karpems

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Does anyone have the current reimbursement rates for OMT?

Thanks!
 

JaggerPlate

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Does anyone have the current reimbursement rates for OMT?

Thanks!
OMM reimbursement is my favorite SDN topic (for real). There are quite a few threads around here if you search. Essentially, it boils down to a few things (from what I've seen):

1. A lot of people talk about opting for the cash based services. Everyone always discusses the OMM guru at their DO school who ran a really lucrative cash based OMM clinic or who did while still teaching them, etc. You can also look around online ... these guys exist, and charge hundreds of dollars an hour for OMM. A lot of people on SDN have seen these docs too and say their volume is steady and the overhead is non-existant

2. You can bill for it. I've heard some docs say it isn't worth it, one resident say he billed more in his ACGME FM residency compared to any other resident because of OMM, and I've also read an article from the OMM guru blog hosted by SDN, where a doc broke down his insurance based OMM clinic ... and made it sound tough, but not impossible.

3. There are people who do a mix. Most with the intent to move towards a cash based model.

Sorry I don't have the thread just to pull up ... maybe I can include them later. Just search 'OMT reimbursement' or 'OMT cash' or google 'OMT guru blog Student Doctor,' and this stuff should pop up.
 

thakerm

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Does anyone have the current reimbursement rates for OMT?

Thanks!
i believe it depends on your region. around my area, its around 40 bucks i think on top of the regular check up fee.
 

Bacchus

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When I was treated over the summer my insurance was billed for 2 regions @ $65.
 

st2205

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I'd be curious to know, with a cash-based practice, how exactly this would differ with chiropractic in terms of gathering a patient population. Unless, of course, DOs get a lot of referrals. I know chiropractic practices are rather risky... but I really have to wonder about the marketability between the two. As most people don't really know what a DO is (and likely don't really know what a chiropractor is [w/regard to scope of practice]) it makes it hard for me to imagine there being much of a difference in success in building a practice, save for the possible increase in referrals from MDs/DOs.
 
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As most people don't really know what a DO is (and likely don't really know what a chiropractor is [w/regard to scope of practice]) it makes it hard for me to imagine there being much of a difference in success in building a practice, save for the possible increase in referrals from MDs/DOs.
Dude, I think you'd be surprised about the number of people who seek out DOs for things like lower back pain. I work at an Urgent Care that has several DOs, and at least one out of every three shifts I work somebody new is calling and asking about getting treated by them.

I think that people who honestly want to be pain free without narcotics and have had success with OMM really rave about it to their friends. They become very loyal patients and very, very good advertising for the clinic. I think these patients like DOs better than DCs because they know that if need be, they will be put into the regular pipeline of high tech imaging, surgery, and all the other things an MD does. The "woo factor" of chiropractic isn't operating here - after all, a DO is a real doctor that can stitch you up, read x-rays, manage your diabetes, and still do OMM.

Don't get me wrong - most of what is done at that clinic is regular run of the mill medicine - but having the OMM ace up ones sleeve can really help build a practice. It'd be really hard to build a practice doing OMM solely, but it is a nice adjunct to a regular practice.

N=1 and all that, but it's my story and I'm sticking to it.
 

homeboy

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Dude, I think you'd be surprised about the number of people who seek out DOs for things like lower back pain. I work at an Urgent Care that has several DOs, and at least one out of every three shifts I work somebody new is calling and asking about getting treated by them.

I think that people who honestly want to be pain free without narcotics and have had success with OMM really rave about it to their friends. They become very loyal patients and very, very good advertising for the clinic. I think these patients like DOs better than DCs because they know that if need be, they will be put into the regular pipeline of high tech imaging, surgery, and all the other things an MD does. The "woo factor" of chiropractic isn't operating here - after all, a DO is a real doctor that can stitch you up, read x-rays, manage your diabetes, and still do OMM.

Don't get me wrong - most of what is done at that clinic is regular run of the mill medicine - but having the OMM ace up ones sleeve can really help build a practice. It'd be really hard to build a practice doing OMM solely, but it is a nice adjunct to a regular practice.

N=1 and all that, but it's my story and I'm sticking to it.
That's an unfortunate mentality.

Part of your job as a physician is to educate your patients, and if you're simply taking their money because you can legally charge them $65 to "pop some ribs" and massage their neck, you're doing a disservice to your patient and medicine in general.

