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Average OP PT billing
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Average OP PT billing - May 24, 2005 5:26:00 AM
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curio
Posts: 70
Joined: May 22, 2003
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I once came accross an article detailing what the average OP PT bills annually...any ideas...?? I have a friend working for a POPS clinic and he is being paid peanuts...I was arguing with him and wanted some hard numbers to add strength to my argument that he is being used and abused....
Thanks in advance!
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Re: Average OP PT billing - May 24, 2005 7:43:00 AM
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TLB
Posts: 353
Joined: September 13, 2002
From: Arizona
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On average you should net 80-100.00 per visit.
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Todd
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Re: Average OP PT billing - May 24, 2005 5:18:00 PM
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jma
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From: NY
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Where can one find these "averages" for what reimbursement is for the various PT services provided?
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Re: Average OP PT billing - May 25, 2005 6:49:00 AM
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hmgross
Posts: 292
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From: Minnesota
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I haven't been in business long enough to determine what my "average" reimbursement is. I think some of the things you need to consider is: geographic location, case mix (medicare vs work comp) and what you mean by "visit" Is it a 2 or 3 unit visit you are referring to? If I had to guess, I would say I am reimbursed $60-70 based on a 2 unit visit. Hope that helps.
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Holly Gross PT
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Re: Average OP PT billing - May 25, 2005 7:14:00 AM
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curio
Posts: 70
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I came accross the article in advance maybe a year or two ago..and have yet to find it again....but it detailed some informatin as to how much revenue a PT generates for an OP facility...I beleive it was b/w 3-4 hundred K per annum....
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Re: Average OP PT billing - May 25, 2005 3:31:00 PM
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jma
Posts: 2414
Joined: August 24, 2000
From: NY
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Would is be safe to assume that different health insurance companies have different rates of reimbursement?
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Re: Average OP PT billing - May 25, 2005 3:47:00 PM
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TLB
Posts: 353
Joined: September 13, 2002
From: Arizona
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Some insurance companies reimburse more some less, some clinics charge more per unit some less. Take the sum of all revenue divide by the # of visits either monthly, quarterly or whatever and substact your contractuals = average revenue per visit.
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Todd
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Re: Average OP PT billing - May 26, 2005 3:55:00 PM
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jma
Posts: 2414
Joined: August 24, 2000
From: NY
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It sounds that if certain insurance reimburse more, then one would stick to them but then again, no everyone may be enrolled in it.
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Re: Average OP PT billing - May 26, 2005 6:42:00 PM
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TLB
Posts: 353
Joined: September 13, 2002
From: Arizona
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jma,
Your correct, I've been on both sides. If you take all insurances no matter what the reimbursment, as most PT's do starting out, then ultimately your working harder and not smarter. If you limit yourself to the one's who pay better (say work comp and BCBS) then your working smarter and not harder. The catch 22 comes into play when your starting out and trying to make a name for yourself, get more people in the door equals more revenue (which decreases you revenue per visit) and that in turn is actually hurting yourself and the rest of your profession. You'll find this frequently in corp. PT and POPTS, trying to run the little guy out of business and take over the marketplace. After which they will renegociate the contracts (at a higher rate) because they are the only player in town and they can. You have to get established somewhow and draw from there. The insurance game is crazy. jma, why don't give some of your experiences and enlighten us all on this matter.
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Todd
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Re: Average OP PT billing - May 26, 2005 11:12:00 PM
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goodlooks58
Posts: 425
Joined: October 21, 2002
From: CA
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I have been in private practise since 1986 in CA. My 2004 year was the worst regards to reimbursement. My average used to be 90 per visit, now I average 50. This is because the HMO and their capitated payments. The catch is that the HMOs con you by saying take our capitated payment and in return market to the docs to send you other well paying pts. This way they sucker PTs like us in giving excellent care to the capitated patients and the docs see that the PT is fool by seeing their HMO pts so then they keep on loading you with all the HMOs and send the good paying pts to the other clincs where they may have a $ incentive or the other PT is their golfing buddy or sending to the Hospital PT to look good in the eyes of Hospital's CEO etc...I strongly believe in Direct Access to fight this con game of insurance comp. PTs need to start thinking like Acupuncturists, Massage Therapists etc and start thinking in getting cash payments. There are always anticipated hurdles in a new way of thinking....however, I see no end to the Insurance comp (the middle man) dominance in my financial future. PTs in general do not want to be accountable to the outcome of our care. If the patient does not get better we as PTs always find excuses. MDs and Dentisits do the same e.g. Last year my Dentisit ruined my crown by not doing proper root canal. I had to pay $1000 from my procket to fix the problem by going to an Endodontist and the Dentisit who messed up crown said..maybe you ate walnuts or something hard...He did not want to accept the fact that he did not fill the root canal to the root thereby leaving an unstable top of the tooth making it suceptible to break.
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Re: Average OP PT billing - May 27, 2005 2:41:00 PM
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jma
Posts: 2414
Joined: August 24, 2000
From: NY
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Actually Todd, I do not have a private practice. I worked for one and experienced what you described, with the exception of not working with patients with workers comp. Eventually, it became an automobile factory that kept growing but the company didn't. Didn't like that and eventually left.
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Re: Average OP PT billing - June 1, 2005 4:26:00 PM
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Nicole Matoushek PT MPH CSHE CEES
Posts: 727
Joined: January 15, 2005
From: St. Petersburg, FL
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Reimbursement for services is a very important topic. Reimbursement typically varies depending on payor source (Medicare, private or work comp), fee schedule, state, and terms of contractural agreement/method of reimbursement.
There are various methods of reimbursement including: case rate/condition rate, fee for service, fee schedules/modified fee schedules, Usual and Customary programs and capitated plans.
In addition, there are ways to maximize your reimursement by maximizing clinical efficiencies (such as case rate/condition rate programs and capitated programs) and providing appropriate documentation of medical necessity for UR/UM and appeals/claims denials.
I have an entire online training course devoted to provider contracting and optimizing your position and reimbursement if anyone is interested. It focuses on the various methods of reimbursement, terms of agreements, contractual process and maximizing reimbursement.
More info can be found at [URL=http://www.workinjuryconsultants.com]www.workinjuryconsultants.com[/URL] or
[URL=http://www.ergorehabinc.com]www.ergorehabinc.com[/URL] or by emailing me directly.
Fine tuning your contracting process can result in a significant increase in your average rate of visit reimbursement.
Nicole Matoushek, MPH, PT
[URL=http://www.ergorehabinc.com]www.ergorehabinc.com[/URL]
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Nicole Matoushek, PT, MPH, CSHE, CEES
http://www.ErgoRehabinc.com
http://www.ErgoRehabBlog.com
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