Ease of setting up a psychiatry private practice?

[sunlioness]

Good luck making that decision, Whopper. I think you'll do well no matter what you decide.

As for me, I know I made the right decision getting out. I just finished my first week at New Job, which is being an inpatient attending at the program where I trained. I am really rusty. I don't really have a ton of teaching experience and that's going to be an adjustment. And yeah, I felt like a deer in the headlights a few times this week. But even so, in my first week of an overwhelming new job, I had fun and looked forward to going back every day. I can't remember the last time I felt that and I have to think that feeling it in the first week has to be a good sign.

So yeah, there are just different types of people who do well in different types of environments. And the cool thing is that we're lucky enough to be in a field where the demand is great enough that if you do one thing for a little while and end up not liking it, it's really not too hard to find something else to try.

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[whopper]

Something that applied to me in residency was no matter what I did, after several months of it, it got boring. I wonder if you continue to do what you do, the honeymoon phase will go away. I hope not. If you are working where you trained, you likely have the option to move around in the department.

I'm having an instructor from my fellowship come over my place among some other friends. I'm going to tell him about all my options on the table and ask him for some guidance. The guy who wants me to take over his practice told me this type of thing is like sailing. You have to react based on the situation and that things are always in a state of flux. He told me not to see something as winning or losing but merely a step forward in life.

 

[sunlioness]

Something that applied to me in residency was no matter what I did, after several months of it, it got boring. I wonder if you continue to do what you do, the honeymoon phase will go away. I hope not.

I hope not too. But even so in my group practice job and in my solo practice, I actually never liked it. I kept waiting to like it, thinking I would probably like it when I was more used to it or was more established or whatever thing. I tried to convince myself that I liked it, but I never really did. So yeah, I might lose interest in doing only inpatient after a while and want some more variety, but the fact that I am starting out liking it is actually really exciting.

There actually will be opportunities to do other things on down the pike if I want to. They're planning on opening an IOP and outpatient offices here at this satellite hospital before too long and when that happens, I could become involved with that if I wanted to. IOP actually sounds really cool, but I think it's going to be a little while before I want to do more outpatient.

 

[Manicsleep]

x

 

[Chimed]

Something that applied to me in residency was no matter what I did, after several months of it, it got boring. I wonder if you continue to do what you do, the honeymoon phase will go away. I hope not. If you are working where you trained, you likely have the option to move around in the department.

That is my fear about going into private practice. However, it seems like since starting my Child fellowship, things never get boring.

Part of the reason I want to go into academics is because of the idea of getting bored in private practice. In academics, there seems to be much more variety, especially if you're doing a combination of research, clinical work, and teaching.

 

[whopper]

That is my fear about going into private practice. However, it seems like since starting my Child fellowship, things never get boring.

Some things I haven't done yet that I'm curious about are 1) doing my own PP, 2) being in the administration psychiatric organization and 3) being faculty.

I got opportunities in all 3 areas. I was asked to be in the administration in a mental health community board by someone I highly highly respect a few weeks ago. A clinic in Indiana wants me to be their psychiatric consultant and is willing to pay me 2x what the state pays me (but it is over an hour drive there). I got asked again to join the university where I did fellowship.

I'm actually having frustration over this. Each time I tell a place no.....I feel terrible about it.

The current private practice I work at is doing fine but the problem is I'm finally getting over my post fellowship burnout and I'm thinking, "I could be working at my own practice instead of being someone else's employee."

 

[Chimed]

What about setting up an entire private clinic that is staffed with 2 to 3 psychiatrists, several therapists (maybe 5), an officer manager (to take care of finances and insurance), a clerk (for scheduling and phone calls), and an NP (to handle prescription refills and triage phone calls)? Could I not only see patients, but also be the clinic director and get paid an administer salary? I could see a clinic like this being similar to our academic set-up where everyone meets once or twice a week to discuss cases and coordinate care.

 

[Manicsleep]

x

 

[digitlnoize]

What about setting up an entire private clinic that is staffed with 2 to 3 psychiatrists, several therapists (maybe 5), an officer manager (to take care of finances and insurance), a clerk (for scheduling and phone calls), and an NP (to handle prescription refills and triage phone calls)? Could I not only see patients, but also be the clinic director and get paid an administer salary? I could see a clinic like this being similar to our academic set-up where everyone meets once or twice a week to discuss cases and coordinate care.

