Hi, I have been in private practice for about 6 months. I started out accepting only one insurance and billed them their contracted rate.
Now that I am in network with several insurances, each with different contracted billing rates, my billing is getting tedious. I am nervous about losing money by underbilling.
I have checked with other providers who have reported having billing rates specific to their practice which makes billing rates uniform for all insurances.
How can I bring this uniform billing rate to my practice. Do I need to make a new fee schedule and inform my patients of this change as they will be seeing this change on their EOB.
Posts: 12
Joined: December 18, 2008
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Hi,
I'm sorry to jump in with different line of thoughts here; however I see that you just opened up your practice. I'm planning to open up my own but am completely lost in getting enrolled with the insurance companies. Could you please guide me? I'm planning to get enrolled with medicare right now; however, they need the facility or treatment area lease paper etc. I still don't have a place cause I don't want to jump rent a place before getting enrolled in any of the insurance company. Could you please suggest me some way out or guide me please.
I again apologise to jump in here with a different line of thought. If you want I can email you. Please provide me with your email address. Thanks
It has been my experience that you will have to have a physical location prior to gaining your credentialling. Unfortunately, this is one of the often hidden expenses of opening a practice as you will need a credit line to have an early cash flow.
You should have an established fee schedule which is notably greater than your highest reimbursing payor so you minimize the risk of under charging. For your current insured patients this will probably not have an effect on their bottom line as the insurance company will automatically take the adjustment.
I am in North Carolina. You need to check your state regulations in terms of what is permissible. I wish I knew exactly. I don't want to mislead you. The one thing I know in general is that you need to get on the insurance panel if they are accepting new providers. I suggest you start with that.
Great to see a couple of new practice owners eager to learn about insurance billing. I am a PT owner operator and would be happy to share my fee schedules with you. It is very basic: we bill $100 for the eval and $40 per unit for all other CPT codes. We came up with that by calling other clinics in the area. Some clinics will be more some less. We tried billing the exact fee schedule for a while, but started to underbill when payers updated reimbursement rates.
Our billing software allows us to enter an allowed amount which gives us a good indication of what we can expect to collect, but all claims go out with the above standard fees. If you have any specific billing or credentialing questions don?t hesitate to email me. I am always eager to assist other private practice owners.
FL, Your fees seem low, but then again I am sure that there are geographical considerations when setting your fee schedule. In the northwest we are charging 180/eval and 60/unit. with an average of 75% reimbursement.
Posts: 12
Joined: December 18, 2008
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Thanks everyone. Well I have one more question. What if the insurance companies don't have the openings right now? Do we keep callling them? How does this work? I mean how often we should call them or should we mail the forms? How does this works. I'm planning to open up in New York area. Any help or sharing of experience in any other geographical area will be appreciated.
Send in your materials and then continue following up with them, maintaining very good communication. If you can do some surveying of the other accepted practices in your area and then determine any potential services which you offer that are not offered elsewhere. This will help to demonstrate your specialty of services offered. Good luck.
Posts: 456
Joined: October 22, 2002
From: CA
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Shahpt: I was wondering what is the reimbursement rates in New York and the surrounding suburbs e.g Long Island. We always hear about the negatives on the rates in New York, however, there are PTs in private practise and there are some who also willing to start new. So shahpt, are you willing to educate us on the rates?
Posts: 12
Joined: December 18, 2008
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Hey, Thats a really good question. See this is why I'm posting here because I too want to know the in and out of the private practice. I really don't know much about the rates in NY and trying to find out the same. However, from the place I used to work before there weredifferent rates for different insurance companies and they say that you have to have the contracts with the insurance company. The rates are to charged accordingly. For example, I know that GHI was the worst payer. No matter what you charge for evaluation or treatment the place I worked only recieved some $45 for evaluation and $20for treatment. This I came to know when I was in short of time for evaluating a patient and my supervisor told me its OK, you can do rest some other time (in whispers- GHI is not going to give us anything more than 45).
I will but definately post whatever I find out in process. I would love to know if someone knows how can I find out more about the insurance rates. Thnaks
Shah PT. I dont mean to discourage you, but I worked some 6 odd years in New York and tried everything you are trying right now. The only insurance panel I almost got on was United Healthcare and their reimbursement rates would not have let me practice anyway. All the insurance panels told me was that they had enough providers. Move to another state..
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