FP insurance re-imbursement

Discussion in 'Family Medicine' started by ComicBookHero20, Dec 17, 2008.

  1. ComicBookHero20

    ComicBookHero20 Senior Member
    10+ Year Member

    May 17, 2004
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    Now this sounds idiotic but one of my friends fathers who does Outpatient Primary Care as an Internist

    he insists that although there is huge overlap between what he does in his practice versus what an FP would do in the outpatient setting

    that let's say he bills for evaluating a HTN pt (i think the reimbursement is $50) that he get's the $50, but an FP who would do the EXACT same thing would get less than $50

    this sounds really silly and not plausible

    but he says this with such certainty as he knows the sky is blue and grass is green

    the other issue is, and this has been reverberated on this board, not too many people know how to bill or anything about billing
  2. Blue Dog

    Blue Dog Fides et ratio.
    Physician Gold Donor SDN Advisor Classifieds Approved 10+ Year Member

    Jan 21, 2006
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    Attending Physician
    If you're billing Medicare, it doesn't matter what specialty you're in. Everyone gets paid the same thing for the same code.

    Private insurers, on the other hand, can negotiate whatever fee schedules they want. Two different people in the same specialty can be reimbursed differently for doing the same thing. Of course, you'll have difficulty figuring this out, since it's illegal for physicians to compare fee schedules (collusion).

    The reality is that unless your friend's father has some sort of leverage with or strategic value for a given insurer, chances are he's being reimbursed pretty much the same as the other primary care physicians in his area, regardless of specialty.
    #2 Blue Dog, Dec 17, 2008
    Last edited: Dec 17, 2008
  3. sophiejane

    sophiejane Exhausted
    Moderator Emeritus 7+ Year Member

    Sep 18, 2003
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    Resident [Any Field]
    Exactly. So the friend's father's blanket statement is false. It's entirely possible that an FP somewhere has negotiated for higher reimbursement than he is getting for that visit for HTN.

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