Cash-based Question (Full Version)

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JSPT -> Cash-based Question (May 12, 2006 1:02:00 AM)

How exactly do cash-based practices work? Do you set a price per hour and then bill the patients directly? Can the patients seek reimbursement from their insurance provider? What is a common fee for services?

I have read a lot about cash-based practices on this site, but still don't have a clear idea of how they work.

Thanks in advance.



SJBird55 -> Re: Cash-based Question (May 12, 2006 1:24:00 AM)

I have had a few cash-based patients. They either do not have insurance OR they decided they wanted to pay me out of pocket and then send in a statement to their insurance company. I have a specific contract the patient and I sign. The contact outlines the negotiated fee schedule that the patient and I will agree to. That fee schedule defines the expected amount of money they would be responsible for paying for the various CPT codes. To make it easy on my biller (so that charges could be inputted into the ledger) and easy for an insurance company for those that wanted to turn a statement in, I kept the CPT codes in place. I don't have my sheet here, but I used language that the CPT codes would just describe the type of procedure provided (which means for those patients the level of supervision is at my discretion). The patient generally pays at the time of the appointment.



ehanso -> Re: Cash-based Question (May 12, 2006 10:58:00 AM)

SJB is this the same fee and billed to medicare patients?



FLAOrthoPT -> Re: Cash-based Question (May 12, 2006 12:13:00 PM)

i just have a set fee for evaluations, then based on complexity of problem I guess you can say I charge per visit. I discount visits if they are coming in regularly, but if they come back in the future I charge the eval rate again. I also know many people doing across the board set fee for eval and set fee per hour, all of which can be attempted to be recooped by patient to their insurance co. if they wish.
I must say the more you charge the more people think your service is worth. At one time last year I was charging 200 bucks for an hour visit and getting it.



SJBird55 -> Re: Cash-based Question (May 12, 2006 12:25:00 PM)

Falls, everyone gets charged the same with me. It is the contracted amount paid to me that varies contract by contract. If someone wants to pay out of pocket for care, I have a standardized expected fee schedule that the patient and I sign. It is set higher than Medicare's fee schedule. Ben, I wouldn't even dream of charging what you did last year - the population of people in this area generally couldn't afford that kind of rate.



drbuddy -> Re: Cash-based Question (May 12, 2006 12:39:00 PM)

Isnt it illegal to have a dual fee schedule? In other words, isn't medicare going to have a problem with you charging them more than you charge a cash patient?

I heard you can have a time of service discount if the patient pays in full each visit, but not so sure you can just discount your fee schedule based on how people are paying.



FLAOrthoPT -> Re: Cash-based Question (May 12, 2006 1:00:00 PM)

i do not treat medicare, so it is not a problem to have as many fee schedules as you want. Yes, if you are going to treat medicare and accept medicare, then yes, you need one schedule of fees. Then again, yo umust treat EVERY pt like a medicare pt, so one on one care for everyone...how many of you are doing that?!



FLAOrthoPT -> Re: Cash-based Question (May 12, 2006 1:02:00 PM)

an SJ, people can afford what they want. If someone can shell out 400 bucks for a new driver for golf, they can afford money to help get them in better golf shape. If someone can afford 250 bucks on herbal remedies for their back pain, they can afford 200 to be in less pain or pain free. as long as they are getting the results they want, when it comes to pain, most people are willing to pay just about anything. but i do understand that people on palm beach are living in one of the most expensive zip codes in the nation, so I am sure not everyone can fork out 200 bucks per treatment. However, never sell yourself short.
Ben



SJBird55 -> Re: Cash-based Question (May 12, 2006 2:49:00 PM)

As I had said... I charge everyone the exact same fee schedule. What I get paid depends on the contracts that I have. BCBSM pays better than Medicare. Anyone who has been in an auto accident has the best reimbursement rates. My cash-only folks pay at a higher rate than Medicare's fee schedule.

Medicare can't have a problem with what one is actually paid if one is charging everyone the same. For example, when I've read on here some folks accepting $45/visit. That kind of contract is WAY below what Medicare would pay for 2 or more procedural codes. Is that contract with that low paying insurance company illegal? Not really... those with that contract agreed to accept less for the services provided.

