psychiatry private practice billing

[petermoss]

I'm trying to calculate what a private practice psychiatrist would make, depending on how many patients he sees, etc. But it's pretty difficult to find out insurance companies pay psychiatrists for the most common mental health billing codes. I think I've found out what medicare pays:

Code Description Time (min) Allowable Fee Medicare Pmt
90801 Initial Eval N/A $144 $115
90804 Counseling 20-30 $66 $33
90805 Counseling & medical E/M 20-30 $72 $36
90806 Counseling 40-50 $100 $50
90807 Counseling and medical E/M 40-50 $105 $52
90862 Pharmacologic mgmt N/A (10-15) $52 $26

General office evaluation and management codes:
99204 Initial evaluation: 45 $136.44 $109.15
99212 Straightforward follow-up 10 $37.86 $18.93
99213 Low complexity follow-up 15 $53.07 $26.53
99214 Moderate complexity follow-up 25 $82.80 $41.40
99215 Complex follow-up 40 $120.99 $60.49

Anyone know what allowable fee means? And do psychiatrists normally bill using the counseling codes or do they sometimes use the general office e/m codes too?

And how do insurance companies compare in what they pay?

Also, here's a sample barebones solo practice scenario for you guys to comment on:

Expenses:
Malpractice $5k/yr
Rent (simple office with secretary desk and waiting room) $15k/yr
Billing services = contracted out at 10% of collections
Secretary $30k/yr
Utilities, paper, postage, misc $5k/yr

Total expenses: $55k/yr + billing fees

Income (assuming medicare only since I don't know the insurance reimbursements):
working 4 days per week, 8 hrs each day

1 new patient per day = $110 x4days x4 weeks x12 months = $21120
(takes an hour of your day, then the rest of the day is divided between 15 minute med checks and 1/2 hr counseling/med visits)
med checks for 3.5 hrs = 14/day x $26 x 4days x 4 weeks x 12mo = $69888
counseling for 3.5 hrs = 7/day x $36 x 4days x4wks x 12mo = $48384

Gross income = $139392 - 10% billing fees = $125452
minus expenses of $55k

= net (pretax) income of $70452

yikes
and that's working 32 hrs/wk

I guess you could ditch the secretary (I know people who do this.. true solo) to get your income up to $100k net, but I don't think you shuffle med checks in and out without one. Maybe if you were doing the 40 minute counseling and e/m sessions at $52 each.. but that lowers your billings.

Any thoughts?

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[Anasazi23]

A full-time Medicare practice isn't realistic. Any psychiatrist would work in a clinic seeing the same patients for $115,000-$160,000, depending on location.

Most full-time private practices have a good portion of private pay, and charge a lot more for initial evals (double to triple what you listed) and charge much more for therapy.

Somehow, psychiatrists seem to make double to triple (at least) of what you mention for FT private practice.

 

[outofhere]

I'm trying to calculate what a private practice psychiatrist would make, depending on how many patients he sees, etc. But it's pretty difficult to find out insurance companies pay psychiatrists for the most common mental health billing codes. I think I've found out what medicare pays:


Expenses:
Malpractice $5k/yr
Rent (simple office with secretary desk and waiting room) $15k/yr
Billing services = contracted out at 10% of collections
Secretary $30k/yr
Utilities, paper, postage, misc $5k/yr



Any thoughts?

You don't need a secretary. Get a voice mail system and check it regularly. Billing services usually take about 6-7% of your collections. Most of the folks I know don't even use billing services, they either do it themselves or have the patients do them.

Your malpractice matures in 6 years, so it won't be $5000 when you first start, more like <$1000. And hopefully when it matures, you also have more well paying insurance companies. Blue Cross/Blue Shield pays more.

You can also write a letter to the insurance stating why you demand a higher compensation: speaking more than 1 language, working in an expensive area...etc, and demand more pay.