Like I've posted numerous times, we used to have a faculty member who gave an annual infamous "extra money" lecture, arguing the dollars & "sense" of OMT and how much "extra money" it could bring your practice. Of course, this mentality is entirely defensible if you wholeheartedly embrace the employment of OMT as a first line treatment modality bar none; most do not, regardless of what pre-meds & med students experience in their little osteopathic worlds.

I don't want to enter a big pro/anti OMM debate (though I'm sure I’ve inevitably started one), but suffice to say the ability to bill for a procedure shouldn't equate a means to fluff your practice with ‘extra income.’
 
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Don't get me wrong, Doc - I don't know enough about OMT to judge for myself whether or not it's a rip off. I'm still a few years away from medical school. I just draw blood, do IVs, and shoot some x-rays from time to time. I really like the DOs I work for, and I've never thought of them as guys who'd BS a patient before. I guess I might want to re-evaluate that, based on what some of you are saying...

There really are patients out there that like OMT, though, and will seek it out.
 

homeboy

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Don't get me wrong, Doc - I don't know enough about OMT to judge for myself whether or not it's a rip off. I'm still a few years away from medical school. I just draw blood, do IVs, and shoot some x-rays from time to time. I really like the DOs I work for, and I've never thought of them as guys who'd BS a patient before. I guess I might want to re-evaluate that, based on what some of you are saying...

There really are patients out there that like OMT, though, and will seek it out.
I'm not saying it's ubiquitous...fact is, hardly any DOs even use OMM. This upcoding is not a rampant issue, I just hate the DO hardliners who insist their degree actually means something more than "physician," plain and simple, and try and shove the AOA crap down your throat.
 

Bacchus

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I'm not saying it's ubiquitous...fact is, hardly any DOs even use OMM. This upcoding is not a rampant issue, I just hate the DO hardliners who insist their degree actually means something more than "physician," plain and simple, and try and shove the AOA crap down your throat.
Question for you. Since you're a resident and probably have more access to billing codes/rates than medical students or pre-meds, do you know off the top of your head any general rates for OMT? Is everything by region like I mentioned earlier or can it be based on technique as well?
 

homeboy

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Question for you. Since you're a resident and probably have more access to billing codes/rates than medical students or pre-meds, do you know off the top of your head any general rates for OMT? Is everything by region like I mentioned earlier or can it be based on technique as well?
No clue. At a big allo institution and haven't done OMM since the PE exam.
 

IDBasco

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Question for you. Since you're a resident and probably have more access to billing codes/rates than medical students or pre-meds, do you know off the top of your head any general rates for OMT? Is everything by region like I mentioned earlier or can it be based on technique as well?
Yes, its done by regions.

98925 = 1 or 2 regions
......
98929 = 9 or 10 regions

Or in ICD its 739.x with x = to a specific region like head or UE.

Regions are head, t-spine, c-spine, l-spine, abdomen, pelvis, sacrum, LE, UE and ribs.

This per our OMM lecture on the subject. Can't comment on rates, though, and I imagine they vary anyway. You get paid by the region, not the number of procedures you have to use to address the problem in that region.
 

punkiedad

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I love how there are so many OMM haters after they get accepted or graduate from a DO school.

Homeboy, did you drink too much kool aide and get sick of it, or did you just pretend to like Kool Aide to get accepted to a DO school?
 
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iatros

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That's an unfortunate mentality.

Part of your job as a physician is to educate your patients, and if you're simply taking their money because you can legally charge them $65 to "pop some ribs" and massage their neck, you're doing a disservice to your patient and medicine in general....

...but suffice to say the ability to bill for a procedure shouldn't equate a means to fluff your practice with ‘extra income.'
old holier-than-thou wants to work for free, i guess.

but hey, he probably knows best. after all, he IS at a big allo institution. *impressed*
 

Siggy

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That's an unfortunate mentality.

Part of your job as a physician is to educate your patients, and if you're simply taking their money because you can legally charge them $65 to prescribe OTC pills and tell them to stop smoking, you're doing a disservice to your patient and medicine in general.
Amazing how you can say the same damn thing about other parts of medicine and it sounds just as bad. I guess you aren't a real doctor unless all of your patients are on schedule 2 narcs since prescribing high power drugs is the only true measure of a physician.
 

bones

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The average billing for OMM is ~$50-130 per patient in Missouri last time I checked depending on the number of regions treated ($50 for 1-2 up to ~$130 for 10). This is considered a procedure, which you do in addition to your regular patient visit which you will bill at a normal rate (averaging $60-$100 for primary care follow-ups, perhaps $80-$120 for new patient visits- and sometimes much higher for specialists). Thus, a typical new patient for a primary care doc doing OMM may be $150-$200 and a follow up may bill an average of $100-$140. Before you get excited, remember that insurance companies wait 3-6 months to pay you and take about 35% off the top of this before you see anything, and then you need to pay your office staff, transcriptionists, billers, practice managers, and then pay for lights in your building and rent. You might see between 1 and 6 patients an hour with OMM depending on how efficient you are and how many regions you treat.