If you own the place, and everyone elsevworks for you, then you could take home a "directors" salary. The issue I seevwith this set up is the startup. How hard is it to start something like this?

 

[whopper]

There are three main issues with this.

1) You have to be able to tap into a vein where you can access people in the fields you want. It's not like you can just fill up spots in a day.

2) The people have to be good and work together as a team well. This can be difficult. You don't want a facility where you got bratty people who slack off. People in PP need to be the type that are hard-working, good at what they do, but also wanting to profit because of their skills and dilligence.

3) Is the doctor heading the practice a good businessman? Does the doctor have good human resource skills? Several doctors are the type of person that could've done well on a multiple choice exam but cannot manage people or a business.

Then, when you think about all of these factors, compare that to a job where all you have to do is....your job. All you have to worry about is doing the psychiatric work. Having to worry about the snow being shovelled can be a big pain in the butt when you're also worrying about other things like a suicidal patient.

Another thing to factor is tax-wise there are several tricks you can pull. I don't know if "tricks" is the right word because it's perfectly legal.

E.g. you can designate a company car. This in effect gives you a car that you can use tax-free. You can hire a family member such as your wife or husband to work for the office, in effect creating more office overheard that can be used that again is in a way "tax-free" because the government only starts to tax after you profit. E.g. the office pulls in $400,000 a year, $350K of which is profit, you hire your wife, pay her $50,000 a year, now the gov can only tax $300K vs $350K. Since the wife is on a lower tax bracket than you, it does make a difference.

You can go on occasional dinners and use it as an office expense, that again, in effect, is tax-free. etc.

 

[michaelrack]

E.g. the office pulls in $400,000 a year, $350K of which is profit, you hire your wife, pay her $50,000 a year, now the gov can only tax $300K vs $350K. Since the wife is on a lower tax bracket than you, it does make a difference.

.

Assuming they are married filing jointly (there are tax disadvantages to filing other ways), there is no difference between a husband making 400,000 and the wife 0; and the husband making 350k and the wife 50k on income taxes. I think there is actually a disadvantage on social security taxes when the wife makes 50k.

 

[whopper]

Good point!

 

[dynamite]

I'm thinking about going into private practice with a friend, then probably add a couple of other friends in the next 2-3 years.

Here one question I have for those of you who've been through it:
- What percentage of your collections goes toward overhead? I live in a major metropolitan city, and am looking for an office in prime downtown, probably about $1500 a month rent. I currently work as an independent contractor for a private practice group, and they take 40% (!) of my collections for overhead. I'm working there about 15 hours a week. This seems too high for me, but maybe I'm wrong. So what is reasonable percentage of collections for overhead?

Whopper - when you left your group to go into private practice yourself, did the majority of patients come with you? I'm wondering if I'm gonna be able to overcome the institutional transference.

All this is very exciting, but also very scary! I fully intend on being nascent for at least 4-6 months, which is really scary.

 

[Manicsleep]

x

 

[dynamite]

Your overhead should not be 40% in psychiatry.
In other medical specialties, overhead can routinely be 50-60% or even higher.

Psychiatry is a very low overhead specialty and you need to use that to succeed. For a 4 person group, you could be as low as 10 percent but in a metropolitan area 20% is more accurate with outsourced billing. Your 'prime downtown' idea doesn't sound like the best idea to me. I would go with a pretty nice area but a well appointed office. Your patients will come. You can always get an office in a prime area later if you want to attract cash patients.

The more you minimize overhead, the better you will do. You can always expand later but you need the foundation.

RE: your institutional transference. This is one of the few places a non-compete clause can actually be enforced.

Yeah, that's what I thought. That's why I'm thinking about going out on my own.

The whole downtown thing is secondary to:
1) I want to be downtown as it is just more exciting to me and I'm someone who kinda needs to be around the bustle
2) In my case, going in the suburbs may actually be less easy for referrals as I currently hold an academic position and know many faculty who are downtown and could probably leverage those connections better. Of course, downtown is saturated, so...all things being equal, I'd rather be downtown.

