Payor Mix

[mehul_25]

Advertisement - Members don't see this ad

Any thoughts on the following payor mix?

50% BCBS 120-130% of Medicare
20-25% Medicare
15-20% Medicaid
5-10% Small Payors, WC

thanks

 

[lobelsteve]

Any thoughts on the following payor mix?

50% BCBS 120-130% of Medicare
20-25% Medicare
15-20% Medicaid
5-10% Small Payors, WC

thanks

Drop Medicaid. In the last 2 practices I have seen, the cost of doing the paperwork and getting paid, exceeded the amount paid. We lost almost none of the patients by making them self-pay and they paid $200-250 for an intitial eval and $90-95 for a follow-up visit. The cost of their UDS came out of their pocket and they were put under as tight or tighter scrutiny for C2-C3 Rx's. Many negotiated payment plans to allow for procedures. One paid for a disco out of pocket, another had superior hypogastric blocks, GF blocks, and is considering an SCS. I am discouraging the SCS due to the huge costs, hoping she will get married into insurance shortly.

You need to get on more WC panels.

 

[Aether2000]

I agree....drop Medicaid. The telephone calls we received from this incredibly needy population dropped by 70% when we decreased our Medicaid population from 17% to under 2%. We also have far fewer drug diversion issues, substance abuse issues, missed appointments, failures to follow through with the treatment plan, and paperwork nightmares created by the states in order to reduce costs (read: make health care inaccessable to these people because of cumbersome and time consuming forms that must be filled out for every aspect of their care). We cannot accept Medicaid patients in our state as self pay. Medicaid is not a health insurance plan, it is a law, so be certain in your state that you can charge Medicaid patients out of pocket.