Contract Rate for Procedures

[Asprin]

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I've started a new pain management practice, and I am in the credentialing process. Can someone provide me with a list or a reference list of in contract rates that I should negiotiate for (best rates). Also, I need to develop my own rates (independent of insurances) to bill for out of network patients, can someone provide me of a list for this as well. Thanks.

 

[Doctodd]

your rates should be the same.....but in network will pay what they pay no matter what you charge. Your rates should be about 3 times medicare, and should be consistent for all your codes. Depending on what state you live in, the percentage on your contracts will vary....i dont accept anything under 80% of Medicare(Florida sucks like that). You should do some reading on the main page of painrounds.com....lots of valuable info for starting a practice.

 

[ampaphb]

I've started a new pain management practice, and I am in the credentialing process. Can someone provide me with a list or a reference list of in contract rates that I should negiotiate for (best rates). Also, I need to develop my own rates (independent of insurances) to bill for out of network patients, can someone provide me of a list for this as well. Thanks.

It is a violation of antitrust laws for physicians to share their fee schedules

 

[Tenesma]

actually it is a violation of the contracts we sign with the insurance companies -

antitrust makes it illegal for us to share those schedules in order to negotiate with said insurance companies

i recommend medicare x 4 - that should help with out of network visits - and then create a sliding-scale for self-pay patients (% discount based on documented need - easy to set up)

if you are solo you are stuck basically taking whatever they hand you - without a large number of patients and without data to document your better outcomes you are basically unable to do ANY negotiating -

i have tried MANY times as a solo guy to negotiate with larger insurances and basically what they tell me is that they don't negotiate - take it or leave it - and they don't care...

i have been successful with smaller insurances - but they don't have a real impact on my practice (like 3 or 4 patients per year)

 

[Doctodd]

true, but you can buy a book that has the mean rates for physicians in your county/area. Then you pick the percentile you want...i chose 95% cuz im a specialist. This applies to me cuz i have Personal Injury auto patients and the judge/attorney/insurance company can depose me on why my rates are what they are. I am going by the book.

 

[Xclamp]

DT,

Care to elaborate on what book that might be?

Thanks