Question for the resident moonlighters doing inpatient work (pay/work load)

[BiscoDisco]

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I've been getting the feeling I'm getting a raw deal in one of my current moonlighting gigs. Every attending at my program whom I mention this to seems shocked at the work load. I cover the entire unit on a given weekend. I am responsible for phone call Friday-Monday morning, done from home. Overnight calls generally aren't very much. I round Sat/Sun seeing each patient in the hospital once. I also do new intakes and discharges.

A typical weekend might look like this: 35-40 follow ups, 12-16 new admissions, 1-3 discharges. I've never had less than 50 patient encounters over the course of the weekend. Pay is $3800 plus a 60/40 cut of billing after 42 encounters. I have yet to see what this works out to because they have several months to collect on billing.

So I'm curious, what is the work load of other residents doing weekend inpatient coverage? How much are you getting paid?

 

[Wheatbread]

That’s way too much work for a resident. As an attending I have similar load on weekends but I make twice as much. Our residents that moonlight here see about 6 new patients a day, they get paid hourly, though I don’t know how much.

 

[Monocles]

I've been getting the feeling I'm getting a raw deal in one of my current moonlighting gigs. Every attending at my program whom I mention this to seems shocked at the work load. I cover the entire unit on a given weekend. I am responsible for phone call Friday-Monday morning, done from home. Overnight calls generally aren't very much. I round Sat/Sun seeing each patient in the hospital once. I also do new intakes and discharges.

A typical weekend might look like this: 35-40 follow ups, 12-16 new admissions, 1-3 discharges. I've never had less than 50 patient encounters over the course of the weekend. Pay is $3800 plus a 60/40 cut of billing after 42 encounters. I have yet to see what this works out to because they have several months to collect on billing.

So I'm curious, what is the work load of other residents doing weekend inpatient coverage? How much are you getting paid?

You're getting ripped off.

1) the workload is too high
2) pay should be at least double. How are they getting away with skimming 40% of your earnings?

 

[BiscoDisco]

I guess I assumed because outpatient practices take a 40% cut, it would make sense the company who staffs this hospital would too? I had a feeling I was doing way too much work.

 

[Mad Jack]

I've been getting the feeling I'm getting a raw deal in one of my current moonlighting gigs. Every attending at my program whom I mention this to seems shocked at the work load. I cover the entire unit on a given weekend. I am responsible for phone call Friday-Monday morning, done from home. Overnight calls generally aren't very much. I round Sat/Sun seeing each patient in the hospital once. I also do new intakes and discharges.

A typical weekend might look like this: 35-40 follow ups, 12-16 new admissions, 1-3 discharges. I've never had less than 50 patient encounters over the course of the weekend. Pay is $3800 plus a 60/40 cut of billing after 42 encounters. I have yet to see what this works out to because they have several months to collect on billing.

So I'm curious, what is the work load of other residents doing weekend inpatient coverage? How much are you getting paid?

Brutal. I may also be getting ripped off, I cover an 18 bed unit, two ERs (usually 3-6 patients/weekend need to be seen by me personally, otherwise it's just disp), and two small hospital consult services (usually 1-2 patients per weekend) for $3500. Typically it's 14 follow-ups and 2-3 new patients per day on the unit, depending on blocked beds. This also requires overnight phone coverage.

 

[calvnandhobbs68]

I guess I assumed because outpatient practices take a 40% cut, it would make sense the company who staffs this hospital would too? I had a feeling I was doing way too much work.

They usually take a 40% cut if you're a regular employee getting healthcare benefits, retirement, CME, etc etc.

Not if you're moonlighting. Wayyy higher rate if you're moonlighting.

 

[Stagg737]

Agree with the above, that's crazy. Why are you only getting 60/40 after 42 encounters? You're getting ripped off at $3800 for the first 42 encounters. And 48-60 encounters in a weekend is too much for anyone IMO, let alone a resident. I had one weekend call day in residency where I saw 30 patients (worst day by far) and you'd have to offer me $3800 just for that day for me to consider doing that again.

For context, in residency our most common moonlighting positions were outpatient corrections or the state hospital. The state hospital paid 5K for 48 hour coverage and from what I understood it was for 30-35 f/ups with 5-6 new ones (max) and no discharges unless pre-planned for the whole weekend (f/ups only need to be seen once). Imo, that's still low but the state hospital also hires NPs since it's a FPA state and knows they can pay residents less.

