I really have no idea. Im finding out from more and more people that a good amount of insurance does not even pay medicare rates. Especially as i will be solo i have no negotiating provider a large group may have.
I'll go ahead and probably apply to like 10 panels. Not sure how many that CAPQ thing will get me into alone. Then at some point those panels will have to send me the amounts they are willing to pay. I will then have to see what is resonable. and only take those ones. The cynic in me says out of those 10 about 2 will pay better than medicare, 4 will pay medicare or 10% less, and 4 will pay >10% less than medicare. I really don't want medicaid pts but i might enroll just in case to have it as an option. In my state medicaid pays $40 for 99213, $60 for a level 4.
Plus, why would an insurance company want to pay more than medicare anyways unless a large group is not accepting them and they are desperate for coverage.
It's a little concerning that you are planning to go into private practice and don't have any idea of how very basic aspects of practice work.
private insurance companies generally pay more (often a lot more) than medicare. Why do you think so many physicians are scared of a single payer/medicare-for-all plan? because they fear it would significantly slash their reimbursement. If 80% of plans paid the same or much worse then don't you think physicians would be clamoring for single payer? Also while it is true that larger groups have more negotiating power with insurance companies, this is usually not much of a problem for psychiatry as most hospitals aren't keen on providing outpatient psychiatry services and psychiatrists tend to work in office-based settings (office based = private practice typically some model of solo or small group).
they pay a lot more than medicare because people pay a lot of money for private insurance and they need to be able to justify that by the services they provide. In general mental health gets the short shrift but as E&M codes are used across specialties this usually means there might be variance in how much is paid for psychotherapy but the E&M codes will pay decently. At the same time, insurance companies will often set their own amount for what an RVU is worth, and then the reimbursement for a given code will be based on how many RVUs that code is worth per the AMA's CPT book.
In terms of whether to take medicare or not - This is not simply about reimbursement, but also the kind of patient population you work with. Generally medicare patients are either 1) over 65 2) on SSDI 3) have ESRD or 4) have ALS. 1 and 2 are obviously the vast majority. you might not want to treat geropsych patients. patients on SSDI may have much less incentive to get well and thus may not be satisfying to treat in a private practice setting. OTOH if you have your heart set on doing psychodynamic/psychoanalytic treatment and won't be able to get enough patients otherwise, you might be willing to take medicare patients to fill your practice and do what you love even if it means taking a hit to your income.
Patients on medicaid or obamacare will often have alot more psychosocial issues, may be on SSI or seeking disability, tend to be alot sicker, may have more medical comorbidities. They are much more likely to need integrated care and case management services. They may be less than ideal psychotherapy patients. As such they are not typically good patients for a solo private practice.
In terms of which insurances to take - this is partly based on what they reimburse or how much of headache they are to deal with. UnitedHealthCare (and its carveout optum) are one of the worst in terms of mental healthcare coverage and unlawful restrictions on care and tend to pay poorly. Aetna is another one that has been sued several times for denial of coverage. You can get a good idea of what insurances pay the best by looking up private practice psychiatrists in your area and seeing which insurances they take. Usually it is better to take a limited number (say 2 or 3) insurances that are known to pay decently. The exception to this is if you are planning to have a high-volume med management practice seeing patients for 10-15 minutes visits, in which case you want to take as many insurances as you can as your income will be through seeing as many patients as you can rather than what you get per patient. But in that scenario you would definitely want to have someone doing your billing (and that could be a lot of work), and want to hire staff like a secretary or share those resources with other psychiatrists. One common model of practice is for several psychiatrists to have solo practices in a building but share those resources. High volume practices have will increase your risk of malpractice claims however - as it means you will be seeing more patients, at longer intervals, for shorter, and will know them less well. It would probably not be feasible to screen them.
On the other hand if you have a smaller practice - particularly a psychotherapy based one, or where you are seeing med management patients for longer (say up to an hour) and more regularly, you may want to screen all the patients yourself. Screening would include their ability to pay, their suitability for treatment in an office-based setting, that they fit with your philosophy style, and they are patients you want to see (for example you might want to screen out patients who have just been discharged from the hospital, who are chronically suicidal, who are court-ordered for treatment, who are on multiple controlled substances). You may also decide to have a cash only practice. Away from the NE, it is true that most people expect to use their insurance but if you wanted to you could have a sliding scale to accomodate a range of patients. I have heard some psychiatrists say that they will charge more for patients who seem more difficult/annoying during the screening. So you can think to yourself, "how much would be worth my while to see this patient?" You want to have some sort of rule for no-shows or cancellations <24-48hrs. This could be a nominal fee or it could be the entire amount of the visit. keeping a credit card on file for these purposes would be important. You may also want to charge for patient calls >5mins. One way of doing that is prorated by the hourly charge. You can do this in an insurance based practice (even for medicare patients as medicare does not cover phone calls). you can't charge for prior auths though (or shouldn't) with the exception of it is because the patient is insisting on some version of the drug that requires PA when something else would have been fine and is causing grief for no reason.
I would imagine there must be psychiatrists in private practice in your area who are on the volunteer faculty of your program who you could talk to about all these sorts of things.
you also want to talk to an attorney. They can help with the legal aspects of setting up a practice, as well as helping draft forms for running a practice (i.e. consent forms). You need to come up with a policy for dealing with suicidal patients, how you handle out of hours problems (for example whether you'll have an answering service or be available yourself), and coverage for when you are away. Although a lot of psychiatrists have a "go to the ER" out of hours or when they are away, this is unethical and frowned upon as well as being inappropriate except for emergencies.You also want to talk to an accountant.
The other issue to think about is documentation. Older psychiatrists might still just have handwritten notes. Others simple use word. Others might use Practicefusion or Valant. Regardless you want to make sure what you do is HIPAA compliant.
point is you have a lot to think about and it would be very foolish to think you just hang up your own shingle without consulting a lot of people and thinking it through. It may be very rewarding to have a private practice for the some, but for others it's not worth the headache.
. Don't think I have enough time to realistically do all this before lets say august. Guess I'm starting to see why almost no one starts out PP unless maybe doing cash only-part time with a side job.
