Solo practice insurance reimbursement as percent of medicare

[orion1978]

I am planning on starting my own ENT practice. For solo or small practices, what percent of Medicare reimbursements are you seeing in a large, competitive urban area? I have heard that 125% is what to expect in insurance contracts.

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[chestsurg21]

So this is my experience for general surgery
Medicaid hmos pays Medicaid or better.

Medicare advantage ranges from 85% of Medicare to 100% but usually 90% to 100%

Ppo insurance is usually 110% with some exceptions like United healthcare or some exchange plans where they will do 90%

it’s specialty specific and I know you said large urban area but even between Boston and say houston you will probably see a 10 to 15% difference (with Boston being lower)

Smartest thing I recommend is ask your peers in the area

 

[orion1978]

So this is my experience for general surgery
Medicaid hmos pays Medicaid or better.

Medicare advantage ranges from 85% of Medicare to 100% but usually 90% to 100%

Ppo insurance is usually 110% with some exceptions like United healthcare or some exchange plans where they will do 90%

it’s specialty specific and I know you said large urban area but even between Boston and say houston you will probably see a 10 to 15% difference (with Boston being lower)

Smartest thing I recommend is ask your peers in the area

That's insane. I moved to my market initially because it was a good state for docs. We're at 105-110% of Medicare. Currently, I'm looking into whether it's possible to charge a per visit fee (i.e. $20-30) as a blanket fee for typically free services such as phone refills, forms, patient portal, etc.

 

[dpmd]

That's insane. I moved to my market initially because it was a good state for docs. We're at 105-110% of Medicare. Currently, I'm looking into whether it's possible to charge a per visit fee (i.e. $20-30) as a blanket fee for typically free services such as phone refills, forms, patient portal, etc.

We charge a forms fee. Not per visit, just per form (not sure if it is a charge per individual form or just a blanket fee for all the forms brought at one time).