If I do cash at time of visit, there is no need for a billing service, is there?

 

[kstotes]

I'm reading through everyone's experience and I'm left wondering one thing... where is the guy who practices out of his own house (thereby investing "rent" into his mortgage), no office staff (because he sets his own appointments in a planner he bought at Office Max), fee for service (in excess of $200 an hour), and recognizes that taking calls overnight is NOT standard of care and is in fact a useful therapeutic tool in setting boundaries with patients and teaching them "self-soothing".

My residency program has a very strong analytic base and therefore we have a lot of old school analysts who are in extremely cush private practices, take zero overnight call, and charge big money. One even recommends to all of us that when we have a practice we get an extra line for the house with an answering machine. He mainly treats severe personality disorders and they know- call me, leave a message, I will get to it within 24 hours, if you need more than that you must need to be in the ER... so go.

Anyone have experience with that model? Not necessarily the analyst model but the fee-for-service , LOW overhead, HIGH fee?

 

[whopper]

I've heard this brought up before.

I do not recommend this type of practice unless you've had a patient for some time and trust them to know where you live. Many patients, when they first walk into the office, are in a situation where you don't know just how destructive the person could be.

The only way I could think of where such a thing could come to fruition was if you had an office and then cherry-picked patients out of that group to your office at home.

 

[TheWowEffect]

40 % is pretty much a standard figure if you want to join or work with a private group in Psychiatry. There is no way to calculate the exact overhead for each person in group practices; thus, a standard figure like 40 % is used and it is definitely not too high.

The only way to lower this is to have your "own solo practice" with a couple of therapists or psychologists, and even then it is not guaranteed.

 

[michaelrack]

I've heard this brought up before.

I do not recommend this type of practice unless you've had a patient for some time and trust them to know where you live. Many patients, when they first walk into the office, are in a situation where you don't know just how destructive the person could be.

The only way I could think of where such a thing could come to fruition was if you had an office and then cherry-picked patients out of that group to your office at home.

This type of practice is definitely possible, but not something that can be easily entered into straight out of residency.
Some academics will cherry-pick pts for a side home practice (if allowed by their dept)

 

[whopper]

The PP I work in is currently out-of-pocket and insurance only. I did pick up a few medicare patients that I see at a greatly reduced rate (we don't accept medicare), because they were patients that I knew needed the help and the local community mental health center is filled with psychiatrists that don't know what they are doing (e.g. the patient's depressed and the doctor put them on Abilify only.) This is certainly not a setting where I'm getting malingerers faking to get something of abuse. Many of my patients are white-collar. Those that are blue collar are still people, that if they weren't my patients, I'd be happy to be their friends.

I still get patients, despite this setting, that can be destructive. I had a borderline PD patient call the office, screaming over the phone, and making suicidal gestures. I had another guy, very wealthy, call me up as if I was his only doctor. The guy was having panic attacks because he made a multi-million dollar deal and it was going south. He would make demands to the effect of, "Doctor, I want to see you now. I insist!" Despite me not having any office hours to fit him in that day.

You don't want people like that knowing where you live or having access to a home number.

 

[notdeadyet]

He mainly treats severe personality disorders and they know- call me, leave a message, I will get to it within 24 hours, if you need more than that you must need to be in the ER... so go.

Oh boy...

 

[medium rare]

Anyone have experience with that model? Not necessarily the analyst model but the fee-for-service , LOW overhead, HIGH fee?

I run this kind of practice (low overhead, high (I guess) fee), but I am not an analyst and do not recommend practicing out of your home for many reasons (several already mentioned) although I have colleagues who do.

I share a suite with three other psychologists and we each pay 1/4 of the total expenses including a full-time office manager who does all of our billing and scheduling. The total over head is low and largely predictable averaging about $2000 a month each for everything including malpractice. I don't take insurance but we will submit claims for patients who have out-of-network benefits. I have all the business I can handle and the more I work, the more my expense ratio improves. But, I limit myself to about 40 clinical hours/week - any more than that and I can feel the burnout coming.