As a resident, you're likely going to get paid less anyway unless the employer is truly desperate. But this position is just pretty terrible. I wouldn't touch this for anything less than $6k for the weekend (and that's still bad). How much are you usually taking home after that 60/40 cut? To compare that to a per RVU production bonus, at 60/40 you're basically making $31 per RVU after your 42 encounters.

 

[BiscoDisco]

Agree with the above, that's crazy. Why are you only getting 60/40 after 42 encounters? You're getting ripped off at $3800 for the first 42 encounters. And 48-60 encounters in a weekend is too much for anyone IMO, let alone a resident. I had one weekend call day in residency where I saw 30 patients (worst day by far) and you'd have to offer me $3800 just for that day for me to consider doing that again.

For context, in residency our most common moonlighting positions were outpatient corrections or the state hospital. The state hospital paid 5K for 48 hour coverage and from what I understood it was for 30-35 f/ups with 5-6 new ones (max) and no discharges unless pre-planned for the whole weekend (f/ups only need to be seen once). Imo, that's still low but the state hospital also hires NPs since it's a FPA state and knows they can pay residents less.

As a resident, you're likely going to get paid less anyway unless the employer is truly desperate. But this position is just pretty terrible. I wouldn't touch this for anything less than $6k for the weekend (and that's still bad). How much are you usually taking home after that 60/40 cut? To compare that to a per RVU production bonus, at 60/40 you're basically making $31 per RVU after your 42 encounters.

So I haven't received anything yet because the company has up to 4 months to collect billing, thus I havent been paid. I will be owed for encounters in excess of 42, but I'm not expecting it to make up for the work load.

 

[Mad Jack]

So I haven't received anything yet because the company has up to 4 months to collect billing, thus I havent been paid. I will be owed for encounters in excess of 42, but I'm not expecting it to make up for the work load.

What region are you in? I've also gotta say, that's extra awful if you're paid after collections. My gig is W2 and comes with malpractice and a 401k

 

[BiscoDisco]

What region are you in? I've also gotta say, that's extra awful if you're paid after collections. My gig is W2 and comes with malpractice and a 401k

Major/desirable metro in southwest.

 

[Mad Jack]

Major/desirable metro in southwest.

If anything you should be making more in that region than I am in the Northeast, and you're doing far more work on top of it

 

[comp1]

Separate of income...this is not a safe amount of patient care to be delivering over a weekend.

 

[docksan]

I've been getting the feeling I'm getting a raw deal in one of my current moonlighting gigs. Every attending at my program whom I mention this to seems shocked at the work load. I cover the entire unit on a given weekend. I am responsible for phone call Friday-Monday morning, done from home. Overnight calls generally aren't very much. I round Sat/Sun seeing each patient in the hospital once. I also do new intakes and discharges.

A typical weekend might look like this: 35-40 follow ups, 12-16 new admissions, 1-3 discharges. I've never had less than 50 patient encounters over the course of the weekend. Pay is $3800 plus a 60/40 cut of billing after 42 encounters. I have yet to see what this works out to because they have several months to collect on billing.

So I'm curious, what is the work load of other residents doing weekend inpatient coverage? How much are you getting paid?

What the heck? You are being seriously under-compensated.

 

[dl2dp2]

I don't understand how the hospital can squeeze in 12 new admits over the weekend lmao
Usually nursing refuses new admits after admit number 3.

 

[calvnandhobbs68]

I don't understand how the hospital can squeeze in 12 new admits over the weekend lmao
Usually nursing refuses new admits after admit number 3.

Weekend discharges are also lame too unless they're all wrapped up in a bow and he's basically just signing a discharge order.

 

[dl2dp2]

Weekend discharges are also lame too unless they're all wrapped up in a bow and he's basically just signing a discharge order.

I remember doing a job like this as a resident covering 40 patients over a weekend. I refused to discharge anyone and just say that they are still too sick to be discharged. The unit is always full anyway, and I just copy-forward the Friday notes after a 2 min mental status exam. I never change meds. No one cared. I did 1 admit per weekend max. I finished all my notes at 10AM then goofed off on Netflix the rest of the day. On some occasions, ER or floor sends a consult but can usually be wrapped up in 30 min.

Did have to stay in house though for overnights in the call room.

I think I was paid $100 or $125 per hour, and so at the time it was ~$2400 per day and around $6000 per weekend, which I thought was a lot of money at the time, given I was paid 65k a year.

