retroactive claims and payment?

[vistaril]

So as some of you know I've taken an inpatient job with quite a hefty commute where I have to bill/collect on my own. I'm going to have to eat the self pay/no pay inpatients(yay) but there will be a good number of patients on this unit with insurance and that's how I will be paid. The problem is I'm not on these panels yet(it's really one panel that has different branches) and it's going to be some time before I can get on. I've paid someone 3000 dollars who is supposed to be 'the guy' to expedite the process, but even then it's going to take a few months at least. And I start work there in less than 2 weeks. I've already discussed this situation with the hospital and they were like "not our problem, but if you don't start at our start date don't plan on starting period".

So am I just going to have to eat these reimbursements? Or can I retroactively submit them? the thought of working for absolutely nothing for a couple months(well actually negative money since I pay my own medmal and such) is not appealing at all......

---

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[wolfvgang22]

Are you trolling us? Because this is beyond terrible. I'd rather work at McDonald's.

 

[Shikima]

I'd just cancel the arrangement at this point and find alternative work. Sounds like you're going to be a chump.

 

[michaelrack]

bill out of network and/or bill the patients directly

 

[erg923]

You've paid to get on insurance panels? Just one of many of the parts of this story that seem ludicrous.

 

[michaelrack]

You've paid to get on insurance panels? Just one of many of the parts of this story that seem ludicrous.

It sounds like he has paid someone to do his credentialing.

 

[vistaril]

You've paid to get on insurance panels? Just one of many of the parts of this story that seem ludicrous.

ummmm.....paying someone to help facilitate/expedite the credential process is *very* common. In this case if they allow me to get on these panels 5-6 week quicker than I otherwise would, that would save me money.

 

[vistaril]

bill out of network and/or bill the patients directly

That's not going to fly. Part of the privileges in admitting here(and gaining this contract) involves me taking BCBS.

 

[vistaril]

I'd just cancel the arrangement at this point and find alternative work. Sounds like you're going to be a chump.

actually i'm getting 100% of the collections here....that's a good deal and better than most. There is just a little legwork involved in getting it. The problem is that the commute for this job is such that both ways it will cut into my ability to work elsewhere. But if someone lived here and had this arraingment...they could knock out the unit in 3.5 hours at most and the per hour salary would be very nice.

 

[vistaril]

Are you trolling us? Because this is beyond terrible. I'd rather work at McDonald's.

Im collecting 100% of my fees for the insured patients. That's not 'beyond terrible'.

 

[Trismegistus4]

Are you trolling us? Because this is beyond terrible. I'd rather work at McDonald's.

This looks more and more likely all the time.

 

[Shikima]

actually i'm getting 100% of the collections here....that's a good deal and better than most. There is just a little legwork involved in getting it. The problem is that the commute for this job is such that both ways it will cut into my ability to work elsewhere. But if someone lived here and had this arraingment...they could knock out the unit in 3.5 hours at most and the per hour salary would be very nice.

It is presumptive and you're rationalizing. Remember, a bird in hand is worth 2 in the bush.

 

[vistaril]

It is presumptive and you're rationalizing. Remember, a bird in hand is worth 2 in the bush.

well no it's not all that presumptive because I know how long it takes to see inpatients for me(I'm not the fastest btw). As for the second comment, this doesn't even make sense.....the patients are there and I have the contract to see them. So it is in hand. Having guaranteed patients that I'm getting on the panel to see is as in the hand as it gets when it comes to the real world. By that standard nobody who works in real private practice would ever have any birds in hand.

 

[vistaril]

On a somewhat related note, the social worker who helps arranges placement, dispo, petitions, etc on the unit emailed me to 'discuss our schedules' when I start. She stated that her hours are 730-400 and that the provider I'm replacing and her would start rounds with 'the rest of the team'(I guess a nurse and ??) in the conference room at 8am and was asking if this was ok when I started. She states it worked well for her because then she was able to be done with a lot of stuff before her afternoon groups started.

