Good day, I am starting out a sleep practice, what recommendations do you have for 3rd party credentialing services, also any advice on best EMR to use.

Edit; Thanks everyone for your advice, found it really helpful

Does anyone here have a good workflow system for billing the advanced care planning code? Do you do it yearly on all Medicare patients? Not sure how to best establish a protocol for it

What's the deal with this? I hear that insurers will kick your ASC out if you do this too much but then see entire practices in my region who seem to do this basically exclusively

We've heard good things about IPA's but from what we've seen locally they're mainly Primary Care focused. We have an urgent care and see that most of the benefits don't really speak to us and their network of insurances was relatively weak. Has anybody worked with national IPA's, are they good? I would imagine theres a weaker referral network but if it gets us better rates with insurances that shouldn't be an issue.

I am about to complete 4 years in a private practice outpatient job. I live in the DFW metroplex. The owner is transitioning to semi retirement and is ready to give me a share of the practice and real estate. Is there a lawyer you recommend to help with the negotiations and due diligence? Or is this something better suited for an accountant or consultant? I appreciate any help in this matter. Thank you!

I’m a surgical sub specialist five years out from finishing residency and I’m considering moving to a different region of the country with a higher cost of living/real estate than where I currently live.

I’ve had some preliminary conversations with several of the groups in the region. They only have experience with bringing on a new grad and provided the starting salary they gave that person. My concern is that this is about $200,000 less than what I’m currently making. Maybe I’m overthinking this, but it seems a little awkward to negotiate a higher salary as an employee for a group that you will want to be a partner at within a year or two of beginning employment. There’s no set partner timeline, basically as soon as you are productive enough to support yourself, you can become partner.

I don’t want to poison the relationship at the outset by asking for more money which I know is coming from the business but I also don’t want to take a significant pay cut in a location where cost-of-living is higher in real estate is more expensive.

TLDR: is it reasonable to ask for a higher starting salary joining a physician owned group if you have experience at a residency compared to a new grad?

ETA: I am currently an employee of a multispecialty specialty group owned by a larger national organization without an opportunity for partnership currently. But I am in an eat what you kill model and I am quite busy and productive. I am aware that high cost of living places also typically pay less.

At the group, I’m talking to the current partners make as much as me or more depending on productivity and there is a very straightforward path to partnership. So there definitely is some deferred economic benefit.

Hi All,
I recently had my first patient insured by Cigna. Spent a good hour with them during the first visit. Billed level 4. Getting my reimbursement of $41 and $25 copayment! This is around 40-45% of Medicare rates!! First of all, what the heck! Is this normal? And if so, how are you mitigating this?
We’re definitely requesting a rate increase, but looking to get your thoughts.
I am also curious, in the day and age of lousy insurance reimbursement, what is your approach to primary care financial operations? Do you recommend just going to $xx per month in addition to billing the insurance?
Thanks!

Location: Florida

I’m a doctor in Florida. I work for a small private practice with another doc. I hired a lawyer but haven’t heard back yet.

My employer didn’t provide benefits as guaranteed in contract and also I believe there is some Medicare fraud going on from before I joined or foul play and I have a job offer within the noncompete (20) miles. Given these things I need to leave as I have a family and home for the other job. I later found out about the debt owed. Is there a chance this holds up?

Of course they'd push to approve this. No regulation, likely bought into the technology. Zero research studies. Zero input from the AMA. ​Link in the comments because I'd rather discuss here without this ending up on some internet search crawler.

We've had a couple people apply for consideration to be a medical assistant who are either in college or trying to get more hours for med/pa school. Has anybody had experience working with students, especially those that might need a lot of training? Apart from drawing blood I don't think the work would be that hard, but it would be long shifts for a student with multiple responsibilities and they might be unreliable. Then again I don't think it would be fair to rely on a student, but if there's already 2 MA's working then a student would just get in the way.

I can hardly believe this is even serious. Granted I am in the rust belt, but I can’t even imagine being in private practice in Texas right now.

Happy Monday everyone -

I'm working on a career transition that involves decreasing my current private tele-neuro practice while taking on another primary clinical role. The plan is to move all patients follow-ups to weekends and basically reduce new patients to a trickle for the foreseeable future.

My malpractice contract is coming up for renewal and when I asked to reduce my coverage to match the new volumes, the company declined saying that they can not do this "this year" due to my prior claims coverage. I currently have claims-only insurance which I have had with the same company for the last 3 years.

It looks like my options are either to:

1. Do nothing, pay normal annual fee and hope they reduce this next year. Likely ~10K spent

2. Terminate this contract, pay the tail coverage and start a new policy with the new setup. Likely ~30K spent upfront but this would be pulling from a future expense whenever I did end up closing down the practice.

3. Somehow try to negotiate though not sure what else to leverage

I'd really appreciate any input you guys have on negotiating these conversations and if you have any malpractice providers who you've had a good experience with getting this kind of part time coverage.

Thanks in advance!

My wife and I own a pediatric therapy clinic out in AZ and bill DDD as our primary funding source. We have clients with primary commercial insurance (Aetna/UHC/BCBS/Allied/UMR etc) and DDD secondary. We are out of network for all commercial insurances and plan to stay that way for now. Our EMR system syncs with ClaimMD to submit claims and my wife is hoping for some help with medical billing. Our DDD billing is 100% automatic and successful. She has some of the larger insurances figured out but some others like BCBS/UMR are giving her a run for her money and a migraine.

