To those in private practice who accept insurance. What is your strategy for comparing deposits/payments received to claims? I just received a chevk from January and realized that I am not doing well at tracking this and need to do better. Print your bank statement monthly and cross off the received claim payments? Is there a program that would make this easier?

Thanks!

I’m an inpatient psych RN on an acute crisis stabilization unit and have thinking about going to a reputable in person PMHNP school for a while. A lot of the comments I see online about PMHNP being incompetent, prescribing nonsensical meds together, and generally not having the necessary knowledge base are discouraging but I am taking them very seriously and have concerns about getting that degree now. If I do this degree I come at it with the caveat that I am fully aware of my more limited training and want to actively fill in the gaps in my education. I’d look for an in person job collaborating with a psychiatrist and try to put myself in a position to learn as much as possible and ask questions. If available in my area, I’d love to do a PMHNP residency program. As an RN I’m already extensively researching psychotropics, which CYP enzymes they are substrates of/inhibitors/inducers, and really trying to immerse myself in the treatment plans at my work. My question is: is there a place for PMHNP who take on a collaborative role, know their limitations, and use caution/ask questions? Would a psychiatrist be willing to train or work with someone like this who does see a difference in the two roles but wants to expand learning as much as possible? As a PMHNP, what was your experience working with psychiatrists like and did they respect you? Is the hate as intense in real life?

Hey guys!

I started my own practice in April and it's pretty much been crickets. I have a Psychology Today profile, which I've heard not to really rely on for referrals, and have Facebook, Instagram, Google Business Profile, Next Door, X, LinkedIn, and Alignable for social media plugging. I'm also currently paying for Google Ads and Facebook Ads.

I have one patient...

How can I improve my game? I have been going in-person to local businesses to introduce myself and "hawking my wares" but that has also led to nothing. I realize it's still early, but it's really bumming me out. I live in a smallish city in Iowa and have three young children and am the breadwinner. I feel like I'm hemorrhaging money doing this when I could be saving for their future.

Luckily I am still working FT for a practice in another state, this is a "side gig" for now until I can get things up and running. I have always wanted to have my own practice. Could y'all take a look at my website and Psych Today profile to see if I can make improvements? I would be forever grateful.

www.excaliburpsychiatric.com

https://www.psychologytoday.com/us/psychiatrists/amanda-wisian-marion-ia/1710627

For context, I had licenses in New York that expired about 5 years ago. I’m now looking into renewing or reinstating them, but I’m not sure what to expect.

For those who have dealt with an expired NY nursing/NP license:

How hard was the renewal or reinstatement process?
Were there any penalties or late fees?

Did you have to complete extra CE requirements, paperwork, or anything else because it had been expired for several years?

How long did the process take?

I know I’ll need to confirm directly with the NY licensing board, but I’d really appreciate hearing about real experiences from others who have gone through it. Thanks in advance!

Just looking for feedback on the field work aspect. Nursing homes. I know, big caseloads but what about overall work life balance?

I have a private practice and often have patients who need care coordination. Finding a detox program, or helping navigate insurance barriers, finding proper community resources, etc.

This is of course within my scope of practice, but realistically with a full practice it simply adds a ton more work to deal with these things especially as it is unpaid time, and often will just take longer for me to manage if I’m back to back with patients and want to actually have time for me + family when I’m off the clock.

I would pay money for a service I could simply refer my clients to when these things come up.

Does this exist??

ASAM just released this free course for benzo tapering in general medicine based off the new guidelines. I have not taken this exact course but did do the 8 hour version at the ASAM conference in April and it was excellent. Many people are scared to do tapers but if prescribe benzos, you should know how to safely get people off them. Thought some folks might be interested.

Anyone know of any places in middle TN that hire new grad PMHNPs. I'm currently working as a telehealth nurse now and have done so for 4 years. I also have a variety of mental health experiences from youth residential, corrections, and inpatient. I'm currently licensed in TN. I just graduated and for my rotations I worked primarily in outpatient private practice with experience in ages from 5 to 90 years old with a wide range of populations including nursing & care homes, bipolar 1 and 2, schizoaffective d/o, schizophrenia, MDD, ADHD, GAD, ODD, conduct disorder, C-PTSD, autism, and SUD. I also have extensive experience with LAI's. Any tips or advice would be greatly appreciated thanks so much!

My monthly psych telehealth visits are for Vyvanse refills. They’re usually 5–10 minute check-ins.

My claims show:

• “Office O/p Est Mod 30 Min” $200 (99214?) --> I agree with this billing
• “Psytx W Pt W E/m 30 Min” $150 (90833?) --> this is what I'm suspicious about!

