Private practice billing questions

[gator2886]

I see many doctors own their own C-arms with blocks done in their offices. Am I to understand correctly that you can only bill the professional fee for this? No facility fee?
What is the advantage to owning and maintaining a C-arm and ancillary equipment to do any procedures if that is the case? Why not have your own office to see patients and take procedures elsewhere? I understand the inefficiencies of a hospital may push you to not do them there but an ASC that welcomes you seems best. Obviously owning part of that ASC optimal but even if that is not the case it would still be no overhead as opposed to the office.

---

Members don't see this ad.

 

[DOctorJay]

the reimbursement you would get in your office is better than you would get if you were to bring cases to an ASC that you don't have shares in, same with the hospital. much easier to offer services for cash this way as well.

ASIPP

The Voice of Interventional Pain Management

www.asipp.org

 

[Ducttape]

on that website, look at the 2019 Physician Fee Schedule to see what the difference is in charges. these are the rates Medicare pays.

remember that pretty much everyone bills more than this amount to private insurances.

but.... if you do them in your office, you are getting reimbursed also for staff, equipment, the office, maintenance of the machine, etc. Office based rates should be much higher than what they are.

 

[lonelobo]

Office rate is a combo of A facility and professional fee...just look at Medicare and try to negotiate with your insurers depending on where you practice

 

[drusso]

on that website, look at the 2019 Physician Fee Schedule to see what the difference is in charges. these are the rates Medicare pays.

remember that pretty much everyone bills more than this amount to private insurances.

but.... if you do them in your office, you are getting reimbursed also for staff, equipment, the office, maintenance of the machine, etc. Office based rates should be much higher than what they are.

The problem is that the inputs used in the formula to set the rates for a physicians' office, the ASC, and HOPD are all different. You guessed it, that drives the differential in SOS. So, in order to get to fairer, more site-neutral payment, all sites need to be using the same inputs. My MA or RN or billing person isn't cheaper because she works in an office versus a HOPD or ASC. I still have to pay market rates and compete with HOPD and ASC's for employees, but am reimbursed less? Plus, I've got to pay state and local taxes which the non-profit hospitals do not? How is that fair?

HOPD vs. ASCs: 5 insights on the reimbursement gap - Becker’s ASC

CMS determines reimbursement rates for hospital outpatient departments and ASCs using two different measures of inflation, resulting in significant cost differentials.

www.beckersasc.com

"CMS determines reimbursement rates for hospital outpatient departments and ASCs using two different measures of inflation, resulting in significant cost differentials. For HOPDs, CMS uses the hospital market basket, which measures the cost of medical expenses. For ASCs, CMS uses the Consumer Price Index – Urban, which measures the cost of products such as milk and bread."

 

[Ducttape]

oh god. another diversion in to SOS.

I need an SOS on the constant chittering about SOS...