 

[kstotes]

Great! So maybe you can fill me in... why doesn't everybody do this? Any opinions on what holds people back?

PP fee for service = set your own hours, no insurance audits and hassles, no amending your treatment and documentation to please insurance reviewer, as long as you are good at setting boundaries/rules with patients it shouldn't be too intrusive to your lifestyle

I keep waiting for this horrible reality to surface about PP fee for service that I'm unaware of that explains why people dont' do it. The common answers (24 hour call, isolation, no vacation coverage) all don't actually seem to be realities and can be handled by good theraputic skill and business management. The only other response I hear is that people feel guilty about providing service only to clientele that can afford to see you. Even had an attending called such practitioners "greedy". Why is medicine the one field where people are made to feel guilty for making good money. Attorney's bill per hour, whether they are reading a brief, calling collateral, whatever- you pay. Why should medicine be any different?

 

[digitlnoize]

Great! So maybe you can fill me in... why doesn't everybody do this? Any opinions on what holds people back?

PP fee for service = set your own hours, no insurance audits and hassles, no amending your treatment and documentation to please insurance reviewer, as long as you are good at setting boundaries/rules with patients it shouldn't be too intrusive to your lifestyle

I keep waiting for this horrible reality to surface about PP fee for service that I'm unaware of that explains why people dont' do it. The common answers (24 hour call, isolation, no vacation coverage) all don't actually seem to be realities and can be handled by good theraputic skill and business management. The only other response I hear is that people feel guilty about providing service only to clientele that can afford to see you. Even had an attending called such practitioners "greedy". Why is medicine the one field where people are made to feel guilty for making good money. Attorney's bill per hour, whether they are reading a brief, calling collateral, whatever- you pay. Why should medicine be any different?

The realistic drawbacks I've heard tossed about are:

1. Hassles of running a business. Some people find it easier just to collect a paycheck and be done with it. Running a small business isn't for everyone.

2. Pathology. Most of the patients in PP will be stable, and to some, less interesting than doing in patient work.

3. Benefits. Some people like working for a place that gives you retirement, state, or whatever benefits in addition to your paycheck. In PP you pay for these out of your own pocket.

4. Time to build up patients. Taking insurance will get you patients much faster. I think you can still fill up doing cash PP, but it will take longer to get there. Some people want to quick money of employment. Hard to turn down a 200k job offer in favor of uncertainty and (hopefully) temporary poverty.

5. Location. Not everywhere can support a practice like this. Not everyone wants to relocate to a place that can.

That's about all I've got...FWIW, I agree with you. I'd like my own place. I'll take the small business headaches instead of the insurance/employee headaches.

 

[medium rare]

The realistic drawbacks I've heard tossed about are:

1. Hassles of running a business. Some people find it easier just to collect a paycheck and be done with it. Running a small business isn't for everyone.
2. Pathology. Most of the patients in PP will be stable, and to some, less interesting than doing in patient work.
3. Benefits. Some people like working for a place that gives you retirement, state, or whatever benefits in addition to your paycheck. In PP you pay for these out of your own pocket.
4. Time to build up patients. Taking insurance will get you patients much faster. I think you can still fill up doing cash PP, but it will take longer to get there. Some people want to quick money of employment. Hard to turn down a 200k job offer in favor of uncertainty and (hopefully) temporary poverty.
5. Location. Not everywhere can support a practice like this. Not everyone wants to relocate to a place that can.

That's about all I've got...FWIW, I agree with you. I'd like my own place. I'll take the small business headaches instead of the insurance/employee headaches.

I think these are all legitimate reasons that keep many from doing a self-pay practice - particularly the uncertainty of revenue streams when starting out. For me, these have never been compelling enough factors to make me want to take a salaried position and give up the autonomy that comes with private practice. Others feel completely the opposite.

 

[Sharpie1]

How do you get word out about yourself? If you don't accept insurance how does anyone know about you?

 

[nitemagi]

Why is medicine the one field where people are made to feel guilty for making good money. Attorney's bill per hour, whether they are reading a brief, calling collateral, whatever- you pay. Why should medicine be any different?

You're really asking why doctors want to not be viewed the same way we view lawyers? Think about it for a second.