My response: My daily coverage schedule of this unit will vary a lot day to day. Some days I'll get there early. Some days late and I might not come in until after lunch. I have a long commute so it's safe to say there won't be any days where I start seeing patients before 8am as I don't wake up super early as a rule. It's important for you to know that I am not a salaried employee at this facility and thus there will not be regular/consistent hours for me. I'm anticipating other clinical responsibilities where I live that will also be unpredictable, so that will likely be a factor in my schedule. If we are there at the same time you are welcome to see patients with me and discuss specific concerns you have with patients and dispo/paperwork, but I don't see ourselves having schedules to align well each day to do this.

 

[wolfvgang22]

 

[hamstergang]

On a somewhat related note, the social worker who helps arranges placement, dispo, petitions, etc on the unit emailed me to 'discuss our schedules' when I start. She stated that her hours are 730-400 and that the provider I'm replacing and her would start rounds with 'the rest of the team'(I guess a nurse and ??) in the conference room at 8am and was asking if this was ok when I started. She states it worked well for her because then she was able to be done with a lot of stuff before her afternoon groups started.

My response: My daily coverage schedule of this unit will vary a lot day to day. Some days I'll get there early. Some days late and I might not come in until after lunch. I have a long commute so it's safe to say there won't be any days where I start seeing patients before 8am as I don't wake up super early as a rule. It's important for you to know that I am not a salaried employee at this facility and thus there will not be regular/consistent hours for me. I'm anticipating other clinical responsibilities where I live that will also be unpredictable, so that will likely be a factor in my schedule. If we are there at the same time you are welcome to see patients with me and discuss specific concerns you have with patients and dispo/paperwork, but I don't see ourselves having schedules to align well each day to do this.

Well, that actually doesn't make me think any worse of you, but not for the reason you'd hope.

 

[finalpsychyear]

3k to expedite the process?? I've seen lots of companies do it for 200 per panel. In all likelihood it won't save a ton of time.. and hopefully you get a partial refund if it is not ready to go in 5-6wks.

Did you panel with medicare/medicaid? They may allow retroactive claims if your in process of being a provider for them.
You are likely going to work the first 3-4 weeks for free then?

I'm sorry to hear your situation is this bad. All the best.

 

[vistaril]

Well, that actually doesn't make me think any worse of you, but not for the reason you'd hope.

ummm....I didn't hope or not hope anything with respect to your feelings of me.

 

[vistaril]

3k to expedite the process?? I've seen lots of companies do it for 200 per panel. In all likelihood it won't save a ton of time.. and hopefully you get a partial refund if it is not ready to go in 5-6wks.

Did you panel with medicare/medicaid? They may allow retroactive claims if your in process of being a provider for them.
You are likely going to work the first 3-4 weeks for free then?

I'm sorry to hear your situation is this bad. All the best.

I'm already with medicare/medicaid and the facility is making sure things are in order there.

The paneling is a bit different here than most places. One player really dominates things, and then there are several different carveouts/subs of that. So if you add up all the different panels with the panel(which is probably a better analogy), it probably only comes to like 350 per subpanel. Not terrible.

 

[vistaril]

you do realize that in the real world that's how it typically works right?(in terms of work flow on the unit)

 

[OldPsychDoc]

you do realize that in the real world that's how it typically works right?(in terms of work flow on the unit)

Well in my dimension, the real world involves working constructively with a team and treating social workers as colleagues instead of as someone incidentally doing "dispo/paperwork" on our behalf...but I think we determined long ago that you operate in an alternative reality.

 

[vistaril]

Well in my dimension, the real world involves working constructively with a team and treating social workers as colleagues instead of as someone incidentally doing "dispo/paperwork" on our behalf...but I think we determined long ago that you operate in an alternative reality.

in this case 'real world' means not a salaried VA/govt/academic job but rather work in which someone is paid directly for their production(and no I don't mean some very limited RVU bonus structure at the very end that invariably makes up a small % of the total package). You don't mind doing all these things because you ARE PAID for them. People who are living directly off their codes aren't going to do a lot of things that aren't related to generating those codes......you are paid a salary and as part of that salary have a responsibility to do certain things(only one of which is see patients efficiently and generate codes). These things almost certainly involve administrative tasks, teaching residents, organizing workflow, etc....but since you are paid for performing these duties, it's reasonable for you to do them. It's not reasonable to expect people who aren't paid to do something to go out of their way to make accomodations for salaried people(in this case this social worker) in helping them do their job. If the hospital wanted to pay me to help organize workflow or manage a team, they would do so.