Medicare doesn't require one-on-one for every patient... there is that "group" code that has to be utilized in cases where patients overlap. And... the CPT codes utitilized by all insurance companies do have a level of supervision defined, which means, it isn't just a "Medicare" thing.

Ben, comparing an object to a service isn't a reasonable argument. I might agree to something like $200/hour if it were a one or two time kind of a thing.... but, physical therapy isn't a one visit kind of thing. If you do 5 visits at $200/visit, you're running $1,000 right there. In my opinion, that just isn't reasonable and I myself wouldn't pay that kind of money to any therapist... I won't expect anyone that comes to me to pay that kind of money either. Realistically, we have no guarantees in our business and I won't elevate myself and believe that my services are always the answer. What I charge has nothing to do with selling myself short, but more to do with being reasonable and affordable.

And, just to let you know... many of my accounts that are sitting in my A/R that are $200 to $300 or more because of the patient's deductibles - guess what? Patients don't write me a one time check and clear their account - they send me $20-$30 each month to pay if off. Why do they do that? Well... many folks are living paycheck to paycheck. It always makes me smile when I get one of their payments - they are good people doing the best they can and making the effort and taking care of their responsibility.



FLAOrthoPT -> Re: Cash-based Question (May 12, 2006 7:04:00 PM)

different strokes for different folks, and different areas of the country dictate different procedures. Then again, I am sure you are a democrat and you are sure I am a republican. In the age when your same patients you are pittying are paying 100 a week for cigarettes and 50 a week to their chiropractor for their adjustments and 85 a week for their haircuts and 200 a month fo rtheir cell phones, they too can afford your expertise in being the best person around in diagnosing, managing/consulting, and treating their dysfunctions. I am not saying i am right and you are wrong, I know you love to argue, so hold on to your horses, I am just saying it is awesome that our profession is so varied and made up of all kind of people and is so different even in geography and region as much as in practice.
night-
Ben



goodlooks58 -> Re: Cash-based Question (May 12, 2006 9:18:00 PM)

My practise is also in an affluent area, however, people in general get bitchy when it comes to pay for medical or for their pain. People think that everyone in the medical community is ripping them off and the Government owes them. Eating at a nice restaurant and paying a bill of $100 is done easily with a big grin but when folks have to pay co-pay or deductibles, they suddenly feel cold and their face begin to droop. Maybe it's our American right to whine about everything. ( "Oh hot coffee fell on my lap let's sue McDonald's for zillion $$" )



SJBird55 -> Re: Cash-based Question (May 13, 2006 2:47:00 AM)

Geesh, Ben... politics don't matter. I mean, it never crosses my mind what anyone is or how they vote. For your info, I vote by what the person says the person will do - I have a mixed voting thing when I toss my chadless thingy in someone's hands.

Obviously, you are in an area where there is lots of cash around - men pay $9-11 a haircut; women $20-25. Most of my patients aren't seeing and don't go to a chiropractor.

My area is probably going to get worse financially - GM has closed quite a few plants... other automotive manufacturing companies are closing their doors... people in the area I live are moving out and getting jobs out of Michigan. I have never seen as many homes for sale or for rent in Lansing. I haven't heard any of the Governor's campaign commercials yet... but Dick DeVos is definitely mentioning keeping jobs in Michigan.

What it comes down to is knowing what your market will pay. The hospital down the road from me had a fee schedule of $80 every 15 minutes while I was employed with them. They do not negotiate... anyone without insurance has to pay it in full. Guess what? I'm the one the patients choose because what I offer is more reasonable to them. In fact, they thank me for considering their kind of situation and appreciate that I understand.

And, I guess, if truth be known, our insurance doesn't cover any office visits (our own family's health insurance). I personally wish all physicians had something in place for those without insurance coverage - so, since I'm in a position to make decisions now, I created something that I wish for myself. If 100% of patients attending my clinic paid out of pocket at the negotiated amount, my business would be healthy and I'd be making a decent profit. Actually, I'd be doing even better because the language in their signed contract does not limit me to one-on-one treatments only. LOL

Yeah, good... no one likes to be responsible; everyone likes to blame. Of course people are going to whine about co-pays and deductibles... for years and years especially in this area, there weren't any! Having to pay for somethihg that was included in the insurance package in the past pisses off some people. In Michigan, for now, if one wants the least amount of health care expense 1) be a teacher in the public school system or 2) work for the government. Those folks still have the best policies around. That may change with all the budget cuts, but for now, they have great policies.