 

[kstotes]

How do you get word out about yourself? If you don't accept insurance how does anyone know about you?

My impression is that is where the business end comes in that people are hesitant about.

One PP I talked to a child psychiatrist so it's a little different but she has great ideas-- become part of a local church and put an add in the bulletin, take out an add in the local high school year book "congrats grads, sincerely Your Friendly Neighborhood Psychiatrist", go around to each and every pediatrician/PCP/OBGYN within X miles and bring their office lunch, get active in local AACAP/APA (full practices refer to non-full practices) , do consults at a local community hospital, introduce yourself to the principal of every school in the area, go visit your local political representative. Bottom line, it seems like if you can market YOURSELF to people they will refer. In child it's probably a lot easier because of need but in general I always remind myself-- most specialties LOVE to refer psych complaints to a psychiatrist so all they need is someone they can remember "if i call Dr. kstotes he will get my PITA patient an appointment sooner than later and won't creep my patient out".

This is all in theory though as I try to gather advice from others, no practical experience here. Probably sounds easier than it is. It seems there is an abundance of information about public sector psychiatry and all the PP fee for service/"boutique" people don't tend to forum and didactic as much. I can only assume they are somewhere "being viewed as lawyers" and counting their money while twiddling their mustaches and and killing bunnies while laughing maniacally... bc if you make money in medicine you must be evil. So I'm told.

 

[dl2dp2]

Great! So maybe you can fill me in... why doesn't everybody do this? Any opinions on what holds people back?

PP fee for service = set your own hours, no insurance audits and hassles, no amending your treatment and documentation to please insurance reviewer, as long as you are good at setting boundaries/rules with patients it shouldn't be too intrusive to your lifestyle

I keep waiting for this horrible reality to surface about PP fee for service that I'm unaware of that explains why people dont' do it. The common answers (24 hour call, isolation, no vacation coverage) all don't actually seem to be realities and can be handled by good theraputic skill and business management. The only other response I hear is that people feel guilty about providing service only to clientele that can afford to see you. Even had an attending called such practitioners "greedy". Why is medicine the one field where people are made to feel guilty for making good money. Attorney's bill per hour, whether they are reading a brief, calling collateral, whatever- you pay. Why should medicine be any different?

the other thing is that often it's not this black and white. everyone I know does both salary and PP so you get the positives from both worlds. You work at a clinic and get paid by the gvt/hospital 30 hours a week, get great benefits and stability and the satisfaction of dealing with patients who really need your help. Then you work another 10 hours doing private practice, sharing some office space, get a taste of running a business etc. If you get really popular you scale up or down according to your desire. And it's way easier to fill 10 hours than 50 with cash only.

 

[TheWowEffect]

My impression is that is where the business end comes in that people are hesitant about.

One PP I talked to a child psychiatrist so it's a little different but she has great ideas-- become part of a local church and put an add in the bulletin, take out an add in the local high school year book "congrats grads, sincerely Your Friendly Neighborhood Psychiatrist", go around to each and every pediatrician/PCP/OBGYN within X miles and bring their office lunch, get active in local AACAP/APA (full practices refer to non-full practices) , do consults at a local community hospital, introduce yourself to the principal of every school in the area, go visit your local political representative. Bottom line, it seems like if you can market YOURSELF to people they will refer. In child it's probably a lot easier because of need but in general I always remind myself-- most specialties LOVE to refer psych complaints to a psychiatrist so all they need is someone they can remember "if i call Dr. kstotes he will get my PITA patient an appointment sooner than later and won't creep my patient out".

This is all in theory though as I try to gather advice from others, no practical experience here. Probably sounds easier than it is. It seems there is an abundance of information about public sector psychiatry and all the PP fee for service/"boutique" people don't tend to forum and didactic as much. I can only assume they are somewhere "being viewed as lawyers" and counting their money while twiddling their mustaches and and killing bunnies while laughing maniacally... bc if you make money in medicine you must be evil. So I'm told.

Very good advice. Can tell you from first hand experience that this strategy works like charm..

 

[medium rare]

My impression is that is where the business end comes in that people are hesitant about.