 

[nexus73]

Why isn't this better coordinated? Learning experience anyways, to require insurance lead time before taking the next job like this.

 

[vistaril]

Why isn't this better coordinated? Learning experience anyways, to require insurance lead time before taking the next job like this.

I didn't have a full time job anyways now....so there was no issue of coordination here. You would have a point if I left a job I had to immediately transfer to this position and there was an unwanted lag time.

 

[nexus73]

I didn't have a full time job anyways now....so there was no issue of coordination here. You would have a point if I left a job I had to immediately transfer to this position and there was an unwanted lag time.

You may disagree with my perspective, but having a start date now and being weeks out on private insurance credentialing is not coordinated. As it stands you're going to be seeing insured patients with no idea if the insurance will pay you.

 

[hamstergang]

You may disagree with my perspective, but having a start date now and being weeks out on private insurance credentialing is not coordinated. As it stands you're going to be seeing insured patients with no idea if the insurance will pay you.

It's weird that he'd see patients for free but not talk to the SW for free.

 

[vistaril]

You may disagree with my perspective, but having a start date now and being weeks out on private insurance credentialing is not coordinated. As it stands you're going to be seeing insured patients with no idea if the insurance will pay you.

yes and my point was in my situation waiting until the insurance panels kicked in wouldn't do me any good because I wouldn't be working a full time job in that window anyways.

 

[vistaril]

It's weird that he'd see patients for free but not talk to the SW for free.

not as weird as you being unable to read apparently. I don't mind talking to the social worker and discussing patients and cases with her. I'm just not going to organize my daily schedule to correspond exactly to hers because it is not convenient for me and interferes with other clinical activities I'll be doing elsewhere.

 

[trophyhusband]

Well it seems painfully obvious that you're still living in Alabama and that means you're in probably the worst insurance market in the country as BCBS of Alabama is all but a monopoly in that state https://www.advisory.com/daily-briefing/2014/10/14/10-states-with-the-strongest-insurance-monopolies. I've always heard BCBS of Alabama is the worst insurer in the country to deal with outside of maybe United and Cigna. On top of that you're going to work for an "employer" that clearly doesn't value you at all. Your situation is so far outside of the mainstream experience that people can't help you. It's unfortunate, but based my on my wife's experiences people are willing to bend over backwards to get psychiatrists in the door... so how could she or anyone like her give you advice?

At any rate, you're dealing with a monopoly who has made their credentialing process so onerous that it sounds ridiculous. This is not an organization that I would expect to pay me retroactively. Good luck.

 

[vistaril]

Well it seems painfully obvious that you're still living in Alabama and that means you're in probably the worst insurance market in the country as BCBS of Alabama is all but a monopoly in that state https://www.advisory.com/daily-briefing/2014/10/14/10-states-with-the-strongest-insurance-monopolies. I've always heard BCBS of Alabama is the worst insurer in the country to deal with outside of maybe United and Cigna. On top of that you're going to work for an "employer" that clearly doesn't value you at all. Your situation is so far outside of the mainstream experience that people can't help you. It's unfortunate, but based my on my wife's experiences people are willing to bend over backwards to get psychiatrists in the door... so how could she or anyone like her give you advice?

At any rate, you're dealing with a monopoly who has made their credentialing process so onerous that it sounds ridiculous. This is not an organization that I would expect to pay me retroactively. Good luck.

1) I'm also not sure how your wife could give me any advice because she(a psychiatrist I presume?) isn't here to speak for herself and do so. I'm just curious....but does your wife go on topic specific message boards and speak towards your experiences? I have an aunt who lost a daughter to cystic fibrosis- can I go on a CF message board and speak about my experience in losing a daughter from my aunt's perspective? If so, how useful would that be?

