How to go solo from a group practice.

[trixter888]

Hello everyone.

I was wondering if those who have made a transition from a group practice to their own solo practice might be able to help me with this transition. I will spare you the details about why I am leaving.

Current situation: I am a 1099 employee and in the process of credentialing. I would like to set up a private practice cash only.

Questions:
-My main question is that if I get credentialed under his group practice, can I then start up my own practice to take Cash Only patients? I don't want to run into a scenario where I am breaching a contract because I am taking cash from a patient who has insurance. Should I reach out to each individual insurance company to see what the policy is to ensure that I can see cash only patients later?
-I plan on updating all my information (NPI, insurance, DEA, CSA, etc) however will this address change affect the credentialing process? Again, I ideally would like to get credentialed and reimbursed but I also want to actively pursue other patients.
-New business: If I am starting my own private practice with cash only intentions will I need a separate NPI (NPI I and II)?

I would appreciate any advice or wisdom others have about completing this process.

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[clausewitz2]

If you are seeing the cash only patients at a different notional address, you are not breaching your contract. You are credentialed with them to provide services at a specific location, not globally. Re: abandonment, check your state statutes. In my state, doing what you are proposing is going above and beyond a bit and it would be enough to provide them with instructions about how to get names of other providers through their insurance companies; to be on the safe side probably also provide a few months worth of whatever you have been prescribing.

You don't need a separate or new individual NPI.

 

[trixter888]

If you are seeing the cash only patients at a different notional address, you are not breaching your contract. You are credentialed with them to provide services at a specific location, not globally. Re: abandonment, check your state statutes. In my state, doing what you are proposing is going above and beyond a bit and it would be enough to provide them with instructions about how to get names of other providers through their insurance companies; to be on the safe side probably also provide a few months worth of whatever you have been prescribing.

You don't need a separate or new individual NPI.

Thanks Clausewitz.

Given that the group practice has multiple providers, I was just going to have them get scheduled with another provider in clinic. I imagine this would be enough?

Additionally in what situation would I need an NPI II? Do I not need one because I am only going to do cash only?

Do you know if me changing the address for all of my DEA/NPI will affect the credentialing process? Just wondering.

Thank you!

 

[calvnandhobbs68]

Id trust them about zero with the back billing thing. I know someone who was told that and a year later is still trying to get paid for those visits that were supposed to be able to be “back billed”. Most private insurance companies are gonna fight about that one…if you weren’t in network then you weren’t in network at the time of service and they probably are going to try to avoid paying as if you were in network.

Different than medicaid for instance where back billing is often possible because if a child is eligible for Medicaid but just not enrolled, that child would have been eligible for services anyway at the time of service provision if the provider was a Medicaid registered provider.

 

[trixter888]

Id trust them about zero with the back billing thing. I know someone who was told that and a year later is still trying to get paid for those visits that were supposed to be able to be “back billed”. Most private insurance companies are gonna fight about that one…if you weren’t in network then you weren’t in network at the time of service and they probably are going to try to avoid paying as if you were in network.

Different than medicaid for instance where back billing is often possible because if a child is eligible for Medicaid but just not enrolled, that child would have been eligible for services anyway at the time of service provision if the provider was a Medicaid registered provider.

Currently I am only seeing Medicare and Medicaid. They state that I can back bill only with those. I am seeing no other insurances.

 

[calvnandhobbs68]

Currently I am only seeing Medicare and Medicaid. They state that I can back bill only with those. I am seeing no other insurances.

Got it then that makes sense.

That also matters for your question above. If you’re opted in to Medicare (and possibly Medicaid depending on the state, you need to check your state regulations) you are opted in EVERYWHERE. Which means you cannot charge those patients cash. Some states will allow you to charge Medicaid patients cash if you have them sign something saying you will not submit charges to Medicaid and they understand that but this is super state dependent.

 

[Sushirolls]

Probably should seriously look at the encounter done so far and try to estimate out how much money is on the table for this current/past gig.

Chances are the dollar value just isn't worth the headache of sticking around to see how things unfold. And when you are starting our own practice any downtime you have in early stages will be used, in developing efficiency work flows, or troubleshooting the intake process, or a whole host of other things to optimize. Might want to consider just dropping this gig entirely and not get bogged down by it.

You can always call up the insurance companies they are paneling you with and ask them how your are being paneled. They will tell you if you are under their NPI-II or not if you really want to know. Can also ask them if you leave open your place, can you flip that contract over to be your own or if they will require you to start a whole new application. Just assume 98% will require new applications. All of mine required new, but the Sleep doc subleasing form me got one to just flip over one contract.

 

[trixter888]

Probably should seriously look at the encounter done so far and try to estimate out how much money is on the table for this current/past gig.

Chances are the dollar value just isn't worth the headache of sticking around to see how things unfold. And when you are starting our own practice any downtime you have in early stages will be used, in developing efficiency work flows, or troubleshooting the intake process, or a whole host of other things to optimize. Might want to consider just dropping this gig entirely and not get bogged down by it.

