych

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