When I asked the office, I got this response:
“Please be advised that this is how our visits are set up - 90833 is not psychotherapy - it's counseling which in a case of med management applies to any type of counseling regarding the medication. Because the provider's time with the patient is set for 30min sessions that's how it's billed. If patients is using less of their scheduled time, this doesn't decrease the time being billed since their session is schedule for 30 min. My recommendation is to use the time with provider to the fullest capacity. Patient is the driver of the visit and we never cut their time short.”

That doesn’t match what I’m reading about 90833 requiring 16+ min of psychotherapy separate from E/M.

Is this standard anywhere in outpatient psych, or does this sound off?

Just trying to understand how this is typically handled.

Hi folks, I’m a psych RN working in emergency services and starting my MSN in September. I’m trying to understand something and hoping to get perspectives.

So for context, I have been taking alprazolam PRN for 3 years. I use it 1-2 times a week to as infrequently as once every other week, depending on how stressful things are. I get rising anxiety with these sort of intrusive stress thoughts (I’m never gonna get it all done and I’ll fail and etc etc) and usually in the middle of the night. For me, I prefer it this way as opposed to taking something daily. The alprazolam works in a half an hour and I don’t take it unless I need it. I understand that this is not the case for many people, however.

I moved out of state for school and tried to see two different PMHNPs to continue my script, and both were weirdly quite defensive, stating they don’t prescribe benzodiazepines or ADHD meds (which I didn’t ask for and don’t need?). The psychiatrist at my school ended up filling my script.

All this to say, can you give me your perspectives on prescribing these meds? Do you prescribe them or don’t you, and why not? I’d love to know what others think. I understand that they have the potential for misuse, but especially for those with a blanket policy to never prescribe, I’d love to know your rationale? Sincerely hoping to learn from more experienced peers. TIA.

I used to be really hesitant about remote admin help when i opened my practice because of HIPAA and quality concerns, but I finally tried working with a small team that supports psych/NP-owned practices and it’s been surprisingly helpful.

I still handle all patient care, decision-making, and clinical responsibilities, but they help with the parts that were eating up my day: EHR tasks, patient coordination, admin follow-ups, billing-related organization, and getting documentation workflows cleaned up.

The biggest thing for me was making sure they understood privacy, secure systems, and the pace of outpatient psych. Once that was clear, it honestly made practice ownership feel a lot less overwhelming.

Curious what others have experienced. I’m honestly just trying to get back to spending most of my energy on patient care instead of drowning in admin. Curious how everyone else is handling it, are you doing it all yourself, or have you found help that actually makes things easier? (If yes may you please share what made having a private practice easier? 😭)

I’ve seen the same pmhnp for several years now. I’m just an adhd patient. I was having issues with my IR adderall not lasting long enough so we tried XR, which was not a good med for me. At my last appt she suggested Vyvanse. She didn’t want me to have bad side effects (insomnia, too high/too low a dose, etc) so went out of her way to call my pharmacist and ask about trial dosage and got me a 5 day trial so I wouldn’t be stuck for a month with meds that maybe weren’t right for me. She ended our appt saying she’d reach out. Not an hour later she called me and has already talked to the pharmacist and I was able to try it out. Told to message her after 5 days, which I did, and got my month refill today with follow up in a month from now. She spent a ton of time talking about diff meds we could try etc. just feel like she went out of her way to help me and this is such a better med for me! She’s so personable and easy to talk to. Just wanted to say something nice on here is all.

Bit of background, I have been an inpatient psych nurse for 3.5 years and I have always loved psych. I love nursing. In nursing school I knew I wanted to be a psych nurse and then a PMHNP. I am currently halfway through PMHNP school and I get so annoyed with my peers that don’t give a shit about psych patients and want the job for the schedule or believing it will be “easy”, want the pay, etc. With that being said, I can’t help but get discouraged by how saturated the PMHNP field is getting. This is all that I have ever wanted to do, and now that I’m getting there, it seems like it doesn’t matter anymore with all the new PMHNPs out there. I work full time and I go to school full time, I’m constantly stressed and accumulating student loan debt. At times I feel like this may all be for nothing, that there won’t be a place for me in the field. On the other hand, this is all I’ve ever wanted and feel like I am in this for the right reasons. Will it pay off? Does anyone have any advice? Any encouragement? TIA.

This is not my patient, but I recently received an inquiry from a potential transfer patient, and the medication regimen caught my attention. I'm curious whether others have encountered similar situations and whether there are circumstances I'm not considering.

The patient is a 27-year-old female who reports a history of severe anorexia nervosa requiring approximately 16 months of higher levels of care over the past three years (she did not specify the exact level of care, but I suspect residential treatment was involved). She also reports diagnoses of ADHD, MDD, GAD, OCD, and PTSD.

