Flipped Payment Model for Pathology

[LADoc00]

Im successfully forging ahead with a new business model where I have outpatient work that I directly bill patients and then have them submit the claim to their insurance.

At first I was skeptical that this could be pulled off, now Im very very excited month or so in.

I think this is the way forward. Biopsy/test--->payment--->report+receipt with all information neatly displayed for insurance submission-->patient gets results and engages their own insurance company for repayment.

Old lady calls Anthem everyday to get 100 bucks reimbursement is more effective than an army of billers...and its free.

Guys this is working...well.....have I just "disrupted the industry" with my innovation? hahahah.

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[Spikebd]

I wonder if other groups have tried this?

 

[deleted314957]

This is what many, many businesses do. insurance check going to roofer, etc., etc.when you have smoke/ water damage, they tell you up front that they have no relation with the insurance company. you must submit your own claim.

we stopped doing this ages ago as a “ convenience “ for the patient.(and other reasons).

 

[AZpath]

The main issue to me is how to collect payment.
The next issue is how many people get pissed off that they have file themselves.
You might loose clients over a handfull of unhappy patients.

Does the hospital or clinic send you CC info or cash with the specimen ?
Or do you call the patient for payment and start processing when paid ?
What happens if you are OON or the amount paid is fare less than you charge? Are they going to be more pissed ?
Finally, are you just charging a flat fee that includes a margin for IHC or calling back for if you need IHC?

 

[deleted314957]

The main issue to me is how to collect payment.
The next issue is how many people get pissed off that they have file themselves.
You might loose clients over a handfull of unhappy patients.

Does the hospital or clinic send you CC info or cash with the specimen ?
Or do you call the patient for payment and start processing when paid ?
What happens if you are OON or the amount paid is fare less than you charge? Are they going to be more pissed ?
Finally, are you just charging a flat fee that includes a margin for IHC or calling back for if you need IHC?

You very often CANNOT collect and they WILL be pissed off because our profession has set this precedent. This is one reason that salaried/employment situations are becoming more and more dominant. We screwed ourselves.

 

[LADoc00]

The main issue to me is how to collect payment.
The next issue is how many people get pissed off that they have file themselves.
You might loose clients over a handfull of unhappy patients.

Does the hospital or clinic send you CC info or cash with the specimen ?
Or do you call the patient for payment and start processing when paid ?
What happens if you are OON or the amount paid is fare less than you charge? Are they going to be more pissed ?
Finally, are you just charging a flat fee that includes a margin for IHC or calling back for if you need IHC?

Here is the thing: a smaller number of cash pay patients is worth far more than numerous patients with insurance denials/reductions.

This is the real crux of the issue: Pathology isnt a numbers game, reading the 100th slide of the day is just as challenging as reading the 1st slide. Past a certain point (maybe 30 cases per pathologist per day?), there is NO ECONOMIES OF SCALE for reading surgical pathology so less clients is actually more. Im getting more money per patient, less headache, zero days on AR and yes perhaps, maybe...doing slightly less work but that means I can do other things like drink whiskey in my hot tub.

interesting point: ALOT of people think somehow if they are paying cash upfront they are getting concierge service, which in a very real way they are getting because you are reducing your volumes and focusing on a smaller number of patients, and I think this could lead to more referrals, not less.

Fear prevents most groups from doing anything, except watch their income drop 5% a year to zero or even worse watch their income stagnate but sign out 15% more cases a year just to tread water.

 

[AZpath]

Here is the thing: a smaller number of cash pay patients is worth far more than numerous patients with insurance denials/reductions.

This is the real crux of the issue: Pathology isnt a numbers game, reading the 100th slide of the day is just as challenging as reading the 1st slide. Past a certain point (maybe 30 cases per pathologist per day?), there is NO ECONOMIES OF SCALE for reading surgical pathology so less clients is actually more. Im getting more money per patient, less headache, zero days on AR and yes perhaps, maybe...doing slightly less work but that means I can do other things like drink whiskey in my hot tub.

interesting point: ALOT of people think somehow if they are paying cash upfront they are getting concierge service, which in a very real way they are getting because you are reducing your volumes and focusing on a smaller number of patients, and I think this could lead to more referrals, not less.

Fear prevents most groups from doing anything, except watch their income drop 5% a year to zero or even worse watch their income stagnate but sign out 15% more cases a year just to tread water.

I get that you are not afraid of lost business. Obviously this can work.
OON works too for the same reason.
What about my other questions?

 

[LADoc00]

The main issue to me is how to collect payment.
The next issue is how many people get pissed off that they have file themselves.
You might loose clients over a handfull of unhappy patients.

Does the hospital or clinic send you CC info or cash with the specimen ?
Or do you call the patient for payment and start processing when paid ?
What happens if you are OON or the amount paid is fare less than you charge? Are they going to be more pissed ?
Finally, are you just charging a flat fee that includes a margin for IHC or calling back for if you need IHC?

Not doing this for hospital inpatients or hospital cases in general, Im not there yet. Just outpatients.

We get paid prior to a released result.

We have less than 4% of patients give negative feedback. That is roughly what the negative feedback rate was before as well even with insurance and copay model.

Flat fee, if IHC is needed that needs to be a bundled price (like another $200 max) that your customer service person needs to sell.

 

[reno911]

Not doing this for hospital inpatients or hospital cases in general, Im not there yet. Just outpatients.

We get paid prior to a released result.

We have less than 4% of patients give negative feedback. That is roughly what the negative feedback rate was before as well even with insurance and copay model.

Flat fee, if IHC is needed that needs to be a bundled price (like another $200 max) that your customer service person needs to sell.

What happens if you diagnose a cancer? Do you just sit on the result until you get paid? And if for some reason you don't get paid, then what?

 

[deleted314957]

What happens if you diagnose a cancer? Do you just sit on the result until you get paid? And if for some reason you don't get paid, then what?

That’s the rub. I said, jokingly, years ago on this forum, that it would be great if we could hold the diagnosis in escrow. i.e. when we get paid, you get dx. Could be a great way to lose your license if someone complained to the state board.

 

[HeyDalaron]

That’s the rub. I said, jokingly, years ago on this forum, that it would be great if we could hold the diagnosis in escrow. i.e. when we get paid, you get dx. Could be a great way to lose your license if someone complained to the state board.

A solution would be to provide diagnoses immediately and sell debt to collection agency upon non-payment, similar to what telecom companies do.

 

[deleted314957]

A solution would be to provide diagnoses immediately and sell debt to collection agency upon non-payment, similar to what telecom companies do.

Isn’t that what most folks do? Sign out case (i.e. provide the diagnosis) then generate a bill. Bad debt gets written off or goes to collections or generates a lawsuit depending on the aggressiveness of the group.

We will face a plethora of problems in this field until we control SUPPLY AND DEMAND.