Billing Q

[nvshelat]

So they don't teach us about billing in med school...
I recently had an endoscopy done... my claim shows the following:

GI doc - Billed 1100, Paid 274 by plan
Anesth - billed 1000, paid 985 by plan

My questions are:
(1) Is it normal to get paid only a small % of what you bill
(2) why did the anesthesiologist get paid by the insr comp so much more than the GI doc and
(3) when you dont get comp'd for the full amt you bill, is there any place you make it up? or is it w/ incr volume?

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[urge]

I would love to anesthetize you.

 

[Coastie]

Yeah, seriously. Post your insurance type, and encourage your friends to get the same plan.

I would love to anesthetize you.

 

[nvshelat]

United

They make us get it thru school - its either that, medicaid, or cov'd by spouse or parents.

Guess a couple o' anesthesiologists have been gettin lucky...

My other surgical procedure this yr:
said surgical specialist: billed 6450; insr paid 445.43
said anesthesiologist: billed 1440; insr paid 890.


But in all seriousness, i really don't get it... can someone explain the discrepency??

 

[militarymd]

Holy crap...everyone should have insurance like that....

Frequently there is a negotiated rate, where the insurance company pays a certain amount of your fee....and depending on the arrangement you may or may not be able to bill the patient for the balance.

 

[core0]

So they don't teach us about billing in med school...
I recently had an endoscopy done... my claim shows the following:

GI doc - Billed 1100, Paid 274 by plan
Anesth - billed 1000, paid 985 by plan

My questions are:
(1) Is it normal to get paid only a small % of what you bill
(2) why did the anesthesiologist get paid by the insr comp so much more than the GI doc and
(3) when you dont get comp'd for the full amt you bill, is there any place you make it up? or is it w/ incr volume?

I can answer the GI part. Every practice has their standard fee for a procedure. This is set relatively high so that if the one patient in the world with real insurance walks into your office you can charge them the full freight. Usually there is another number that is negotiated directly with the insurance company. Since their are thousands of procedures, usually the insurance company says we will pay you "x%" of Medicare rate. If you are in a strong position to negotiate, which GI usually is then it can be something like 150%. If you are in an oversaturated market it may be something like 90%.

Here is an example of EGD payments for Medicare:
http://www.ethiconendo.com/docs/2008Gerd_rev_1.pdf

The global fee is the physician fee. So for an EGD Medicare would pay $286.41 without biopsy. I am guessing you are in the Northeast because
1. The reimbursement sucks
2. The insurance is paying for anesthesia.

The other part of the bill is the reimbursement for the AEC. If you had it done in a hospital outpatient GI lab then the fee is $541.59. For an AEC the fee is $337.76. A lot of AECs are owned by the GI physicians and this makes the endoscopy much more lucrative.

Finally there is usually a geographic adjustment for cost of living in certain areas. This may mean the average payment will be more or less depending on the local costs.

David Carpenter, PA-C

 

[m3unsure]

Few questions that I couldn't find by searching the forum.

How do anesthesiologists pull in large figures specifically?
What percentage of the salary is actually billing insurance companies or Medicare? % from hospitals on average? Are the billable services of different value from CRNAs?

How do CRNAs pull in high figures than GPs even when working regular shifts adding up to less than 40-50 hrs/wk? Is there a comparable job for anesthesiologists? And would the pay be around the same?

I'm just wondering based on a few sources about the billing because I want to know how a CRNA could possibly be more cost-effective than a MD, especially when call and malpractice coverage become an issue. For example, a CRNA salary of 120000 for two 24 hour job/week seems ridiculous(ly good). Another search on gaswork in IL,IN,WI yielded no call jobs from 130-190. That's also good concerning no malpractice fees for nurses.

How can this help or hurt to keep MD anesthesiologists alive for at least the next 2,3,4 decades? How can CRNAs push out MDs from a financial aspect in gas (if they work a lot of "shifts")? Would it be via hospitals or some other source? Or are these agencies just lying on gaswork to get you to call? Car salesman

On a side note, there are many CRNA groups on gaswork that are completely autonomous. They supposedly are doing some vascular and heart cases. One actually emphasized no "MDA!!!!" How common is this? I've never seen a CRNA in the room for longer than 15 minutes giving a coffee break, and he/she is ready to call us back in as soon as possible.

Knowledge from practicing physicians in the private world would be helpful. If preferred for whatever reason to remain anonymous, then please send me a private message. Thanks to all.

 

[Arch Guillotti]

How do CRNAs pull in high figures than GPs even when working regular shifts adding up to less than 40-50 hrs/wk? Is there a comparable job for anesthesiologists? And would the pay be around the same?

I'm just wondering based on a few sources about the billing because I want to know how a CRNA could possibly be more cost-effective than a MD, especially when call and malpractice coverage become an issue. For example, a CRNA salary of 120000 for two 24 hour job/week seems ridiculous(ly good). Another search on gaswork in IL,IN,WI yielded no call jobs from 130-190. That's also good concerning no malpractice fees for nurses.

