One of the biggest challenges I hear from folks in private practice taking insurance is that the money flows out as fast as it comes in. No if it's flowing out in the gas tank of your Massarotti, I want you to stop reading this and tell the rest of us how you're managing to do it legally. If you're in the rowboat with me, then let's keep talking this out together. (In case it's not obvious, I'm not using AI to generate this post. It was fun, but it was going to be an expense I couldn't justify keeping in the budget.
Budgeting was the number one tool in my box for discovering the leak. I made a detailed spreadsheet of everything I was spending, everything that was coming in, and broke it down by individuals in the office, and then the average income per client appointment. I kept the later less complicated by focusing on the core code I use - 90837. When I bill 90837, I make between $42 and $152 for the session, based on the insurance company paying for the service. There is no difference in what the service entails in terms of resources across individual sessions. The only difference is what the insurance company has promised to pay me in the contract we signed.
Realizing that the pay per session was my constant, I decided to figure out what it was on average for the budget I was trying to rebuild. I counted the number of clients I was seeing for each insurance panel over the course of the month. I take approximately 15 different insurances, so this is purely representative:
Insurance A pays $42 x 6 clients = $252
Insurance B pays $117 X 37 clients = $4329
Insurance C pays $152 x 22 clients = $3344
So I collect an average of $121.92 per 90837
Youi may have read my blurb about using various companies for billing and having a preference for paying to bill myself for several reasons. One of these was the ability to take insurance they do not cover, such as Medicare. They started taking Medicare last week in one of the states I am licensed in. This game me pause. Then I remembered they leverage their size to get better contracts, this gave me more pause. But the big issues still remained for me - they do not let interns use the platform, even if an insurance agency allows it (there are several). The second big one was how to work on expanding if not through credentialling my employees under my own group EIN and NPI-2.
For now, using these large insurance billing brokerages require having individual providers credential themselves, then they put in your business banking information, so the paychecks come to the same place, and the employees get paid from the main account. I am a trusting person, and I am very transparent with my books, so this doesn't really bother me. But what happens if the employee decides to go off on their own? The clients are in a neat little package and the employee can simple walk away with all of their paying clients intact. (Possibly in violation of a contract, but I don't believe in non-compete clauses, so this is a non-issue for me.) This issue only took me about 60 seconds to consider. I would argue that this is the most ethical, appropriate, and healthy way to conduct a therapy partnership that I can currently imagine. If a therapist chooses to leave their practice, they should be able to take clients with them. Does this not fall directly under the standard of continuity of care?
To wrap the post up - I figured out I was losing about a thousand dollars a month for what I already do by not using the larger billing service, and I will be able to bring on new therapists with ease. I will just need to make sure I cover the company for the overhead if should they decide to leave the practice.
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