That is a great question. I am a Midlevel Provider (NP) in Oregon. I have a solo practice in rural Oregon. I am directly credentialed with almost all of the local insurance companies. I do not credential with the Medicare advantage plans of course because here anyone under 18 is enrolled in the Medicaid plan.
Honestly, my contracted rates are the same as the local physicians in our IPA. If I were an FNP managing Medicare patients this would not be the case. There is no incident to billing in my clinic. I have lists of managed care patients assigned directly to me as well as participating in the PCPCH program.
The only program that I have recently given up participating in is the Rural Health Clinic designation. My CCO contracts were such that there was not wrap around payments for services and the physicians that I have employed did not stay. Physician supervision is a requirement for that particular program.
I cannot speak to Texas contracting, but here in Oregon direct contracting has worked out well.
Lisa Callahan CPNP