TLB -> Re: Cash-based Question (May 13, 2006 10:49:00 AM)

[QUOTE] In the age when your same patients you are pittying are paying 100 a week for cigarettes and 50 a week to their chiropractor for their adjustments and 85 a week for their haircuts and 200 a month fo rtheir cell phones [/QUOTE]Amen, you don't realize what some people pay for on a weekly basis and it's no big deal but when it comes to healthcare. they feel it should be basically free or just a co-pay. Keep feeding the monster and it will continue to grow. It blows my mind that people in my profession feel quilty about charging a reasonable fee for care. Getting rid of billing insurance can't come soon enough, that should be the pt's responsibility and when that happens you'll see the average therapist go down the drain.



Jeffre -> Re: Cash-based Question (May 13, 2006 6:03:00 PM)

The worst is when a pt will ask if they could do their ther ex at home instead of coming to the clinic, but they will pay a personal trainer $50-$100 a visit or more( depending if you live in West Palm or Lafayette) for 3x week for 3 months.



FLAOrthoPT -> Re: Cash-based Question (May 13, 2006 9:30:00 PM)

exactly



SJBird55 -> Re: Cash-based Question (May 14, 2006 1:45:00 AM)

Chuck Felder just posted on PTManager some info on charges. Information he provides comes from PT Benchmarking.

Median charge per licensed provider hour: $137.24
Median collection per licensed provider hour: $91.74

Based on his data and the definition of median, Ben, I believe that your $200/hour is at the high end of the spectrum.



FLAOrthoPT -> Re: Cash-based Question (May 14, 2006 5:40:00 AM)

a very smart person once told me:

you are only worth what someone will pay.

There is no reason gas is 3.50 a gallon, other than we want it and we'll pay for it. What I am saying is, if you think your services are invaluable and far better than someone elses, try to bump your rates up, you'll be surprised, many people will pay it if you seem to know what you're talking about.



Jeffre -> Re: Cash-based Question (May 15, 2006 6:10:00 AM)

I think this is talked about in a book called Influence by Cialdini (?). I'm not sure but he might call it percieved worth. His gives an example of a jewelery store owner who is having trouble selling a certain line of jewlery. By mistake the owner raises the price of the jewlery by $100. Next thing you know the pieces are flying off the shelves. How many times have you heard someone say "if it costs that much it has to be good"? Or how many times someone has bought something more expensive than what they usually buy because they think it has to be better.



bhenchodh -> Re: Cash-based Question (May 16, 2006 11:00:00 AM)

Very interesting dialogue going on here but can all of you tell all of us EXACTLY how much are you charging for cash business? Even if you have one standard fee schedule what is the dollar amount? I will share mine. It is pretty much 100 for IE, RE, 70 bucks for most CPT codes besides modalities which are cheaper. I have a standard fee schedule as I take Medicare, and I am located in NJ. I charge the same to cash patients. 50% have paid all believe it or not and 50% b%*#h and moan. I don't collect aggressively ( like my optometrist does.... 30 days then a letter from his lawyer bro... jeez), I do offer payment plan of paying off balance over 1 year. Also I want to know why most therapists keep there fee schedules a secret. As if revealing it would make them lose money. Ever drove down route 1&9 near Jersey City. Its like the gas cartel makes sure everyone charges the same, but our gas prices are SWEET compared to the rest of the country. Unfortunately our reimbursement rates are not, so my point is lets educate each other and maybe those who think that 45 bucks a treatment is a good rate may think twice.



FLAOrthoPT -> Re: Cash-based Question (May 16, 2006 11:56:00 AM)

I go to people's homes, and a bit more focused on all manual treatment. for manual treatment patients it is 200 for eval, and 150 for treatment routinely. I have dropped to 100 for treatment for some of the people doing 3 times a week at an exacerbation period. I have also gone as low as 50 a visit for high school soccer team for orthopedic consults. All in all I bill no less than 100 a visit.



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