I don't really understand how a functioning unit could be 1/3 full every Friday. Something doesn't really check out. And how could someone admit 12 but only discharge 3? This means that the unit still had empty beds on Monday. None of this makes sense.

 

[BiscoDisco]

Separate of income...this is not a safe amount of patient to be delivering over a weekend.

Agreed. Im getting out of this hospital.

 

[BiscoDisco]

Weekend discharges are also lame too unless they're all wrapped up in a bow and he's basically just signing a discharge order.

Nope. The NPs who cover during the week don't even send scripts...

 

[BiscoDisco]

I remember doing a job like this as a resident covering 40 patients over a weekend. I refused to discharge anyone and just say that they are still too sick to be discharged. The unit is always full anyway, and I just copy-forward the Friday notes after a 2 min mental status exam. I never change meds. No one cared. I did 1 admit per weekend max. I finished all my notes at 10AM then goofed off on Netflix the rest of the day. On some occasions, ER or floor sends a consult but can usually be wrapped up in 30 min.

Did have to stay in house though for overnights in the call room.

I think I was paid $100 or $125 per hour, and so at the time it was ~$2400 per day and around $6000 per weekend, which I thought was a lot of money at the time, given I was paid 65k a year.

I don't really understand how a functioning unit could be 1/3 full every Friday. Something doesn't really check out. And how could someone admit 12 but only discharge 3? This means that the unit still had empty beds on Monday. None of this makes sense.

The unit has way more beds than staffing. There's something like 80 beds and about half to 2/3 are full at any given time. They don't have the nursing staff to cover that many patients. You better believe they'd let me see all 80 if they had the nursing staff to support it however.

 

[Merovinge]

You are making an administrator a lot of money if that makes you feel any better...
But really, this is a learning experience and you are right to be discussing with your attendings. I am surprised your PD is not in discussion with you about this given that they are signing off on the moonlighting. It's also quite a bit of liability you are taking on given the quality of the hospital seems pretty low, ,this work has much higher rates of liability than say outpatient practice. A malpractice suit to start a career has been real tough on the folks I have seen it happen to.

 

[dl2dp2]

The unit has way more beds than staffing. There's something like 80 beds and about half to 2/3 are full at any given time. They don't have the nursing staff to cover that many patients. You better believe they'd let me see all 80 if they had the nursing staff to support it however.

OMG lol this is utterly insane.

 

[BiscoDisco]

You are making an administrator a lot of money if that makes you feel any better...
But really, this is a learning experience and you are right to be discussing with your attendings. I am surprised your PD is not in discussion with you about this given that they are signing off on the moonlighting. It's also quite a bit of liability you are taking on given the quality of the hospital seems pretty low, ,this work has much higher rates of liability than say outpatient practice. A malpractice suit to start a career has been real tough on the folks I have seen it happen to.

I hear you.

To me, the liability feels relatively low despite the number of patients seen. My feeling has been that generally for weekend inpatient psych, aside from doing discharges, the risks seem very low. The patients are hospitalized, I'm not making major med changes, we have a FM provider available for med consults. Given all that it seems unlikely to have something direct damage which could be directly tied to the action (or inaction) of the weekend covering doc. Happy to hear your thoughts on the liability though as I realize you've been doing this much longer than I have.

 

[ObsequiousAplomb]

I hear you.

To me, the liability feels relatively low despite the number of patients seen. My feeling has been that generally for weekend inpatient psych, aside from doing discharges, the risks seem very low. The patients are hospitalized, I'm not making major med changes, we have a FM provider available for med consults. Given all that it seems unlikely to have something direct damage which could be directly tied to the action (or inaction) of the weekend covering doc. Happy to hear your thoughts on the liability though as I realize you've been doing this much longer than I have.

You don't have to actually commit malpractice for the accusation to affect your career. A state board might ask if you've ever been named in a lawsuit. Regardless of the outcome, it does not look good to have a case where someone tries to argue you were neglectful and you openly admit to seeing this many patients.

Even ignoring the liability, which may be low or may not, I would never take this job. I could never get the horrible taste out of my mouth if I accepted this insultingly low amount of money for that much work. If they're that desperate for weekend coverage they should be paying $80-120 per encounter. If they want an NP to do it instead then this is one of those situations where I just don't care about mid-levels creeping.

 

[psychmd03]

So I will diverge from the rest and first ask what is the payor mix you’re seeing? And what is the normal rate insurance pays for a 99232 and 99223/9072?