2) As someone who actually lives here, I can say that the job market in the state of Alabama as a whole is actually pretty good. It's not a blue cross issue for the most part. It's a location specific issue(more limited than the whole state) having to do with contract obligations between hospital systems and who owns those contracts and whatnot. There could be 20 different insurers here equally competing and that same issue would still exist.

3) 3k is not a terrible deal for credentialing as a total(for everything you need). I wouldn't call that 'so onerous'. It's actually a little less than some people pay.

 

[hamstergang]

not as weird as you being unable to read apparently. I don't mind talking to the social worker and discussing patients and cases with her. I'm just not going to organize my daily schedule to correspond exactly to hers because it is not convenient for me and interferes with other clinical activities I'll be doing elsewhere.

I can read just fine. I just didn't care to be precise enough is a thread where you're trying to make the worst of a situation if you're even being honest about it. This wouldn't be the first time you misrepresented your position on this forum.

 

[trophyhusband]

1) I'm also not sure how your wife could give me any advice because she(a psychiatrist I presume?) isn't here to speak for herself and do so. I'm just curious....but does your wife go on topic specific message boards and speak towards your experiences? I have an aunt who lost a daughter to cystic fibrosis- can I go on a CF message board and speak about my experience in losing a daughter from my aunt's perspective? If so, how useful would that be?

2) As someone who actually lives here, I can say that the job market in the state of Alabama as a whole is actually pretty good. It's not a blue cross issue for the most part. It's a location specific issue(more limited than the whole state) having to do with contract obligations between hospital systems and who owns those contracts and whatnot. There could be 20 different insurers here equally competing and that same issue would still exist.

3) 3k is not a terrible deal for credentialing as a total(for everything you need). I wouldn't call that 'so onerous'. It's actually a little less than some people pay.

1. No point in taking the bait.

2. If you say so.

3. I've never heard of anyone paying anywhere near 3k to credentialed/paneled so I would definitely call it onerous. At any rate, your shtick of asking for advice and then arguing with people who respond is tiresome. You don't actually want help you just want to come post "woe is me" stuff on here which is fine but I'll just avoid it from now on...

 

[vistaril]

1. No point in taking the bait.

2. If you say so.

3. I've never heard of anyone paying anywhere near 3k to credentialed/paneled so I would definitely call it onerous. At any rate, your shtick of asking for advice and then arguing with people who respond is tiresome. You don't actually want help you just want to come post "woe is me" stuff on here which is fine but I'll just avoid it from now on...

1) It's 'bait' to point out that you are not a psychiatrist and yet you routinely comment on such matters which only psychiatrists have experience with? Or even someone who works in mental health, healthcare, etc in any capacity?

2) I did say so. As someone who lives here.....and more importantly practices psychiatry.

3) You've never 'heard' of anyone paying anywhere near 3k to get credentialed/paneled probably because you are not a psychiatrist or any type of provider that requires paneling so of course you aren't going to be discussing the matter with other people in that way. Hell I'm not a plumber so I've never heard of anyone spending xxx on plumbing supplies.....but the only way I would know about that is if I was routinely talking shot with other plumbers and going through a shared experience. As for me arguing with advice I've received, this is specific to the situation- the reality is there are not a lot of psychiatrists who post routinely in this forum in true private practice or something close to it. The forum has always been mostly students/residents and then psychiatrists who either work for the govt or work in academics. And that's ok.....it's just that they cannot always contribute a ton to certain questions. Note that I typically ignore threads that involve work topics/issues I have no experience or interest in(like research...I don't know crap about this so why comment?). So when someone who has only worked for the VA or whatever makes a charged comment about issues they have never dealt with(like real credentialing, insurance panels, codes/collections, etc) I just sort of roll my eyes to myself and assume they are repeating something they have heard from others(which is typical of questionable value for various reasons). But heck, at least they are coming from it as a psychiatrist who doesn't have that as a personal experience....as opposed to someone who is coming at it as a non-provider completely who also doesn't have personal experience with the matter.

