C&A Cash Rates

[MrFlyGuy]

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Hi all,

I just joined a group private practice and they currently are charging for $425 for initial 60 minutes appointment and $225 for 30 minute.follow-ups.

Do you think that this is market rate for a child psychiatrist? Of course it depends on the market but I'm in a wealthier suburb but with a lot of competition in the area.

 

[randomdoc1]

depends on your income goals and what the patient population is willing to or able to pay. Considering the average household income is 80k as of 2023 pre tax with an average household size of 2.5 people....Americans don't have a lotta dollaz. It'll be mostly a trial and error process. I'd love a pay rate like that but....Americans are terrible with money and it's compounded with economy realties soooooo.....

Also, wealthy regions does not necessarily mean willing to spend more. I remember doing charities and asking for donations. And I got 3x more donations in impoverished areas than wealthy areas. They got there in part from being thrifty with their money!

 

[MrFlyGuy]

depends on your income goals and what the patient population is willing to or able to pay. Considering the average household income is 80k as of 2023 pre tax with an average household size of 2.5 people....Americans don't have a lotta dollaz. It'll be mostly a trial and error process. I'd love a pay rate like that but....Americans are terrible with money and it's compounded with economy realties soooooo.....

Also, wealthy regions does not necessarily mean willing to spend more. I remember doing charities and asking for donations. And I got 3x more donations in impoverished areas than wealthy areas. They got there in part from being thrifty with their money!

Well I get a 75/25 cut (which I'm happy with) so it's not like I see all of that but yeah it's not too shabby. Yes, Americans are bad with their money paying thousands of dollars to bring their family to Disney but question paying reasonable fees for medical appointments (one of the reasons I enjoy my cash pay patients is clearly they value their mental health).

 

[randomdoc1]

Well I get a 75/25 cut (which I'm happy with) so it's not like I see all of that but yeah it's not too shabby. Yes, Americans are bad with their money paying thousands of dollars to bring their family to Disney but question paying reasonable fees for medical appointments (one of the reasons I enjoy my cash pay patients is clearly they value their mental health).

sounds awesome ; )

 

[Merovinge]

I live in a wealthy suburb and the going rate is $500-650/hour for normal CAP (obviously 1/2 that for 30 min f/u), there are a few nationally famous folks who charge more. Your pricing is a bit low, but not wildly so.

 

[TexasPhysician]

Cash rates are geography specific. The range is massive.

 

[clozareal]

Can you set your rates with this group? It mostly depends on what the market can bear along with how good you are at marketing. Those rates are lower than adult psychiatrists in my area but I'm also in a VHCOL area. I inquired about insurance contracts, which paid more than that in my area a few years ago when I asked prior to my CAP board certification, but those are similar to what insurance is paying.

 

[allantois]

What insurance is paying $425 for intake??

 

[Atreides]

What insurance is paying $425 for intake??

Depends how long your appointment is. 99205 + 99417x2 + 96127x4 could get you there for higher paying insurances.

 

[calvnandhobbs68]

I'll say conversely in my area there's almost nobody that charges cash for C+A, everyone takes at least 1-2 insurances. Insurance also pays nowhere near 425 for an intake unless you split it into 60min initial and 30min f/u.

So yes this is highly specific to availability of child psych, how typical it is for psychiatrists to be cash only in your area and probably how many NPs are in the area as well.

 

[MrFlyGuy]

Thank you for all of your advice. I was able to raise my rates to 250 every 30 minutes for follow up appointments.

Quick question, can I write off the portion of the profits (75/25) that go to the group on my taxes? If I wasn't paying the cut to the group practice I would be able to write off my own business expenses that they are covering through my cut. I'm 1099 under my own LLC if that matters.

 

[splik]

Thank you for all of your advice. I was able to raise my rates to 250 every 30 minutes for follow up appointments.

Quick question, can I write off the portion of the profits (75/25) that go to the group on my taxes? If I wasn't paying the cut to the group practice I would be able to write off my own business expenses that they are covering through my cut. I'm 1099 under my own LLC if that matters.

No. You cannot write off money you never earned. So If you only get paid the 75% you cannot write off the 25%. However if you claim 100% as income, then you can write off the 25%. Since your 1099 would only report the income they pay you after the deduction (unless they are weird), you can't deduct it because it's not an expense. The same is true for credit card fees etc - if you only report the income after the fee deduction, you cannot deduct it, but if you report the income before deduction then you can. It works out the same either way

 

[Ironspy]

No. You cannot write off money you never earned. So If you only get paid the 75% you cannot write off the 25%. However if you claim 100% as income, then you can write off the 25%. Since your 1099 would only report the income they pay you after the deduction (unless they are weird), you can't deduct it because it's not an expense. The same is true for credit card fees etc - if you only report the income after the fee deduction, you cannot deduct it, but if you report the income before deduction then you can. It works out the same either way

My credit card processor deposits the full payment in my account and charges the fee as a separate transaction. Example-if the transaction is $100 and fee is 3%, I get a deposit of $100 and a separate fee of $3. My accountant said I could write off the cc fee which is what I have been doing.

 

[clozareal]

The initial fee is so much less important than the follow-up ones because it's just a one time charge and will help get patients through the door easier if it's lower. I'm of the opinion that it should not be just double your half an hour visit rate for a 1 hour intake, but rather more like 1.5x.

 

[calvnandhobbs68]

My credit card processor deposits the full payment in my account and charges the fee as a separate transaction. Example-if the transaction is $100 and fee is 3%, I get a deposit of $100 and a separate fee of $3. My accountant said I could write off the cc fee which is what I have been doing.

Right that's what he's saying by "if you report the income before deduction then you can". You have to realize the income in order to write off an expense. You can't deduct against income you never had.