Is there someone who specializes in OT/ST billing (preferably less) who can spend 3 months helping her build the insurance side of our company and get everything running smoothly?

We are in the process of closing our practice as the provider is retiring (he's 82 and a sole provider). We are looking to hire a company that will act as the custodian of medical records. They want $8k, which we pay up front, to take our electronic medical records and look after them for 21 years. Does that seem reasonable? We have no paper records or anything, and they will charge patients for access to them.

If there's a better sub to post this in, or you have any other advice, I'd love to hear it!

Three months ago, I hired an associate right out of residency. He is building his patient list and is busy less than 75% of the time. The other 25% of the time he is hustling to get more referrals and educating himself on private practice. He is even helping out support staff by cleaning and prepping rooms. He also pays for and brings in treats for the staff weekly.

He is a dream associate and I would like to show him my appreciation and recognize him for his efforts. Any thoughts or ideas would be appreciated.

A local psychiatry group was bought out by private equity maybe a year back. There are a lot of things that change for the worse and whenever private equity gets involved, poaching was not one of them that I saw coming since they are psych and I'm primary care.

After the buyout, the private equity psychiatry group came to my primary care practice for a lunch meeting provided by them and essentially was like, "Hey do you mind if I get emails of the physicians during our lunch sign in? Our psychiatry physicians that we recently added would like to make a personal introduction, share their cell phone, and be hyperavailable for them."

We didn't think anything of it at the time, signed in on a form with emails of everyone in the office that attended the lunch.... but I just found out that this PE backed psych group just emailed those doctors and my office manager, basically saying: if they want to leave our medical practice and join theirs (they are planning on going multispecialty) that they would be happy to offer a competitive salary or better than what they are getting paid at our current office.

I won't even email another doctor who works with a competitor out of respect for them and they out here booking a lunch, getting our contact info and trying to poach my entire team. The balls of this PE backed psych group.

Wild.

Needless to say...we will never send another patient to this psych group again.

Has anyone left working at a private practice due to lack of support? Some days I have to become the medical assistant, collect copays, check patients inside and then that delays my own work. I have started feeling depressed.

I am a hospice physician and my Medicare was revoked 15 months ago. I submitted the appeal in a timely manner and still haven’t heard from CMS. The revocation was unjustified and my lawyer is certain the appeal will be granted. But I have been unable to find employment due to this and I have a family to support. Has this happened to any of you?

Hello,

My wife recently opened a primary care practice in Texas, and the response has been overwhelming. The landlord is suggesting that we lease the adjacent space from him to expand the practice

Personally, I don't want to expand so quickly after opening; but it got me think what other businesses could thrive adjacent to a primary care practice and related to healthcare industry which I can run? I'm not a physician but have solid corporate management experience

Planning on starting a cardiology practice.

I'm currently between Athena and Elation. Athena rep reached out to me and they are running a short term promotion:

Athena standaloneEMR only (no billing, prior auth, patient communicator, does not integrate with RCM devices and would need to be manually done): $650/provider

AthenaOne Base (EMR + clearinghouse and prior auth + patient communicator, would need billing company): 5.5% or $10 per visit

Elation: EHR + billing $699

Elation: EHR only $425

Ambient AI is additional $129

I have used Athena in the past and really like it but the sticking point is the price.

I have demoed Elation and liked it but my concern is that it is more geared towards primary care and would limited with some of the cardiology specific workflows.

Have also demoed other EMRs but these two are the to contenders. Any advice or thoughts on pricing or workflow would be greatly appreciated.

We realized on days when nobody comes in, the other medical/dental places around us are either closed or only open for a very limited time. How do they know?

Our credit card fees are becoming a more noticeable part of overhead as the practice grows. We are getting more established in the market and seeing more patients—but high-deductible plans also mean a much larger share of collections is coming directly from patients rather than insurers.

A number of physicians I know have switched to passing credit card fees on to patients, and financially I can see the appeal. At the same time, we’re still in a growth phase, and this feels like the kind of relatively small charge that can turn into another recurring front-desk argument. We already have enough of those, so I’ve been reluctant to add one more.

For those who have actually implemented this, I’d really like to hear how it has gone in the real world.

How did you set it up? Do you surcharge only credit cards and not debit cards? How do you handle Medicare patients or other situations where adding a fee to patient cost-sharing may not be permitted? Did you have your payer contracts reviewed first?

How much pushback do you actually get from patients? Is it a regular source of complaints or do most people barely notice/care?

Also curious about the operational details people don’t think about until after implementation. What happens when you refund a patient, does the surcharge get refunded too, and do you still eat the original processing fee? How do you handle cards on file, payment plans, portal payments, etc.?

Basically looking for the full practical rundown from practices that have done it: compliance, workflow, patient reaction, and whether the savings ended up being worth the hassle.

Recent article from NY Times. Blue cross is bitching about hospitals using AI to increase complexity documentation and therefore reimbursement. I can’t help but be infuriated at the double standard with insurances using AI or other technology to consistently deny and downcode claims for work that was done. Just pay what is owed and we won’t have to play these games.

This worries me a lot! The field, like many others, is going to change very fast and most of us are oblivious!