RE: plea for advice

[Guest guest]

I’ve also heard that we are not

supposed to compare our fees, but I wonder if that is truly illegal or if that

is just some form of “urban legend” that gets passed on down the

line. Really, why would it matter if we did get together & set our

fees higher? Companies still don’t have to pay it. Also, why

are doctors different than, say, car dealers or barbers, where prices are

readily known? Also, patients know our fees so why does it matter if

another doctor knows them too? I am also not a lawyer but I have never

understood that one.

Re:

plea for advice

If you want to get more

detailed, Ingenix sells a cusotmized fee survey that is specific to your

geographic area; it costs $300. It tells you the 50th percentile, 75th

percentile, etc not just for e+m codes but for all procedure codes.

That's a lot of money for a solo start up

Alternatively,

I found in my hospital library a book published by a similar third party

research company that listed the 50th, 75th, 90th fee schedule for all CPT

codes adjusted for locality. There are many books like that around.

Check with your librarian.

postrio

wrote:

Hi , I have a couple thoughts. One is

that you set your fees relative to medicare reimbursement rates because those

are published and readily available. Private insurance reimbursement is

not as easy to nail down prior to start up. The usual business model

is to take all the insurance you can the first year until you are busy.

Then you have the luxury of weeding out the poor payers. Insurance

reimbursement can be all over the map. Sometimes an insurer will

reimburse 125% of Medicare for a given code. What you want to avoid

is setting your fee for a 99214 at $104, only to find out that two or three of

your insurers give you the full $10! 4 for the visit. That means they

would have reimbursed more, but they are not required to give you any more than

what's on your fee schedule. Here are the mean fees from the AAFP

Practice Profile Survey! May 2004 for the Pacific region, level 1-5:

New: 62, 97, 137, 191, 242. Established: 35, 57, 78, 118,

174. Those are about 10% higher than national averages. If you want

to get more detailed, Ingenix sells a cusotmized fee survey that is specific to

your geographic area; it costs $300. It tells you the 50th percentile,

75th percentile, etc not just for e+m codes but for all procedure codes.

That's a lot of money for a solo start up, however if you are going to do your

own billing, it might be worth it to know you are not under charging. You

might go in on it with someone else in your zip code.

As for call, contact

solo doctors in your area to find out about call groups. There will

likely be more than one that would love to share call with one more doctor.

samanthasanfran

wrote:

I'll

be opening my doors in 8 weeks and am starting to tackle some of

the nitty gritty aspects of setup. I'd really appreciate reading

people's thought on the following questions:

What's the benefit of

charging more than the insurance companies will

pay? (Why bother?)

What do you do about call coverage? (I'm

single and would really like

to be able to go out on a date every once in a

while without taking my

patient panel with me, if at all possible.)

What organizations do you

belong to and why (medical, business, networking

groups, chamber of

commerce)? Thanks in advance to all who

reply, Malm, M.D. San

Francisco, CA

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DSL Something to write home about. Just $16.99/mo. or less

Yahoo!

DSL Something to write home about. Just $16.99/mo. or less