 

[trophyhusband]

1) It's 'bait' to point out that you are not a psychiatrist and yet you routinely comment on such matters which only psychiatrists have experience with? Or even someone who works in mental health, healthcare, etc in any capacity?

2) I did say so. As someone who lives here.....and more importantly practices psychiatry.

3) You've never 'heard' of anyone paying anywhere near 3k to get credentialed/paneled probably because you are not a psychiatrist or any type of provider that requires paneling so of course you aren't going to be discussing the matter with other people in that way. Hell I'm not a plumber so I've never heard of anyone spending xxx on plumbing supplies.....but the only way I would know about that is if I was routinely talking shot with other plumbers and going through a shared experience. As for me arguing with advice I've received, this is specific to the situation- the reality is there are not a lot of psychiatrists who post routinely in this forum in true private practice or something close to it. The forum has always been mostly students/residents and then psychiatrists who either work for the govt or work in academics. And that's ok.....it's just that they cannot always contribute a ton to certain questions. Note that I typically ignore threads that involve work topics/issues I have no experience or interest in(like research...I don't know crap about this so why comment?). So when someone who has only worked for the VA or whatever makes a charged comment about issues they have never dealt with(like real credentialing, insurance panels, codes/collections, etc) I just sort of roll my eyes to myself and assume they are repeating something they have heard from others(which is typical of questionable value for various reasons). But heck, at least they are coming from it as a psychiatrist who doesn't have that as a personal experience....as opposed to someone who is coming at it as a non-provider completely who also doesn't have personal experience with the matter.

You make a lot of assumptions... hilariously incorrect ones but whatever. You don't want help so good luck.

 

[Trismegistus4]

Please, everyone, let's all stop giving vistaril the attention he desires.

 

[vistaril]

I can read just fine. I just didn't care to be precise enough is a thread where you're trying to make the worst of a situation if you're even being honest about it. This wouldn't be the first time you misrepresented your position on this forum.

you flat out completely misrepresented what I said. And now have the gall to flat out lie about it. That is an entirely different matter than not being 'precise enough'.

 

[vistaril]

You make a lot of assumptions... hilariously incorrect ones but whatever. You don't want help so good luck.

No, they are neither incorrect nor hilarious. And you are right in that I don't want help on this matter from a family member of someone who may or may not have something to say.

 

[MLT2MT2DO]

in this case 'real world' means not a salaried VA/govt/academic job but rather work in which someone is paid directly for their production(and no I don't mean some very limited RVU bonus structure at the very end that invariably makes up a small % of the total package). You don't mind doing all these things because you ARE PAID for them. People who are living directly off their codes aren't going to do a lot of things that aren't related to generating those codes......you are paid a salary and as part of that salary have a responsibility to do certain things(only one of which is see patients efficiently and generate codes). These things almost certainly involve administrative tasks, teaching residents, organizing workflow, etc....but since you are paid for performing these duties, it's reasonable for you to do them. It's not reasonable to expect people who aren't paid to do something to go out of their way to make accomodations for salaried people(in this case this social worker) in helping them do their job. If the hospital wanted to pay me to help organize workflow or manage a team, they would do so.

So the "real world" is the sh*thole you've created for yourself and keep trying to push on others?


Sent from my SM-G900V using SDN mobile

 

[Shikima]

I've never paid to be credentialed.

 

[michaelrack]

3. I've never heard of anyone paying anywhere near 3k to credentialed/paneled so I would definitely call it onerous. ...

If that amount includes also getting set up for electronic fund transfers from most of the insurers in an area (including medicare if that is not set up yet), I think it is a reasonable fee- and I have plenty of experience in the area

 

[trophyhusband]

If that amount includes also getting set up for electronic fund transfers from most of the insurers in an area (including medicare if that is not set up yet), I think it is a reasonable fee- and I have plenty of experience in the area

Fair enough, I've seen quite a few of these too but never anything that high. Could be a regional thing as my experience is everywhere but the SE more or less.