In summary: as a primary care doc- for every patient you use OMM on, you can either take twice as long as you usually would or end up making twice as much money if you see them in the same time. In most cities some minimal knowledge of OMM will get many referrals from colleagues as well- simply because there are many patients that they dont know what else to do with (thus an excellent practice builder).



Cash practices paying $120-$250 for follow up visits (medical eval + OMM) and $250-450 for a new patient visit are not that uncommon in big cities (depending on your skill level along what the city will support), and you cut out a significant amount of overhead (the insurance company cut plus most or all of the cost to billers) and you get paid at time of service. A cash practice will demand more skill out of the practitioner- you would need to develop your skills to a high degree and produce real results. Patients expect much more when they pay the full amount out of pocket rather than a 50 cent co-pay...

If you're wondering how sustainable a cash practice is- look at it this way- there are people who are disabled due to pain or injury and want to work. There are people who pay hundreds of dollars per month in medications and wish to be healthy. There are those who have a life altering surgery coming up and who wish for another option.

OMM in the right hands provides an option for many of these people. Many people- myself included, would be willing to pay someone these kinds of fees to fix one of the above issues if it were to come up- so long as someone trusted has seen similar results with that practitioner. I would even be willing to see them several times if it meant I wouldnt need a rod in my back or if it meant I could work again after an injury or could get off hundreds of dollars a month of meds that I would otherwise need to take for the rest of my life.

If you produce no results in a cash practice- you will either offer your patient a refund or you'll have pissed off patients and word gets around fast. If you "cure" their condition and they can work again, or they dont need the surgery anymore- you have a very excited patient who will tell all their family and friends.


Thus, many who are very good at OMM will let the free market decide what their time is worth. If you are just "okay" I'd recommend taking insurance and using OMM as an adjunct to your practice. You will also end up using insurance for your OMM if you are in a high paying specialty already (such as a fellowship trained pain specialist, for example), or if you want to teach and be tied to an academic facility or other big institution, or if you bill for a hospital based OMM service.

I hope that answers your question about OMM billing... I am quite busy but if you have any quick questions you are welcome to private message me.

Michael
 
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JaggerPlate

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The average billing for OMM is ~$50-130 per patient in Missouri last time I checked depending on the number of regions treated ($50 for 1-2 up to ~$130 for 10). This is considered a procedure, which you do in addition to your regular patient visit which you will bill at a normal rate (averaging $60-$100 for primary care follow-ups, perhaps $80-$120 for new patient visits- and sometimes much higher for specialists). Thus, a typical new patient for a primary care doc doing OMM may be $150-$200 and a follow up may bill an average of $100-$140. Before you get excited, remember that insurance companies wait 3-6 months to pay you and take about 35% off the top of this before you see anything, and then you need to pay your office staff, transcriptionists, billers, practice managers, and then pay for lights in your building and rent. You might see between 1 and 6 patients an hour with OMM depending on how efficient you are and how many regions you treat.

In summary: as a primary care doc- for every patient you use OMM on, you can either take twice as long as you usually would or end up making twice as much money if you see them in the same time. In most cities some minimal knowledge of OMM will get many referrals from colleagues as well- simply because there are many patients that they dont know what else to do with (thus an excellent practice builder).



Cash practices paying $120-$250 for follow up visits (medical eval + OMM) and $250-450 for a new patient visit are not that uncommon in big cities (depending on your skill level along what the city will support), and you cut out a significant amount of overhead (the insurance company cut plus most or all of the cost to billers) and you get paid at time of service. A cash practice will demand more skill out of the practitioner- you would need to develop your skills to a high degree and produce real results. Patients expect much more when they pay the full amount out of pocket rather than a 50 cent co-pay...

If you're wondering how sustainable a cash practice is- look at it this way- there are people who are disabled due to pain or injury and want to work. There are people who pay hundreds of dollars per month in medications and wish to be healthy. There are those who have a life altering surgery coming up and who wish for another option.