Because my area in the hospital I moonlighted at it was dominantly medicaid and at the time insurance paid $24 for a 99232. Now they have to pay $43. So you’re actually paid over double that. So to me that looks good. Because you’d be making less billing yourself unless your payor mix is good and you add some therapy codes in. Even the evals from medicaids in my area are $120

Curious of the others blasting the pay what are you able to bill insurers for a normal inpatient follow up that you’d be expecting much higher returns?

 

[BiscoDisco]

So I will diverge from the rest and first ask what is the payor mix you’re seeing? And what is the normal rate insurance pays for a 99232 and 99223/9072?

Because my area in the hospital I moonlighted at it was dominantly medicaid and at the time insurance paid $24 for a 99232. Now they have to pay $43. So you’re actually paid over double that. So to me that looks good. Because you’d be making less billing yourself unless your payor mix is good and you add some therapy codes in. Even the evals from medicaids in my area are $120

Curious of the others blasting the pay what are you able to bill insurers for a normal inpatient follow up that you’d be expecting much higher returns?

Don't have exact numbers but I'd say 2/3 are private insurance.

 

[docksan]

You should be making at least twice what you are getting for that amount of work.

 

[calvnandhobbs68]

So I will diverge from the rest and first ask what is the payor mix you’re seeing? And what is the normal rate insurance pays for a 99232 and 99223/9072?

Because my area in the hospital I moonlighted at it was dominantly medicaid and at the time insurance paid $24 for a 99232. Now they have to pay $43. So you’re actually paid over double that. So to me that looks good. Because you’d be making less billing yourself unless your payor mix is good and you add some therapy codes in. Even the evals from medicaids in my area are $120

Curious of the others blasting the pay what are you able to bill insurers for a normal inpatient follow up that you’d be expecting much higher returns?

Any time you look at this stuff you have to look at what the hospital is actually taking in AND the cost of NOT having a physician. It matters to an extent what your professional billing is but also matters what the hospital charges for the daily facility and other fees. It also matters that if they don’t have someone to round on the patients, they get to bill nothing.

 

[Stagg737]

So I haven't received anything yet because the company has up to 4 months to collect billing, thus I havent been paid. I will be owed for encounters in excess of 42, but I'm not expecting it to make up for the work load.

So further clarifications: Is the productivity bonus based on what is billed or what is collected? I wouldn’t sign a contract at all if it’s collected. If it’s billed you should be able to calculate how much you’d get. Also, patients can’t be admitted unless an attending accepts them, why are you accepting 12 admits in a weekend? What have they told you to convince you to do this?

So I will diverge from the rest and first ask what is the payor mix you’re seeing? And what is the normal rate insurance pays for a 99232 and 99223/9072?

Because my area in the hospital I moonlighted at it was dominantly medicaid and at the time insurance paid $24 for a 99232. Now they have to pay $43. So you’re actually paid over double that. So to me that looks good. Because you’d be making less billing yourself unless your payor mix is good and you add some therapy codes in. Even the evals from medicaids in my area are $120

Curious of the others blasting the pay what are you able to bill insurers for a normal inpatient follow up that you’d be expecting much higher returns?

Well average CMS reimbursement for 99232 is about $75 and 99233 is over $100 now. 90792 is over $200, so you’re lowballing those calculations by a lot. Use 2022 rates and OP is getting hosed.

 

[psychmd03]

Any time you look at this stuff you have to look at what the hospital is actually taking in AND the cost of NOT having a physician. It matters to an extent what your professional billing is but also matters what the hospital charges for the daily facility and other fees. It also matters that if they don’t have someone to round on the patients, they get to bill nothing.

I agree with this that you need to know the facility fees. But also those fees are supposed to help pay for nursing. Social work. And all overhead or at least that’s my understanding. There is a reason psych inpatient is very very hard to make profitable because we don’t really generate much money from our job. So if I’m on the business side I’m for sure taking that into account when it comes to pay.

And as to CMS average I’m not low balling hence why I asked the payor mix. Is it a medicaid heavy case load and what do they pay plus any hospital facility fees. In my area they don’t pay much. I agree if you’re seeing a lot of Medicare and a lot private pay this is a massive low ball. If this is closer to what many hospitals are with that type of volume they will be dominantly Medicaid which both don’t pay psychiatrists or facilities much of anything. It’s actually quite unbelievable to me how little they pay

 

[psychmd03]

Don't have exact numbers but I'd say 2/3 are private insurance.

