Net Production

[pmr10]

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Hello, I was wondering what people found to be a guideline for net production.

Essentially, what percentage of what you bill ends up being paid for? I work in an orthopedic group and our practice is collects around 40-45% (injections and clinic visits).

Are we doing something wrong or is this to be expected?

Thanks!

 

[callmeanesthesia]

Hello, I was wondering what people found to be a guideline for net production.

Essentially, what percentage of what you bill ends up being paid for? I work in an orthopedic group and our practice is collects around 40-45% (injections and clinic visits).

Are we doing something wrong or is this to be expected?

Thanks!

This has come up on several other threads. Depends on your charge master and payor mix. For example, my group charges 250% Medicare, and our payor mix all basically pay Medicare rates. Once you factor in multi-procedure and other discounts, our collection ratio is about 30%, so from my perspective you’re sounds great.

 

[Dr. Ice]

Hello, I was wondering what people found to be a guideline for net production.

Essentially, what percentage of what you bill ends up being paid for? I work in an orthopedic group and our practice is collects around 40-45% (injections and clinic visits).

Are we doing something wrong or is this to be expected?

Thanks!

That’s a good collections percentage. I collect 33% which is bad but I would say 40-45 is at least average/good

 

[jsaul]

Typically practices charge 2.5 times medicare. Based on that they usually collect anywhere between 30 to 40 percent

 

[runfastnow]

Been discussed here before.

Depends on a few things:
- What are you billing out? We do 3x Medicare rates.
- Payor mix.
- Skill of your billing department.

I see a lot of Obamacare products, Medicaid, Medicare. We bill 3x Medicare rates. Collect 38%-42% and have ~50% overhead. So I expect to get paid somewhere around 20% of what I bill out.

I'm sure there are better set ups out there, but in a smaller private practice in a state with awful BCBS/commerical payment rates it is what it is.

 

[pmr10]

Thank you for your input. Similarly, I was told to not do any Medicare procedures (including SCS and bread and butter injections) in the ASC since we do not make a profit at all there, but to do these in the office. I am not currently receiving any shares from the ASC. Is this putting myself at a large disadvantage if I collect a percentage of the professional fees at this time?

 

[GoBeers]

dumb question but what's the point of billing 2-3x medicare if you know you're only going to get paid medicare rates?

 

[Bostonspine]

dumb question but what's the point of billing 2-3x medicare if you know you're only going to get paid medicare rates?

Hopefully commercial insurance and workers comp will pay more but Ic you fee schedule is Medicare levels they will pay you that or less

 

[Status Sciaticus]

dumb question but what's the point of billing 2-3x medicare if you know you're only going to get paid medicare rates?

Hopefully commercial insurance and workers comp will pay more but Ic you fee schedule is Medicare levels they will pay you that or less

Downside of this is that it makes reporting and analysis so overinflated.
Collections rate becomes 1/3 of billed, and physicians get a false sense of what they will collect.

For example, you bill $450 for a 99204, collect $150. Your billing on paper looks like you're collecting 33%.

 

[RoloTomassi]

dumb question but what's the point of billing 2-3x medicare if you know you're only going to get paid medicare rates?

Master fee schedule needs to be higher than your best contracted rate with the best payer for any given CPT or else you're going to be leaving money on the table by charging less than what they are willing to pay.

 

[Ducttape]

generally speaking, you should not be billing a patient more (or less) based on their insurance. the office should bill patients the same amount, even if that means that the medicare patients are billed more than what their policy will pay.

the medicare policy also prevents patients from having to pay more than what is covered.

 

[nvrsumr]

There used to be more contracts that’s paid a % of what u bill. I still see once a year.

if you do PI work you want higher # . doc getting 70% of charges is common at settlement.

In my state this there is a st Supreme Court ruling that damages are based on charges not what insurance pays so the PI attorneys get their 40% of that number

 

[Status Sciaticus]

There used to be more contracts that’s paid a % of what u bill. I still see once a year.

if you do PI work you want higher # . doc getting 70% of charges is common at settlement.

In my state this there is a st Supreme Court ruling that damages are based on charges not what insurance pays so the PI attorneys get their 40% of that number

what state?

 

[cowboydoc]

what state?

That description applies to CO.