OMM in the right hands provides an option for many of these people. Many people- myself included, would be willing to pay someone these kinds of fees to fix one of the above issues if it were to come up- so long as someone trusted has seen similar results with that practitioner. I would even be willing to see them several times if it meant I wouldnt need a rod in my back or if it meant I could work again after an injury or could get off hundreds of dollars a month of meds that I would otherwise need to take for the rest of my life.

If you produce no results in a cash practice- you will either offer your patient a refund or you'll have pissed off patients and word gets around fast. If you "cure" their condition and they can work again, or they dont need the surgery anymore- you have a very excited patient who will tell all their family and friends.


Thus, many who are very good at OMM will let the free market decide what their time is worth. If you are just "okay" I'd recommend taking insurance and using OMM as an adjunct to your practice. You will also end up using insurance for your OMM if you are in a high paying specialty already (such as a fellowship trained pain specialist, for example), or if you want to teach and be tied to an academic facility or other big institution, or if you bill for a hospital based OMM service.

I hope that answers your question about OMM billing... I am quite busy but if you have any quick questions you are welcome to private message me.

Michael
Whoa, Bones ... I didn't even know you posted here any more. I wanted to PM you a while back about something, but didn't think you were still a SDNer. Of course I can't remember it now ... I'll PM you if/when I think of it (it had something to do with OMM).
 

Tekar

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The average billing for OMM is ~$50-130 per patient in Missouri last time I checked depending on the number of regions treated ($50 for 1-2 up to ~$130 for 10). This is considered a procedure, which you do in addition to your regular patient visit which you will bill at a normal rate (averaging $60-$100 for primary care follow-ups, perhaps $80-$120 for new patient visits- and sometimes much higher for specialists). Thus, a typical new patient for a primary care doc doing OMM may be $150-$200 and a follow up may bill an average of $100-$140. Before you get excited, remember that insurance companies wait 3-6 months to pay you and take about 35% off the top of this before you see anything, and then you need to pay your office staff, transcriptionists, billers, practice managers, and then pay for lights in your building and rent. You might see between 1 and 6 patients an hour with OMM depending on how efficient you are and how many regions you treat.

In summary: as a primary care doc- for every patient you use OMM on, you can either take twice as long as you usually would or end up making twice as much money if you see them in the same time. In most cities some minimal knowledge of OMM will get many referrals from colleagues as well- simply because there are many patients that they dont know what else to do with (thus an excellent practice builder).



Cash practices paying $120-$250 for follow up visits (medical eval + OMM) and $250-450 for a new patient visit are not that uncommon in big cities (depending on your skill level along what the city will support), and you cut out a significant amount of overhead (the insurance company cut plus most or all of the cost to billers) and you get paid at time of service. A cash practice will demand more skill out of the practitioner- you would need to develop your skills to a high degree and produce real results. Patients expect much more when they pay the full amount out of pocket rather than a 50 cent co-pay...

If you're wondering how sustainable a cash practice is- look at it this way- there are people who are disabled due to pain or injury and want to work. There are people who pay hundreds of dollars per month in medications and wish to be healthy. There are those who have a life altering surgery coming up and who wish for another option.

OMM in the right hands provides an option for many of these people. Many people- myself included, would be willing to pay someone these kinds of fees to fix one of the above issues if it were to come up- so long as someone trusted has seen similar results with that practitioner. I would even be willing to see them several times if it meant I wouldnt need a rod in my back or if it meant I could work again after an injury or could get off hundreds of dollars a month of meds that I would otherwise need to take for the rest of my life.

If you produce no results in a cash practice- you will either offer your patient a refund or you'll have pissed off patients and word gets around fast. If you "cure" their condition and they can work again, or they dont need the surgery anymore- you have a very excited patient who will tell all their family and friends.


Thus, many who are very good at OMM will let the free market decide what their time is worth. If you are just "okay" I'd recommend taking insurance and using OMM as an adjunct to your practice. You will also end up using insurance for your OMM if you are in a high paying specialty already (such as a fellowship trained pain specialist, for example), or if you want to teach and be tied to an academic facility or other big institution, or if you bill for a hospital based OMM service.

I hope that answers your question about OMM billing... I am quite busy but if you have any quick questions you are welcome to private message me.

Michael
Thank you for speaking common sense in a debate that was going wrong. I think your points about cash basis depending on skill are quite intriguing. I see those people with chronic back pain who have the rods in their backs so often in the ER that is makes me want to hurl. If there is a way to provide our patients relief without cutting or narcs, I'm all for trying it.