Fml that’s nice. I wish I had some hospitals like that with a payor mix like that. You’re getting underpaid then by a solid 50% then.

 

[BiscoDisco]

Fml that’s nice. I wish I had some hospitals like that with a payor mix like that. You’re getting underpaid then by a solid 50% then.

Good to know, I appreciate it.

Out of curiosity, what is your percentage you are seeing in your hospital? I believe I recall you telling me before your public payors were roughly 110ish for EM and therapy and private was closer to 150?

 

[psychmd03]

Good to know, I appreciate it.

Out of curiosity, what is your percentage you are seeing in your hospital? I believe I recall you telling me before your public payors were roughly 110ish for EM and therapy and private was closer to 150?

Unfortunately for me it’s mostly medicaids/mcos. 70-80% depending on the week. I like it because that also means sicker but pay is straight awful. No wonder their are barely any providers to see them

 

[dl2dp2]

Unfortunately for me it’s mostly medicaids/mcos. 70-80% depending on the week. I like it because that also means sicker but pay is straight awful. No wonder their are barely any providers to see them

Well sure, but in my experience when you have a unit like that there are other SPECIFIC ear-marked budget line items for physician salaries.
The salaries are still lower, for sure, but for other reasons. For example, if a state agency or a large nonprofit is in charge of assigning physician FTEs, they don't investigate or follow market trend enough to adjust lined salaries quickly. So what ends up happening is some weird phenomenon where moonlighters get paid much much much more than full-time staff, which causes further staff attrition, which ends up costing the system more.

Think about it, if a unit is constantly losing money, where does the money COME from to salary staff physicians? Something has to give. In theory, moonlighting income should follow market trends more closely. If it's not, it means that the system is even further below par in responsivity. It has little to nothing to do with the reimbursement of the activities themselves because the salary budgets aren't expected to come from the billings from day 1.

I find it hilarious when admins are like "I'm losing money on you". If you are losing money on me, and you haven't hired someone like me for months, what's the point of having this job? This is much less common in the private for-profit world, and really is the outward common manifestation of public misallocation of resources.

 

[Stagg737]

And as to CMS average I’m not low balling hence why I asked the payor mix. Is it a medicaid heavy case load and what do they pay plus any hospital facility fees. In my area they don’t pay much. I agree if you’re seeing a lot of Medicare and a lot private pay this is a massive low ball. If this is closer to what many hospitals are with that type of volume they will be dominantly Medicaid which both don’t pay psychiatrists or facilities much of anything. It’s actually quite unbelievable to me how little they pay

I use the CMS physician fee schedule tool. The lowest reimbursement for a 99232 is $66.42, 99233 is $95.50, and 90792 is $168.68. The other end is $96.33 for 99232, $138.50 for 99233, and 248.57 for 90792 (all being facility fees, 90792 can go much higher for non-facility). Even if you're a straight CMS payor population and only counting the wRVU portion you should be getting more than $43 per 99232 in any geography (at least $48 if you're just using the standard conversion factor).

Regardless, OP seems to be getting ripped off and still would be even with a much larger percentage of CMS patients.

 

[psychmd03]

I use the CMS physician fee schedule tool. The lowest reimbursement for a 99232 is $66.42, 99233 is $95.50, and 90792 is $168.68. The other end is $96.33 for 99232, $138.50 for 99233, and 248.57 for 90792 (all being facility fees, 90792 can go much higher for non-facility). Even if you're a straight CMS payor population and only counting the wRVU portion you should be getting more than $43 per 99232 in any geography (at least $48 if you're just using the standard conversion factor).

Regardless, OP seems to be getting ripped off and still would be even with a much larger percentage of CMS patients.

I wish that were true. I have many many EOBs from BCBS mco, meridian, molina etc that only pay 43 and change per 99232 when I bill them. Also their facility fees are much much lower than the private payors.

It is still important to know payor mix, and average rates to know if you're being ripped off and by how much. The more info you have the more power you have.

 

[surfguy84]

I wish that were true. I have many many EOBs from BCBS mco, meridian, molina etc that only pay 43 and change per 99232 when I bill them. Also their facility fees are much much lower than the private payors.

It is still important to know payor mix, and average rates to know if you're being ripped off and by how much. The more info you have the more power you have.

But so many talk about loads of instances of private paying worse than medicare. So, how do we make sense of payer mix if this is true?