You can always call up the insurance companies they are paneling you with and ask them how your are being paneled. They will tell you if you are under their NPI-II or not if you really want to know. Can also ask them if you leave open your place, can you flip that contract over to be your own or if they will require you to start a whole new application. Just assume 98% will require new applications. All of mine required new, but the Sleep doc subleasing form me got one to just flip over one contract.

Interesting. Right now only about $2500-2800 is on the table. Again, it may not be worth even pursuing. But with no job, any penny counts if you know what I mean!

Sounds like to me that opening a cash practice is the most simple at this time.

 

[michaelrack]

Why not do both (the group practice and your own private practice)? The only complication I can see is the malpractice insurance.... who is providing it, you or the group?

 

[Jules A]

I’d recommend more research into the financial aspects of opening a business with regard to taxes and also retirement account funding. A cash only practice can take a while to build and based on your questions and the fact that you did S-Corp under current circumstances makes me think you would benefit from additional education. Michaelrack’s suggestion to remain at current place while opening your cash practice is excellent.

 

[trixter888]

I’d recommend more research into the financial aspects of opening a business with regard to taxes and also retirement account funding. A cash only practice can take a while to build and based on your questions and the fact that you did S-Corp under current circumstances makes me think you would benefit from additional education. Michaelrack’s suggestion to remain at current place while opening your cash practice is excellent.

I think it is a fair option to do both, but I don't know how much my current employer would like that. I can definitely update my malpractice insurance with this information as I supply it on my own.

In regards to finances, I feel pretty savvy with this and S-Corp was set up with other factors in mind including spouses income and how I want to save/report to the IRS my own income as an employee.

 

[dl2dp2]

I think it is a fair option to do both, but I don't know how much my current employer would like that.

You don't have to tell them, and unless it's explicitly in the contract (disclosure of outside activities) they can't even ask you, and if they ask you don't have to answer, or answer accurately.

Very often people don't disclose even when it's in the contract. And should you decide to disclose, there's a very broad range of what you need to disclose when you disclose outside activities to satisfy compliance (i.e. typically this is related to conflict of interest). It's highly unlikely that your company would fire you for non-disclosure of outside activities that have no conflict of interest.

Given you are 1099, it's highly likely that you don't need to disclose anything, as this runs afoul of IRS definition of what 1099 means. Do your own thing on the side and quit when your solo practice takes off. Trust me, your current employer already knows/assumes everyone's doing that anyway. Nobody was born yesterday.

 

[Mass Effect]

You don't have to tell them, and unless it's explicitly in the contract (disclosure of outside activities) they can't even ask you, and if they ask you don't have to answer, or answer accurately.

Can an employer require you disclose outside activities? Like I get a non-compete, but doesn't that take effect only after termination?

 

[dl2dp2]

Can an employer require you disclose outside activities? Like I get a non-compete, but doesn't that take effect only after termination?

Yes. This happens often with govt agencies and academic institutions for very obvious reasons. COIs also need ongoing updates. However, generally, the approach is not one where outside activities that present with COIs are "forbidden", as many activities that have COIs also have a positive institutional impact from a different angle. This type of work falls under the rubric of "managing COI", and is important in things like intellectual property, equity sharing arrangement, that sort of thing. If you are not dealing with this it's probably above your pay grade.

 

[Mass Effect]

Yes. This happens often with govt agencies and academic institutions for very obvious reasons. COIs also need ongoing updates. However, generally, the approach is not one where outside activities that present with COIs are "forbidden", as many activities that have COIs also have a positive institutional impact from a different angle. This type of work falls under the rubric of "managing COI", and is important in things like intellectual property, equity sharing arrangement, that sort of thing. If you are not dealing with this it's probably above your pay grade.

Guess I should check my academic institution's policies because I'm not familiar with that being in my contract. I had read on SDN previously that some places forbid outside activities but I thought that was something that was struck down in court.

 

[Sushirolls]

Courts are state specific

 

[Jules A]

Can an employer require you disclose outside activities? Like I get a non-compete, but doesn't that take effect only after termination?

Yes and I heard an employer that approves a side gig during contract negotiations could later claim that position is in the non-compete radius after you resign unless specifically noted as excluded from the non-compete criteria as well.

 

[Mass Effect]

Yes and I heard an employer that approves a side gig during contract negotiations could later claim that position is in the non-compete radius after you resign unless specifically noted as excluded from the non-compete criteria as well.

WTF? Why are any of us putting up with such nonsense? I would relish seeing these challenged in court.

 

[calvnandhobbs68]

Yes and I heard an employer that approves a side gig during contract negotiations could later claim that position is in the non-compete radius after you resign unless specifically noted as excluded from the non-compete criteria as well.

I mean just get it in writing and you’re fine. I don’t get why this is so hard for people. Nothing exists unless it was written down somewhere (including medical records)…you can always get screwed over by handshake deals.