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Global billing
Our group is contracted with an outpatient clinic that globally bills and pays us a capitated amount. We are currently looking at a way tie our compensation to our productivity in a way that aligns and protects both entities from fluctuations in volumes and changing reimbursement. Wed like to bill for our own professional fees but that seems to not be an option. Is there an accepted percentage of the global bill that can be tied to the professional component? Im sure this would be different based on modality, study, etc……I havent been information/resources……
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3 Replies
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15-20 percent should be your aim.
Its not tied to modality.-
Even in the global bill there is a pro fee indicated for both RVU and WRVU. The key is what is the conversion rate?
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yes, you can base your professional fees by correlating with the Medicare rates, although realize that other third party payers will probably pay more, and some less.
It’ll be impossible for you to figure out – you’d have to know on a monthly basis how many Blue Cross patients, Aetna, Humana, United Health Care, PPO, HMO, Medicare, Public Aid patients, etc., and what percentage they would be. Also, they might be part of certain HMO’s and PPO’s or other health groups that you and your group doesn’t belong to.
You really want to do that?
In reality it’d be pretty hard, and more importantly – they probably wouldn’t allow you to do that. They own the clinic, they own the patients, and if you want to keep your extra income – then take what they offer. because they no doubt are skimming a bit off the top, but realize – that they are also doing the billing for you and that is probably worth another 5-8% that you are not paying.
What about patients that don’t pay? You still get paid by the clinic promptly.
What about aging on some of these receivables that might have lousy insurance, or PI cases and Worker’s Comp that take sometimes years to settle by the attorneys and then pay the clinics late – but you get paid quickly on a monthly basis.
Are you really willing to wait years and legal struggles to get paid a couple of dollars more?
Been there – and I don’t recommend it. Simplify your life and go on with your work. Otherwise, open up your own clinic and take the responsibility and the huge financial risks.
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