 

[vistaril]

If that amount includes also getting set up for electronic fund transfers from most of the insurers in an area (including medicare if that is not set up yet), I think it is a reasonable fee- and I have plenty of experience in the area

not all that surprising since we are two of the few guys on here who actually have experience billing and collecting for ourselves.

 

[vistaril]

So the "real world" is the sh*thole you've created for yourself and keep trying to push on others?


Sent from my SM-G900V using SDN mobile

that would be a no. Also I've never 'pushed it on others'. I've even said I have been trying to get a govt/VA job.

 

[vistaril]

Fair enough, I've seen quite a few of these too but never anything that high. Could be a regional thing as my experience is everywhere but the SE more or less.

If you actually have some relevant experience on this matter, then share it. Don't ***** out and make these vague references to experience that you then won't qualify in ANY way.

 

[hamstergang]

you flat out completely misrepresented what I said. And now have the gall to flat out lie about it. That is an entirely different matter than not being 'precise enough'.

There was no lying; I told you exactly what my thought process was, and I told it accurately.

I find it somewhat amusing that you've accused me of lying more than once when I've actually been completely truthful on this forum, but you've been caught lying. Isn't that a thing that psychologists have named -- people that lie or cheat assume that others do too more than others actually do?

 

[Armadillos]

Haven't been following the Vistaril shenanigans lately, thought he was leaving medicine to be a slum lord bankrolled by his GI wife who had an army of indentured servant pathologists slaving away for her.

+/- something about seeing clients at a strip club

 

[vistaril]

There was no lying; I told you exactly what my thought process was, and I told it accurately.

I find it somewhat amusing that you've accused me of lying more than once when I've actually been completely truthful on this forum, but you've been caught lying. Isn't that a thing that psychologists have named -- people that lie or cheat assume that others do too more than others actually do?

you told me what your 'thought process' was? What the **** does that even mean? What you SAID was "It's weird that he'd see patients for free but not talk to the SW for free". Since I didn't say that and didn't imply that(and you claim you can read), that is a LIE. You don't get to come back later and make up this **** later like a ***** when there is a record. You've been caught lying more just in this thread than I have i have in 4 years here.

 

[hamstergang]

you told me what your 'thought process' was? What the **** does that even mean?

Maybe you missed it even though you responded to it:

I can read just fine. I just didn't care to be precise enough is a thread where you're trying to make the worst of a situation if you're even being honest about it.

If you don't get it at this point I don't know what else to say.

 

[Trismegistus4]

you told me what your 'thought process' was? What the **** does that even mean? What you SAID was "It's weird that he'd see patients for free but not talk to the SW for free". Since I didn't say that and didn't imply that(and you claim you can read), that is a LIE. You don't get to come back later and make up this **** later like a ***** when there is a record. You've been caught lying more just in this thread than I have i have in 4 years here.

It is weird that you'd see patients for free. Why on earth would you agree to work at this job before knowing you were going to be able to bill? There are so many things wrong with this thread, I wouldn't even know where to begin in describing them all. Why not go do a temporary locums gig somewhere else, until you were empaneled and able to actually get paid at this place? Okay, they told you "if you don't start at our start date don't plan on starting period." In that case, why not tell them to go pound sand? I know you said in the other thread that you can't move, but how can a 14 on/14 off job elsewhere possibly be worse than what you're choosing to inflict on yourself with this arrangement? What is wrong with you? You expect us to believe that you're so desperate for this job, that you're choosing to work there for free for months, in the hope that eventually you'll be able to work there for money? If the climate for psychiatric practice is really as bad as you claim in your area (not that I believe that it is, since you've been posting overly negativistic crap about the practice of psychiatry since at least early in your residency,) your #1 priority should be doing whatever needs to be done in your personal life to turn that "can't move" into a "can move." If you're simply trolling, knock it off. In either case, stop clogging up the Psychiatry forum with this nonsense.

 

[Shikima]

I dunno, I find the trolling kind of fun and the learned helplessness is a real nail biter for a mystery.