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Anesthesia Billing company

Luvssjeter

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I was looking to become a solo anesthesia doctor. I wanted to set up my billing. I’ve looked into a few billing companies and it seems that a lot of them are not that great at collecting from insurance even after all the appeals etc. Does anyone use a a good anesthesia billing company? Also, any billing companies out there that can get good in network rates for individual docs or would I just join an IPA and go through them? Any billing insight would be so appreciated. Thank you.
 
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deleted171991

I am just a lowly employee, so no experience, but I think you're looking at things the wrong way. It's not the billing companies who suck, it's the insurance ones. You're their little doggie, waiting for a bone to be thrown at you, while they feast at the table.

Why would you want to deal with insurance as a solo anesthesiologist? Better offer a great prepaid cash rate to your surgeons, and let them bill the insurance if it's worth to them.
 
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BLADEMDA

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I was looking to become a solo anesthesia doctor. I wanted to set up my billing. I’ve looked into a few billing companies and it seems that a lot of them are not that great at collecting from insurance even after all the appeals etc. Does anyone use a a good anesthesia billing company? Also, any billing companies out there that can get good in network rates for individual docs or would I just join an IPA and go through them? Any billing insight would be so appreciated. Thank you.

IMHO, the game is stacked against the little guy. Everyone wants you to be "in network" but a small player like you will be offered in network rates in the $45-$55 per unit range while the big players get $80-$110 per unit for the same cases. So, you are forced to go out of network just to get the insurance carriers to finally agree on paying you an out of network rate of $80 per unit if you agree not to bill the patient.

Eventually, this game ends when the Congress/President sign a law that forbids out of network billing rates. Then, the question remains whether you get the $80 per unit rate or the big players get reduced to $60 per unit.

The highest unit rate I have ever received is $120 per unit ( out of network) and the lowest was $13 per unit. Of course, there are cases where the insurance carrier tries to deny the claim almost completely.

My point is that being a solo doctor is extremely difficult these days and most billing companies require a minimum revenue stream to even consider taking you on as a client.
 

BLADEMDA

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I have a smaller group in Florida. We have used Anesthesia Business Consultants for since 2009. They aren't perfect but we are treated very well by them.

ABC will require a certain minimum revenue stream to take on a practice. The OP will need to inquire whether he/she meets that minimum for ABC.
 

surgndoc

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On a side note - does anybody have good resources on how to learn more about these topics? Specifically anesthesia billing, practice management and structures, reimbursement rates, healthcare economics, etc.. ? I need to become more versed (pun intended) in these topics but struggling to even decide where to begin. Any guides, web resources, even books or CME type modules would be greatly appreciated!
 

likewhatevs

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I would caution you to stay away from Abeo, but I think they won't be interested in such a small contract.

ABC won't be interested in you.

I've worked with two billers who will take individual clients in western states, anyway. PM me for the details.
 

Mman

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IMHO, the game is stacked against the little guy. Everyone wants you to be "in network" but a small player like you will be offered in network rates in the $45-$55 per unit range while the big players get $80-$110 per unit for the same cases. So, you are forced to go out of network just to get the insurance carriers to finally agree on paying you an out of network rate of $80 per unit if you agree not to bill the patient.

Eventually, this game ends when the Congress/President sign a law that forbids out of network billing rates. Then, the question remains whether you get the $80 per unit rate or the big players get reduced to $60 per unit.

The highest unit rate I have ever received is $120 per unit ( out of network) and the lowest was $13 per unit. Of course, there are cases where the insurance carrier tries to deny the claim almost completely.

My point is that being a solo doctor is extremely difficult these days and most billing companies require a minimum revenue stream to even consider taking you on as a client.

If you are a single doc, you will get whatever rate the insurance company gives you. There will be no negotiation. They will tell you what they pay the other small fish in the pond and that is the most you will ever get.
 
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BLADEMDA

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If you are a single doc, you will get whatever rate the insurance company gives you. There will be no negotiation. They will tell you what they pay the other small fish in the pond and that is the most you will ever get.


