AndyDufrane

Member
15+ Year Member
Sep 6, 2003
266
9
Visit site
Status
so I am about to make a leap into solo PP, actually independent contractor in a community hospital 20 bed IP rehab unit, but there will be opportunities for inpatient consults and build an OP practice, so are there good online resources on setting it up,
 

RUOkie

10+ Year Member
7+ Year Member
Mar 3, 2009
760
53
Status
Attending Physician
Find a healthcare lawyer about setting up your PC (or whatever is needed in your state) and to help you with contract negotiations. Find good/reliable office staff, make sure only one person handles the money. YOU. Do NOT let your office manager write checks or even do the deposits. Get your accountant to do your monthly statements and do your payroll. Find a billing/ collections company who understands PM&R billing.
 
OP
A

AndyDufrane

Member
15+ Year Member
Sep 6, 2003
266
9
Visit site
Status
Thanks RUOkie,
So I am in the phase of setting up the billing, and my billing software company person is asking what percentage of medicare do I want to charge non medicare insurance companies for O/P EMG, fluor guided injections, outpatient visit, etc. isn't usually like 1.2-1.5 x medicare rate, anyone care to share input? thanks
 

nvrsumr

Member
15+ Year Member
Apr 25, 2002
1,941
491
na.com
Status
Attending Physician
Thanks RUOkie,
So I am in the phase of setting up the billing, and my billing software company person is asking what percentage of medicare do I want to charge non medicare insurance companies for O/P EMG, fluor guided injections, outpatient visit, etc. isn't usually like 1.2-1.5 x medicare rate, anyone care to share input? thanks
3 to 5 times Medicare. You want to make sure you catch any out of network payers that will pay your full charges or a percentage. 1.2-5 times refers to what your contracted rate with commercial insurance payers will likely be.
 
OP
A

AndyDufrane

Member
15+ Year Member
Sep 6, 2003
266
9
Visit site
Status
ok I get a sense of it, but how do you go about negotiating the rate with commercial insurance carriers, is there a way to find out in the area where I will be practicing, what the going market rate and then negotiate from that stand point, talk to other docs in the area, who do you talk to at the commercial insurance company, or do you submit a form? thank you in advance
 

RUOkie

10+ Year Member
7+ Year Member
Mar 3, 2009
760
53
Status
Attending Physician
ok I get a sense of it, but how do you go about negotiating the rate with commercial insurance carriers, is there a way to find out in the area where I will be practicing, what the going market rate and then negotiate from that stand point, talk to other docs in the area, who do you talk to at the commercial insurance company, or do you submit a form? thank you in advance
nope. you call the company and ask for a fee schedule. You take it, leave it, or negotiate. How much you can negotiate is dependent upon market penetration. I was OON for United Health for 5 yrs until they came back begging and gave me a good contract. Before that, they wanted to pay me below MCR.
You are not allowed to discuss fees with other physicians that you do not have a contract with (like an IPA or such) because that is considered Collusion and price fixing (don't get me started on the fact that we can't discuss it, but the insurance carriers can --by publishing fee schedules). That is not to say that rates are not discussed. They are, just not officially.
 
OP
A

AndyDufrane

Member
15+ Year Member
Sep 6, 2003
266
9
Visit site
Status
nope. you call the company and ask for a fee schedule. You take it, leave it, or negotiate. How much you can negotiate is dependent upon market penetration. I was OON for United Health for 5 yrs until they came back begging and gave me a good contract. Before that, they wanted to pay me below MCR.
You are not allowed to discuss fees with other physicians that you do not have a contract with (like an IPA or such) because that is considered Collusion and price fixing (don't get me started on the fact that we can't discuss it, but the insurance carriers can --by publishing fee schedules). That is not to say that rates are not discussed. They are, just not officially.
wow, good info to know, don't want to get into trouble, thanks for the good info