Credentialing when "panels are closed"

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Papa Lou

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I've read most of the threads about this topic around the forum with diff specialties, but my particular question hasn't been addressed. It's kind of a business of medicine question. Hopefully one of you guys knows the answer….

I'm opening solo practice in a city saturated with pain docs (bc I want to live there, and despite the saturation, opportunity is there). Most of the insurance panels are closed to new providers. There are two ways in for me, and I'm currently investigating them, but they don't allow me to be completely independent. I was thinking of a third option, and this is what my question is about. If I contract with a hospital to provide inpatient pain service (which I'm fine doing), once I'm paneled by every insurance carrier (they are required to panel me for inpatient services obviously), am I able to use those same contracts to operate my own private practice clinic? My intention would be to run an inpatient service as well as my own private clinic simultaneously.

In the psych forums someone intended to quit their inpatient psych service and open solo a year into the thing, and the response was that if there's a time lapse b/w the two gigs that insurers can reset them back to baseline/no contract and possibly deny starting a new one if market is saturated. My intention would be different. I wonder about this b/c I'm assuming I'd have pretty juicy contract rates if I went in with the HOPD system's contract negotiations/rates. So moving those out for use on my own would be pretty amazing. I just think it's too good to be true.

Maybe being paneled in a hospital is w my NPI but their tax ID for billing purposes (meaning I'd have to have the HOPD bill/collect for me even from my PP clinic)? This would probably end up being too much like a hospital employed community doc (they wouldn't fully open books on collections, try to rope me in with a salary/offer to cover my overhead etc etc next thing you know I'm working for the man when my intention is to operate my own business). Thanks for any help.

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See Mister Mzpktlxzcs's post on how some hospitals credential physicians en mass, and how one can possibly use that to their advantage

Whats your other strategy? Feel free to send me a PM, thanks
 
I've read most of the threads about this topic around the forum with diff specialties, but my particular question hasn't been addressed. It's kind of a business of medicine question. Hopefully one of you guys knows the answer….

I'm opening solo practice in a city saturated with pain docs (bc I want to live there, and despite the saturation, opportunity is there). Most of the insurance panels are closed to new providers. There are two ways in for me, and I'm currently investigating them, but they don't allow me to be completely independent. I was thinking of a third option, and this is what my question is about. If I contract with a hospital to provide inpatient pain service (which I'm fine doing), once I'm paneled by every insurance carrier (they are required to panel me for inpatient services obviously), am I able to use those same contracts to operate my own private practice clinic? My intention would be to run an inpatient service as well as my own private clinic simultaneously.

In the psych forums someone intended to quit their inpatient psych service and open solo a year into the thing, and the response was that if there's a time lapse b/w the two gigs that insurers can reset them back to baseline/no contract and possibly deny starting a new one if market is saturated. My intention would be different. I wonder about this b/c I'm assuming I'd have pretty juicy contract rates if I went in with the HOPD system's contract negotiations/rates. So moving those out for use on my own would be pretty amazing. I just think it's too good to be true.

Maybe being paneled in a hospital is w my NPI but their tax ID for billing purposes (meaning I'd have to have the HOPD bill/collect for me even from my PP clinic)? This would probably end up being too much like a hospital employed community doc (they wouldn't fully open books on collections, try to rope me in with a salary/offer to cover my overhead etc etc next thing you know I'm working for the man when my intention is to operate my own business). Thanks for any help.

I have heard that you could join a bigger group first and get credentials with those insurance company through them. Once you leave the group and start your own, it will be easier to get credentialing with the insurance company that way. I am not sure how true that is, hoping someone else could chime in and give their 2 cents.
 
I'm not sure that's true. I think insurers throw your NPI into the mix of people under an EIN/tax ID and you bill under that taxID. Once you leave that entity you're back to square one from my understanding and experience.

Message sent joshmir...
 
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