 

[splik]

I wish that were true. I have many many EOBs from BCBS mco, meridian, molina etc that only pay 43 and change per 99232 when I bill them. Also their facility fees are much much lower than the private payors.

It is still important to know payor mix, and average rates to know if you're being ripped off and by how much. The more info you have the more power you have.

You are talking at cross purposes. You are talking about medicaid (which is enormously variable from state to state but typically substantially less than medicare) where as stag is talking about medicare, which is not really relevant to this discussion. In my state medicaid pays $37.50 for 99232 and $103.25 for 90792 which is absolute garbage but it is not common for people to bill medicaid here either.

 

[psychmd03]

You are talking at cross purposes. You are talking about medicaid (which is enormously variable from state to state but typically substantially less than medicare) where as stag is talking about medicare, which is not really relevant to this discussion. In my state medicaid pays $37.50 for 99232 and $103.25 for 90792 which is absolute garbage but it is not common for people to bill medicaid here either.

I know they dont line up but I had stated the first time when knowing your payor mix you need to know are you seeing 40+ Medicaid/mcos or you seeing a medicare/private pay. That really changes the game. The places I work are medicaid dominant so you aren't gonna see a lot of pay because both your service fee and facility fees are quite small relative to some straight BCBS

 

[psychmd03]

But so many talk about loads of instances of private paying worse than medicare. So, how do we make sense of payer mix if this is true?

You gotta look at the rates in your area. It is quite variable. You can talk to billers or providers that do billing to get an idea of what they get. I have so many EOBs for just about every insurance in my area including some very obscure ones so I have a good idea for my area but any biller would as well and then you need to talk to the place you will be working and find out what mix they get on average. It will be quite different region to region and even within regions.

 

[BiscoDisco]

You gotta look at the rates in your area. It is quite variable. You can talk to billers or providers that do billing to get an idea of what they get. I have so many EOBs for just about every insurance in my area including some very obscure ones so I have a good idea for my area but any biller would as well and then you need to talk to the place you will be working and find out what mix they get on average. It will be quite different region to region and even within regions.

Do you recommend just contacting billers in my area and getting a sense what information they have on reimbursements? Any other way to get this information you reference?

 

[Stagg737]

I wish that were true. I have many many EOBs from BCBS mco, meridian, molina etc that only pay 43 and change per 99232 when I bill them. Also their facility fees are much much lower than the private payors.

It is still important to know payor mix, and average rates to know if you're being ripped off and by how much. The more info you have the more power you have.

Yikes, that's bad. What're the highest rates you're getting? Those rates sound pretty terrible.

But so many talk about loads of instances of private paying worse than medicare. So, how do we make sense of payer mix if this is true?

That will depend on your setting and situation. Work for a large hospital system and no way that insurance pays worse than medicare/caid. Large systems can negotiate and hold a lot of power. BCBS in a nearby city tried to cut their reimbursement for a 300-bed hospital and within a week there were reports that BCBS folded with their demands when the hospital said they'd just drop BCBS.

If you're in a small practice or solo then you'll be at the mercy of whatever insurance companies want to reimburse. That's why you'll see people on here talking about hospital systems charging insurance thousands of dollars for an initial appointment while solo practitioners get a couple hundred or less.

 

[psychmd03]

Yikes, that's bad. What're the highest rates you're getting? Those rates sound pretty terrible.



That will depend on your setting and situation. Work for a large hospital system and no way that insurance pays worse than medicare/caid. Large systems can negotiate and hold a lot of power. BCBS in a nearby city tried to cut their reimbursement for a 300-bed hospital and within a week there were reports that BCBS folded with their demands when the hospital said they'd just drop BCBS.

If you're in a small practice or solo then you'll be at the mercy of whatever insurance companies want to reimburse. That's why you'll see people on here talking about hospital systems charging insurance thousands of dollars for an initial appointment while solo practitioners get a couple hundred or less.

BCBS will pay 100 or so for a 99232. 90833s for even medicaids pay 60-90 which is just wild to me. It’s very unfortunate

Do you recommend just contacting billers in my area and getting a sense what information they have on reimbursements? Any other way to get this information you reference?

Yeah that’s what I would do if you have someone you’ll be working with. Other way is to contact docs you know or work with that do their own billing so you can get a sense of the payment info. As for mix at hospitals I’d be asking them directly before accepting any offer of a job so you know what you’re getting into and can know if you’re truly being compensated