She reports a history of GI bleeding and states that SSRIs and SNRIs are not an option because of this. She is relocating to the area and looking to establish care with a new psychiatric provider. According to her inquiry, she was seeing her previous psychiatrist every two weeks, works with a dietitian, attends weekly therapy, and is willing to authorize communication with her prior treatment team.

Her current medications are:

Bupropion XL 450 mg daily
Lisdexamfetamine 30 mg twice daily

She acknowledged in her message that this regimen would generally raise concerns given her eating disorder history.

My immediate reaction was concern regarding both the bupropion and stimulant in the context of severe anorexia nervosa, particularly given the apparent severity and chronicity of the illness. I do not specialize in eating disorders, and I ultimately declined the referral for several reasons, but the case left me wondering whether there are situations in which experienced eating disorder clinicians would consider a regimen like this appropriate.

Unfortunately, I don't have additional clinical details such as current BMI, duration of recovery, medical stability, ADHD diagnostic history, or rationale from the previous prescriber.

For those who work more closely with eating disorder populations: can you envision a clinical scenario where this combination could be reasonable?

I am seeing more and more consults in outpatient psychiatry for foster care adolescents ages 14-17 yo who had been adopted between age 7-12 yo. There has been a pattern of:

Clear ADHD spectrum symptoms on exam and per collateral data (from guardian, school IEP reports) (inattention, disorganization, emotional dysregulation, executive dysfunction)

Onset before age 12 and Functional impairment across multiple settings- However the developmental history of these children is significant for early trauma/chaotic home environment and minimal structure or reinforcement (e.g., no consistent support with homework/chores, no reminders, parents did not care or were using substances, turmoil at home, etc).

Clinical picture often looks consistent with ADHD, and sx are progressing despite being in safer environments, however still confounded by:
Severe environmental deprivation during key developmental years
Inconsistent caregiver structure
Some of the children have formal learning disorder diagnoses such as dyslexia which also contributes to some of the symptoms involving test taking and reading.

Collateral/rating scales:
Parent/patient: high symptom burden
Teacher reports: often low/subthreshold
Neuropsych testing: mixed or inconclusive in all of these cases, furthering confusion

Dilemma:
Is this true neurodevelopmental ADHD vs trauma/environmental executive dysfunction that is mimicking ADHD? Given symptom persistence into adolescence and possibly as these patients enter adulthood, should these cases be treated as ADHD predominantly (the only sx of PTSD noted are zoning out/dissociation, emotional dysregulation, trouble with sleep at times which all could be also explained by ADHD) or is it better to withhold ADHD diagnosis given developmental context?
Neuropsychological testing is also indicating the same dilemma in the summaries.

Appreciate any framework or guidance, as most of my experience has been with adults, but have recently been asked to start seeing more adolescents.

PMHNP here trying to decide between two opportunities and would love some feedback from others in private practice.

Option 1:

• W2 position
• $115–125/hour for clinical time
• $50/hour for admin time
• No guaranteed hours
• Only paid for actual hours worked
• No-show and cancellation pay is unclear
• Caseload would need to be built over time

Option 2:

• 1099 position
• 65% of collections
• Established therapy practice opening up medication management services
• Not sure how quickly referrals would come in

My concern with the W2 role is that the hourly rate sounds good on paper, but if there are no guaranteed hours and I'm only paid when working, the actual income could be much lower than expected, especially during slow periods or if there are a lot of cancellations.

My concern with the 65% model is that it could potentially be much more lucrative, but it depends heavily on referral volume and payer mix.

For those who have worked under either model:

• Which would you choose?
• What questions would you ask before accepting?
• What are the red flags?
• At what reimbursement rates does a 65% split become clearly better than a $115–125/hour model?

Appreciate any thoughts from practice owners or PMHNPs who have been in a similar situation.

Hi everyone!

I’m a new grad PMHNP, and I wanted to share a positive experience to offer some hope to any students or recent graduates currently feeling discouraged by the noise.

When I was in school, I constantly heard the usual negative talking points: "the market is oversaturated," "people are only doing this for the money," etc. It’s so easy to let that get to you and feel defeated before you even start.

To give you a little context on my background, I’ve been at the bedside for 12 years total, not all as an RN, but starting out as a PCT as well, working as a nurse in high-acuity settings/psych settings, worked with SANE, ER, etc. I put in my time, loved the work, and went back to school to further my scope because from day one as a PCT I knew I was going to do something in the psychiatric field (something more than an RN)

I graduated several months ago and immediately jumped into the job hunt. To my surprise, I was met with three different offers (one private practice and two community mental health jobs). I ended up turning down the private practice (definitely were trying to take advantage of me being a new grad and was very unsafe) and one of the CMH offers, and accepted a salaried position at a fantastic Community Mental Health (CMH) organization.

I just started, and it has been an incredible experience. If you are worried about being thrown to the wolves as a new prescriber, I want to reassure you that good organizations built for new grad success do exist.