That is most true for in network rates but not for out of network billing. Until a law is passed for your state or the nation, billing out of network DOES allow you to negotiate with insurance carriers. You will end up with over $80 per unit out of network vs $45 in network most of the time. Hence, the pressure for small players ( 1 or 2 MDs) to be out of network.
 

BLADEMDA

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I would caution you to stay away from Abeo, but I think they won't be interested in such a small contract.

ABC won't be interested in you.

I've worked with two billers who will take individual clients in western states, anyway. PM me for the details.

Correct. I would encourage the OP to try to "hook up" with another group for billing purposes. They already have the contracts in place and the in network rate will be so much better. Even if you pay a 10% fee to the affiliated group for billing costs (total) the odds overwhelmingly favor you coming out ahead.
 

Mman

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That is most true for in network rates but not for out of network billing. Until a law is passed for your state or the nation, billing out of network DOES allow you to negotiate with insurance carriers. You will end up with over $80 per unit out of network vs $45 in network most of the time. Hence, the pressure for small players ( 1 or 2 MDs) to be out of network.

going out of network means you don't have a negotiated rate and you send a patient a bill for whatever your "charge" is. You could bill them $200 a unit if you wanted. The only question is how much the insurance company eventually sends you. But in my experience locally with individual docs and small groups, they cannot negotiate anything higher than whatever the insurance company gives them.
 

BLADEMDA

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going out of network means you don't have a negotiated rate and you send a patient a bill for whatever your "charge" is. You could bill them $200 a unit if you wanted. The only question is how much the insurance company eventually sends you. But in my experience locally with individual docs and small groups, they cannot negotiate anything higher than whatever the insurance company gives them.

The insurance company, or its representative, frequently reaches out to out of network billings to see if a fair rate can be agreed upon. If that happens then the company pays up immediately and the patient rarely has any copay. That "fair rate" is in the $80 per unit range not the $45 unit that they initially offered for in network. This perpetuates the cycle of the small group or solo player of billing out of network.
 

BIGphysician

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I was looking to become a solo anesthesia doctor. I wanted to set up my billing. I’ve looked into a few billing companies and it seems that a lot of them are not that great at collecting from insurance even after all the appeals etc. Does anyone use a a good anesthesia billing company? Also, any billing companies out there that can get good in network rates for individual docs or would I just join an IPA and go through them? Any billing insight would be so appreciated. Thank you.

How are you doing this? Dentals and other in-office procedures?


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chocomorsel

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How are you doing this? Dentals and other in-office procedures?


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Out West, get a couple of friends who are surgeons, get privileges at the same hospital and work together.
Or join a group of independents, bring in your surgeon, assist each other with call and there you have it.
Not all regions have exclusive contracts.
 
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BIGphysician

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Out West, get a couple of friends who are surgeons, get privileges at the same hospital and work together.
Or join a group of independents, bring in your surgeon, assist each other with call and there you have it.
Not all regions have exclusive contracts.

You’re doing that full time? You must be pretty popular if you guys have that many surgeon friends to make it a full time gig. That sounds pretty good though. I recently looked up billing companies because I wanted to get involved with covid testing but had no idea how to bill. There are some internet/mobile app/tablet type programs made for independent small scale providers that function as an EMR and billing service - something must exist similar for anesthesia?


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chocomorsel

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You’re doing that full time? You must be pretty popular if you guys have that many surgeon friends to make it a full time gig. That sounds pretty good though. I recently looked up billing companies because I wanted to get involved with covid testing but had no idea how to bill. There are some internet/mobile app/tablet type programs made for independent small scale providers that function as an EMR and billing service - something must exist similar for anesthesia?


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I practiced in NV before. This is how some people did it. Some people were completely independent and had their own surgeons. I joined a group. It can pretty cutthroat though. But you can always drop surgeons you can’t stand too if you don’t want that piece of the pie. Although we are the underdogs in the relationship.
 
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