New Cash Only Private Practice - Work in Progress

[Sushirolls]

Assuming day job is employed elsewhere... You are only in network under that businesses Tax ID number and their Type II NPI number.

You, the individual are not in network, NPI type I, with any of the insurance. EXCEPT Medicare, sort of, and medicaid, sort of.

Medicare you are either in, out, or Non-Par. Sounds like you are in with a different place.

You can't accept cash pay from medicare patients unless you are completely out of network, and medicare knows it, has you on file with their form that you opted out of network, and even then, you have to give Medicare patients a form that says you are out of network... Perhaps, this is a gray area, for those who have medicare advantage plans like humana or UHC etc where you don't submit to medicare but that private insurance company, you might be able to charge them cash... I'm not 100% sure, but have defaulted to not doing so and simply saying OON, sorry, can't help you and can't take cash either.

Medicaid is state based, each state and medicaid is different, but can possibly mirror medicare. Or may be much more simple like a private insurance, and you can simply charge cash because you are not in network at your PP.

You are not in network with any private insurance... until... you have actually submitted to them for your you NPI type I and your Tax ID (+/- type II NPI also). Then after they offer and you sign a contract, your LOCATION and TAX ID and NPI type I (and NPI type II?) will be good to go. If you haven't done this with any private insurance company, you are OON and can charge cash.

---

Members don't see this ad.

 

[Doctorows]

Assuming day job is employed elsewhere... You are only in network under that businesses Tax ID number and their Type II NPI number.

You, the individual are not in network, NPI type I, with any of the insurance. EXCEPT Medicare, sort of, and medicaid, sort of.

Medicare you are either in, out, or Non-Par. Sounds like you are in with a different place.

You can't accept cash pay from medicare patients unless you are completely out of network, and medicare knows it, has you on file with their form that you opted out of network, and even then, you have to give Medicare patients a form that says you are out of network... Perhaps, this is a gray area, for those who have medicare advantage plans like humana or UHC etc where you don't submit to medicare but that private insurance company, you might be able to charge them cash... I'm not 100% sure, but have defaulted to not doing so and simply saying OON, sorry, can't help you and can't take cash either.

Medicaid is state based, each state and medicaid is different, but can possibly mirror medicare. Or may be much more simple like a private insurance, and you can simply charge cash because you are not in network at your PP.

You are not in network with any private insurance... until... you have actually submitted to them for your you NPI type I and your Tax ID (+/- type II NPI also). Then after they offer and you sign a contract, your LOCATION and TAX ID and NPI type I (and NPI type II?) will be good to go. If you haven't done this with any private insurance company, you are OON and can charge cash.

If you are in network with Medicare at your day job and your PP is cash only, are you allowed to decline to see any Medicare patients the sole reason being that they are Medicare patients? And does that change if they want to pay cash?

 

[hamstergang]

If you are in network with Medicare at your day job and your PP is cash only, are you allowed to decline to see any Medicare patients the sole reason being that they are Medicare patients? And does that change if they want to pay cash?

This was answered in that post:
"You can't accept cash pay from medicare patients unless you are completely out of network, and medicare knows it, has you on file with their form that you opted out of network, and even then, you have to give Medicare patients a form that says you are out of network..."

So yes, you MUST decline to see them in your PP. If you take their cash and Medicare finds out, they will be very mad at you. You don't want to make the federal government mad.

 

[hamstergang]

Medicaid is state based, each state and medicaid is different, but can possibly mirror medicare. Or may be much more simple like a private insurance, and you can simply charge cash because you are not in network at your PP.

Does anyone know which states work which way? Or how common either is? I always hear (and say myself) that Medicaid is state-based, but it could be that 49 states have Medicaid set up like Medicare and only 1 doesn't, and then this advice is true but not very helpful.

 

[Sushirolls]

Sometimes the advice you get on an anonymous forum is worth what you paid for it?
Or perhaps it could be an informative project for you to research, spread sheet it, and post up on SDN?

The good news is, Medicaid is very well known to be a positive, well run organization with very accessible information, quality personnel operating customer service, just a phone call away, and very good thorough help section on their websites, with an almost AI like level of search capabilities. They strive for not just quality medical coverage, but pinnacle dissemination of information. A real beacon, in the sea of government expansion, that enforces the mantra, "I'm from the government and I'm here to help (comrade)." An entity that can shake the core beliefs of even Ron Swanson. <---all sarcasm

 

[Doctorows]

This was answered in that post:
"You can't accept cash pay from medicare patients unless you are completely out of network, and medicare knows it, has you on file with their form that you opted out of network, and even then, you have to give Medicare patients a form that says you are out of network..."

So yes, you MUST decline to see them in your PP. If you take their cash and Medicare finds out, they will be very mad at you. You don't want to make the federal government mad.