One PP I talked to a child psychiatrist so it's a little different but she has great ideas-- become part of a local church and put an add in the bulletin, take out an add in the local high school year book "congrats grads, sincerely Your Friendly Neighborhood Psychiatrist", go around to each and every pediatrician/PCP/OBGYN within X miles and bring their office lunch, get active in local AACAP/APA (full practices refer to non-full practices) , do consults at a local community hospital, introduce yourself to the principal of every school in the area, go visit your local political representative. Bottom line, it seems like if you can market YOURSELF to people they will refer. In child it's probably a lot easier because of need but in general I always remind myself-- most specialties LOVE to refer psych complaints to a psychiatrist so all they need is someone they can remember "if i call Dr. kstotes he will get my PITA patient an appointment sooner than later and won't creep my patient out".

This is all in theory though as I try to gather advice from others, no practical experience here. Probably sounds easier than it is. It seems there is an abundance of information about public sector psychiatry and all the PP fee for service/"boutique" people don't tend to forum and didactic as much. I can only assume they are somewhere "being viewed as lawyers" and counting their money while twiddling their mustaches and and killing bunnies while laughing maniacally... bc if you make money in medicine you must be evil. So I'm told.

This is quite accurate. You have to get out and make yourself available to those in the community who will refer to you. This really isn't as bad as it may seem and doesn't have to be a lot of work. The demand for private psychiatric services is high and you won't have to pound the pavement too long before the phone starts ringing.

 

[Sneezing]

The paranoia people have towards working out of their home isn't going far enough. If you are really worried about people knowing where you live then you must have missed the internet era.

All some one needs is a name and they can find out where you live with some basic internet sleuthing. Furthermore, as generations age, the population capable of performing such a search will expand. In summary, people know where you live. Privacy is long gone.

 

[zenman]

Why is medicine the one field where people are made to feel guilty for making good money. Attorney's bill per hour, whether they are reading a brief, calling collateral, whatever- you pay. Why should medicine be any different?

Don't ask a lawyer this question or he will send you a bill.

 

[digitlnoize]

The paranoia people have towards working out of their home isn't going far enough. If you are really worried about people knowing where you live then you must have missed the internet era.

All some one needs is a name and they can find out where you live with some basic internet sleuthing. Furthermore, as generations age, the population capable of performing such a search will expand. In summary, people know where you live. Privacy is long gone.

The biggest problem I've found with this is simply county/city records. Pretty much every county website has a property records search, and you can find pretty much any landowner in there.

Can doctors practice under pseudonyms?

 

[nitemagi]

In california you can have your address removed from the DMV database. Meant to protect against stalkers.

 

[Majesty]

Oh yeah, I agree...do a zabasearch or intelius on yourself.
Do the free one its scary enough. I found records of places I didn't remember I had lived.

 

[Technotronic]

 

[nitemagi]

First time posting.
I am moving to california because my wife got a good job. Northen california bay area but I don't want to say more. I think I am going to try private practice this time around because the best employed jobs here seem to be with inmates or kaiser and I am not sure which is worse.

If I was in your shoes I'd probably look for some locums while getting other ducks in a row. The bay area is definitely more saturated, but I don't know if it's oversaturated. You'll probably need something to tide you over.

 

[Sneezing]

Techno, sent you a PM.

 

[Technotronic]

 

[milesed]

Thanks to all who are posting in this thread so far. I'm considering the PP option as well and the +/- listed so far have me seriously considering it.

I've been medical director for 8 years at a private, non-profit CMHC and love and hate many aspects of this job. The pay has been good (until lately) and benefits are great. I get paid sick, vacation time, state retirement, and paid malpractice. My salary has been frozen now for 3 years due to the agency's recent losses. I have issue with this because every other employee (about 200) here has continued to get yearly raises and performance bonuses. I suggested a lower rate of both for docs to no avail.

I am carrying many who do not bring in any money directly and can relate to the previous posts about laziness in this setting.

I need to get a clear picture of what my expenses and pay may be in order to see if it's worth the headaches of completely running an office. I'd be the only child psyc within a 2 hour drive in any direction so I think I'd stay quite booked up.

Anyone use the system my dentists does? He has us pay the full fee at the visit, then sends us a check for what the insurance has payed.