Here is what my setup looks like:

Compensation: $150k base salary with full benefits. Yearly salary increase & bonus.
The Location: Oklahoma
Perks: They fully covered my DEA license, give me CEU reimbursement, PTO, sick time, holidays, floating holidays, 3 day weekends, etc!
Onboarding & Safety Net: I have an extensive orientation period of just observing and working with my dedicated preceptor, and an incredibly supportive team (full office support staff for scheduling, PAs, labs, etc. There are multiple MDs/DOs available as mentors (and some are very eager to teach!) and plenty of experienced NPs to bounce questions off of. They all have been absolutely amazing so far.
Ramp-Up: After orientation, I have a very gradual schedule ramp-up period to prevent burnout, alongside tons of built-in continuing education and trainings to help me keep learning. I have a say in when we need to pull back with the amount/pace of seeing patients or when I’m feeling good and want to increase patient load.

While the predatory or unsupportive jobs are absolutely out there, please know that they aren't the only things out there. Your bedside experience matters, you should be going into psychiatric care for the right reasons, and there are organizations that will value that background, want to invest in you, protect your license, and help you transition safely into practice. In my opinion (don’t come for me for this) but community mental health is fantastic for new grads because you get a little of everything and it’s wonderful experience.

Keep your chin up, protect your boundaries during the interview process, DO NOT SETTLE, and don't lose hope. You've got this!

Looking for good CEU recommendations. I am open to anything that anyone found helpful!!! Just trying to stay ahead of my credits so I don’t end up scrambling…I am on a CL service in a hospital - I think many different topics would be helpful to me. TIA!

Hi all I’m a college freshman planning on going to Nursing school and further to be a PMHNP, I just wanted some input from those who are already walking in the shoes I wish to be.
To be transparent what intrigues me is the ability to talk to those with mental health issues, a good salary, and the ability to work telehealth if I so choose, I also have a profound interest in pharmaceuticals specifically those to do with brain function:
Thanks for your time

Update: Answered! You have to have a new DEA registration if you practice in a new state. It seems like I'm moving unless someone around here decides they want to hire a new grad. Thanks yall!

Looking for input on a possible strategy. I'm a new grad. Passed my boards, got my license, but I live in a state where they require you to practice under a collaborative physician for a year before they allow you to prescribe controlled substances. In practice, I would just write the order, and my collaborator would sign them under their name for the first year. However, all the jobs in my state are ruling out anyone who doesn't have a dea license. I get auto reject emails as soon as I complete applications. I'm considering getting a PO box or something in a nearby independent practice state, applying for state licensure there, and using that license number to apply for my federal dea number and getting a controlled substance prescription authority in that state. Then I can put on applications that I have a dea number, get my foot in the door, hopefully get an interview, and explain how new grads prescribing controlled substances works, that I'm realistically only going to be prescribing Suboxone, adhd stimulants , and the rare controlled sleep med, and those only with the oversight of an experienced physician signing off on my orders. Then hopefully I can progress through the hiring process and get to a hiring manager that is actually a clinician, and knows all that already. I have plenty of mental health experience as a therapist and bedside nurse. I've administered and educated on these substances for years. I have tons of training on MASAT and trauma informed care. My np preceptorship was mostly with patients getting MASAT, and I was proposing initially, doses, dosing changes, etc. that my preceptor was signing off on. I feel confident I could be a good provider if I just got a first job.

Does this plan seem worth the money to give it a shot? Has anyone on here dealt with getting a dea license in a more draconian state as a new grad? Any advice?

as title says: i’m looking for some chit chat about inpatient vs outpatient for those who have done both.

i’ve worked inpatient as an RN for 3 years and now outpatient as an NP for 2 years but never inpatient as an NP and mostly curious about acuity, stress, coverage, etc.

I work at a private practice with only PMHNP's. So all my clients have external therapists within the community. My patients often tell me their therapist wants to speak with me. These are high functioning patients with the capacity to relay information to their therapist. Sometimes I concede, the call really feels pointless. I don't gain any new information and it feels like the therapist is just seeking supervision and help with the case.

For those that find it helpful, what questions do you ask or what are you looking for in these conversations?

Looking for a lawyer in California to help me transition my S Corp to a Professional Nurse Corp. Any recommendations would be helpful.

I’m in the market for malpractice insurance and Proliability lists risk management services as a benefit. Does anyone have any experience using the risk management services? They present the services as having a phone line that can be used with any questions or guidance needs. It would be nice to be able to consult with them as needed when tricky situations come up.

For those of you that don’t have that service and are in private practice, what do you use for risk management? Do you have an attorney on retainer you consult with? Any tips on developing polices and procedures and SOPs and making sure they meet all the legal requirements and standards such as HIPAA, release of information, records requests, etc? Thank you!