Thanks. I've been wondering if accepting Medicare/Medicaid at your day job would effectively prevent your from having a cash only private practice, glad to hear that's not the case.

 

[smalltownpsych]

I am doing cash pay and more and more I realize that often the most important screening questions are financial. When we take a call, our first statement is to reiterate that payment is required and we don’t bill insurance. Half the people hang up right then and we didn’t want them anyway. These people don’t pay attention to the web info. The people that have resources tend to read more about what we do and get the point right away. A website is needed for those people. I had a family pick my practice for their adolescent last week because what I described online was closest to an intensive outpatient level of services and that I keyed In on a couple of other key needs that matched. Perfect match since that is my intent. Tell everyone who your ideal patients are and why you can help them and they will find you. Good luck!

 

[FI-Prexa]

Update:

I have received several messages asking how things are going. I am long overdue for an update post! Things are going well (and busy) which is why I haven't been able to post lately. I appreciate the messages asking about the practice, its nice to know that people are rooting for you!

I have taken on some new responsibilities at my day job (which is compensated) and the practice is getting busier. I am now up to 8 regular patients. 3 are seeing me biweekly for meds + therapy and the other 5 are monthly currently. I'm busy enough that I typically have 2-3 appointments per week (I only see private patients one week night/week). Referrals have been about a 50/50 split with half coming from the community/advertising and half coming from my inpatient gig (either my patients or from colleagues). I am quite selective with which patients I take so I am comfortable with the growth thus far.

I was able to take a profit in August and September (About $650 and $1300, respectively). I have pretty strict criteria in order to take profit so am happy with the money starting to come in now. I keep a business emergency fund worth 2 months of expenses, set aside taxes (35%) and make sure current month and next month bills are covered (so I guess that's technically 3-4 months emergency fund?). Only then do I take profit. This works for me as I make enough from my day job and my spouse and I never want to have to put our personal money back into the practice. We want it to be fully self sufficient, even if that means slower cash flow initially.

I am now comfortably covering expenses while being one month ahead and taking small profits. So any additional work at this point is pure profit (minus taxes).

Luminello has been great. Communicating with patients is easy regarding labs/refills or other requests. Patient's have not been abusing my availability (likely due to strict screening of new patients and good boundaries). I have received good feedback from patients and their PCPs/therapists who refer. Things that set me aside are that I have no waiting list and actually respond to messages/listen to patients during assessments. I make a point to not do much writing during the assessment and document after. Unfortunately (or fortunately for me), it doesn't take much to set yourself apart as an above average (or great) psychiatrist.

The practicing of medicine itself has been awesome. Its a nice compliment to the work I do during the day (inpatient + PHP + CL). Sometimes its hard to go to the office from 5 pm to 9 pm after a full day of inpatient but once I get there, I enjoy it and feel in the zone.

I always enjoyed when Sushirolls would drop some specific numbers regarding the practice so will try to do that soon. I will also try to be better about answering questions/keeping you guys and gals updated.

Thanks!
FI-Prexa

 

[JuicedToTheSocks]

I don't plan on taking insurance. I will provide a summary of services for patients to use to get some out-of-network reimbursement.

Do you have a goal salary?

What is your motivation for going solo? I'm an MS3 interested in doing something similar to maximize autonomy, salary, and to not work for some annoying geek.

 

[Geraltofrivia]

Hey, great post! I'm interested in basically doing the same. Where can I go to find a guide for how to do this? Haha

 

[ObsequiousAplomb]

Do you have a goal salary?

What is your motivation for going solo? I'm an MS3 interested in doing something similar to maximize autonomy, salary, and to not work for some annoying geek.

Small world. I went in to solo private practice explicitly so that I could make sure I would be working for some geek.

 

[clozareal]

Hey, great post! I'm interested in basically doing the same. Where can I go to find a guide for how to do this? Haha

You find a mentor that will help guide you through this process. Sometimes you pay for this if you want a more formal structure.

Or you can buy a book:

Private Practice Guidebook — Anna Glezer, MD

www.startapsychpractice.com

Amazon product

 

[ObsequiousAplomb]

You find a mentor that will help guide you through this process. Sometimes you pay for this if you want a more formal structure.

Or you can buy a book:

Private Practice Guidebook — Anna Glezer, MD

www.startapsychpractice.com

Amazon product

$32. Did you find it worthwhile?

 

[clozareal]

$32. Did you find it worthwhile?

It gives a good outline on the steps you need to take so it was helpful for me not to miss anything that may have been important. The time it saved me ruminating about specific aspects of starting a PP is worth it in my opinion.

It doesn't go in as much depth as I like for each section but I think I just like a lot of specific detail which you can't do in a book like this since it needs to be general enough to appeal to a broad audience.

 

[Dr. M Toboggan]

Update?