How can this help or hurt to keep MD anesthesiologists alive for at least the next 2,3,4 decades? How can CRNAs push out MDs from a financial aspect in gas (if they work a lot of "shifts")? Would it be via hospitals or some other source? Or are these agencies just lying on gaswork to get you to call? Car salesman

CRNA threads have been beat to death here over the past few years. Most of us are loathe to discuss these topics because they just end in flamewars.

 

[dhb]

1 grand for an endoscopy if the dudes got 20 like you on the day he can work 12 days per year.

 

[jwk]

How do CRNAs pull in high figures than GPs even when working regular shifts adding up to less than 40-50 hrs/wk? Is there a comparable job for anesthesiologists? And would the pay be around the same?

I'm just wondering based on a few sources about the billing because I want to know how a CRNA could possibly be more cost-effective than a MD, especially when call and malpractice coverage become an issue. For example, a CRNA salary of 120000 for two 24 hour job/week seems ridiculous(ly good). Another search on gaswork in IL,IN,WI yielded no call jobs from 130-190. That's also good concerning no malpractice fees for nurses.

How can this help or hurt to keep MD anesthesiologists alive for at least the next 2,3,4 decades? How can CRNAs push out MDs from a financial aspect in gas (if they work a lot of "shifts")? Would it be via hospitals or some other source? Or are these agencies just lying on gaswork to get you to call? Car salesman

On a side note, there are many CRNA groups on gaswork that are completely autonomous. They supposedly are doing some vascular and heart cases. One actually emphasized no "MDA!!!!" How common is this? I've never seen a CRNA in the room for longer than 15 minutes giving a coffee break, and he/she is ready to call us back in as soon as possible.

Knowledge from practicing physicians in the private world would be helpful. If preferred for whatever reason to remain anonymous, then please send me a private message. Thanks to all.

Gas salaries and compensation for anesthetists (and anesthesiologists) are a function of supply and demand, including location and type of practice.

CRNA's rarely if ever do hearts on their own. I would challenge any of them to post the name of a single hospital in the US that does hearts without an anesthesiologist around. Sure, there are plenty of programs that use both CRNA's and AA's for hearts, transplants, big neuro, etc., but virtually all of them have anesthesiologists involved. There are indeed many CRNA's that are practicing independent of anesthesiologists, but even though they claim "independence", particularly in opt-out states, none of them practice truly independently of physicians.

Your comment about not seeing a CRNA in a room for longer than 15 minutes may be an anomaly for your teaching institution - in the real world, that simply isn't how things work. Malpractice insurance is most certainly a concern for CRNA's (where did you come up with that comment?) but it's cheaper than that for anesthesiologists, and frequently paid by the employer or group. However, malpractice rates are creeping up for CRNA's, especially for those banging the independent practice drum.

 

[m3unsure]

Gas salaries and compensation for anesthetists (and anesthesiologists) are a function of supply and demand, including location and type of practice.

CRNA's rarely if ever do hearts on their own. I would challenge any of them to post the name of a single hospital in the US that does hearts without an anesthesiologist around. Sure, there are plenty of programs that use both CRNA's and AA's for hearts, transplants, big neuro, etc., but virtually all of them have anesthesiologists involved. There are indeed many CRNA's that are practicing independent of anesthesiologists, but even though they claim "independence", particularly in opt-out states, none of them practice truly independently of physicians.

Your comment about not seeing a CRNA in a room for longer than 15 minutes may be an anomaly for your teaching institution - in the real world, that simply isn't how things work. Malpractice insurance is most certainly a concern for CRNA's (where did you come up with that comment?) but it's cheaper than that for anesthesiologists, and frequently paid by the employer or group. However, malpractice rates are creeping up for CRNA's, especially for those banging the independent practice drum.

The reason why the CRNA is not really much longer in the room is because the program emphasizes MDs doing those cases. The CRNAs spend a lot of time in the bread and butter rooms like at most programs. How is the situation in the real world?

I know that A physician still supervises CRNAs because most institutions would rather have the surgeon included under the liability blanket. Malpractice is a concern for CRNAs too, but based on my knowledge, their coverage is less of an issue than MDs. However, your comment on their rates going up make senses because I highly doubt the hospital would take on the liability alone without a trickle down effect.

I can only hope and pray to guy upstairs that all the economics and politics don't waste 8 years of my life, especially when NBME is assisting the cause of midlevels to take over. Looks like Obama is likely to be president. If you're a higher up in ASA, make sure to get him behind us. Otherwise, internal medicine aka default option might have not been a bad idea.

 

[m3unsure]

So, let's just say the following without getting the whole CRNA issue started.

If we do a surgery under Medicare/Medicaid, then how much reimbursement for...
the surgeon? and the gas provider?

I was wondering if there is some nice summary comparing both specialties or even with other specialties just under Medicare excluding what private companies give out.