Do any of you in PP bill for no-shows?

What time % do you spend in dealing with insurance paperwork, pre-certs, etc.?

 

[medium rare]

Anyone use the system my dentists does? He has us pay the full fee at the visit, then sends us a check for what the insurance has payed.

Do any of you in PP bill for no-shows?

What time % do you spend in dealing with insurance paperwork, pre-certs, etc.?

Your dentist is an out-of-network provider who accepts assigment (insurance company sends their portion of coverage to the provider). You can either accept assignment or not; I do not. The patient pays me at the time of service or at the end of the month (after discussing payment obligations with them) and my office will file a claim as a courteousy if the patient has out-of-network coverage. But, the insurance payment goes to the patient, not me. I've found this cuts down on cost and time considerably.

I ALWAYS bill for no-shows and take time to discuss this with each new patient at intake. If there is a true emergency causing the no-show, then I usually waive the fee, but I make clear that I require a 24-hour advance cancellation or they will be charged (many require 48-hours or more).

I spend minimal time with billing and insurance paperwork. My office manager handles most of this, but the patient is responsible for contacting their insurance carrier and verifying if they have coverage, if there is an additional out-of-network deductbile and what % the insurance company will cover. If you deal with insurance, this will quickly become very burdeonsome and will require a billing specialist to manage.

 

[nitemagi]

Anyone use the system my dentists does? He has us pay the full fee at the visit, then sends us a check for what the insurance has payed.

Sounds like money laundering to me

 

[digitlnoize]

Your dentist is an out-of-network provider who accepts assigment (insurance company sends their portion of coverage to the provider). You can either accept assignment or not; I do not. The patient pays me at the time of service or at the end of the month (after discussing payment obligations with them) and my office will file a claim as a courteousy if the patient has out-of-network coverage. But, the insurance payment goes to the patient, not me. I've found this cuts down on cost and time considerably.

I don't understand why every physician doesn't do it this way. Why are we footing the bill for the patients and insurance companies without any compensation for it? Stupid business move on our part, if you ask me.

If the insurance companies want their customers to get their payments processed in office, then they can provide the staff for it. Otherwise, the patient will get the superbill, and they can deal with the insurance company directly. Maybe if it happened that way, insurance companies wouldn't be able to get away with the terrible customer service they've been allowed to get away with.

Take a stand! Unite! Resist! Yes we can! No new taxes! All your base are belong to us! And stuff.

 

[Manicsleep]

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[Technotronic]

 

[Manicsleep]

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[digitlnoize]

Soo..Are any of you familiar with these companies that help physicians get started? Market data, reimbursement negotiation, HIPPA, OSHA, incorporating, web pages etc etc and on and on. They charge in the 10s of thousands, anywhere from 5-50k depending on what you want and who you talk to. I think for me the market data and incorporating/accounting seem like they would be the best bang for the buck and it could be had for less than 10k. Still thats a lot, is it worth it?

Do whatever you can yourself, if you can do it well.

There are plenty of programs out there that will let you design and publish a nice, clean website with an easy graphical editor. The incorporating forms aren't that hard to fill out, but consulting an attorney may be a good idea. I think you can do HIPPA and OSHA yourself, especially in an office with such a small staff size.

Market Data is up to you. It could be helpful...what are you going to do with the information? I think you can find similar information out without the pure data. For example, start by finding the affluent shopping areas, then google for psychiatrists in that area. Then you can call and check their availability. If there aren't many psychiatrists or they're booked up, then it's probably a good area. Alternatively, you could look at police reports for a certain area. If there is a high murder rate then stay away. Obviously these are reversed if you're looking for an "underserved" population. Either way, I don't know that you NEED the market data. Find the place with the most Starbucks per square mile and setup shop. Done.

 

[Technotronic]

 

[nitemagi]

One thing I have learned in my early life of trying to make a practice. Get an office space, even if its only for 1-2 days a week. I already had a license, dea etc but for insurance/credentialing, incorporation, business license with the state you really need a separate space.

I think its better to do it 1-2 days a week early on because as you build your practice to fill those slots, you can always expand to more days or get another office but you need to get started somewhere.

That is exactly what I'm doing right now.