Maximizing Gain

[Brian57]

My state which boarders Dr. Smith's state is almost monopolistic when it comes to which company employer buy health insurance from. I'm not going to say who that company is but if it isn't cloudy where you are and look at the sky and you will have a pretty good idea.

Doctors of all flavors can pretty much not do business in my state unless they are in that company's network and I've seen many a bill and EOB for care in the state and I can guarantee you prices that company negotiates for ARE far below the highest price.

You might want to do your own research instead of getting all your info from a guy that has a vested interest in subject and is pushing a different business model.

I realize Dr Smith is pushing his cash business model, and his facility does not offer what a hospital offers, but is his detailed inside information correct? That is all that matters.

[jk]

I realize Dr Smith is pushing his cash business model, and his facility does not offer what a hospital offers, but is his detailed inside information correct? That is all that matters.

Oh so the good doctor doesn’t offer all of the services a typical hospital would And he doesnt have to support the staff required to deal with insurance companies. I wonder how long it took the good doctor to realize that is you have less overhead costs, you can charge less. Wow, I wonder when he came to this epiphany.

One huge problem Brian doesn’t realize is the average person cannot pay cash for medical treatment and as such are relegated to utilizing providers that do accept their insurance. Yes that actually does increase the cost of services but sometimes you take the bad to get the good.

But from what brian has explained, the doctors “detailed inside information” does not sound to be correct. Maybe if Brian would do a little independent research he would realize that.

[ebayuser]

I realize Dr Smith is pushing his cash business model, and his facility does not offer what a hospital offers, but is his detailed inside information correct? That is all that matters.

Brian,

All doctors are willing to negotiate a better price for cash pay upfront (not check or CC but cold hard cash). The average practice pays any where from 5.5% to 20% of their billed accounts as fees to billing agencies. A Good biller can easily make 100K or more per year. Some busier multispecialty offices have two or more billers. Cost add up. If you are getting paid cash front:

1. You already paid (as opposed to insurance where it is a joke to when the money will actually come, if ever)
2. No fees paid
3. No billing costs
4. No collection costs

Doctors I work with will easily offer a 50% discount on their prices for cash up front.

[PayrolGuy]

I realize Dr Smith is pushing his cash business model, and his facility does not offer what a hospital offers, but is his detailed inside information correct? That is all that matters.

His information isn't all correct if what you have posted that he says is actually what he has said.

If you think I'm going to listen to his sales pitches to answer your question you are clearly on dope.

Brian,

All doctors are willing to negotiate a better price for cash pay upfront (not check or CC but cold hard cash). The average practice pays any where from 5.5% to 20% of their billed accounts as fees to billing agencies. A Good biller can easily make 100K or more per year. Some busier multispecialty offices have two or more billers. Cost add up. If you are getting paid cash front:

1. You already paid (as opposed to insurance where it is a joke to when the money will actually come, if ever)
2. No fees paid
3. No billing costs
4. No collection costs

Doctors I work with will easily offer a 50% discount on their prices for cash up front.

This is not universally correct either.

[ebayuser]

This is not universally correct either.

Nothing is universal and although your cryptic one line response to a paragraph worth of information is hard to decipher (i.e. what makes it not correct) I'd wager good money that it will hold true 99.99999% of the time.

[PayrolGuy]

Many medical offices have in house staff that do billing so the incremental expense for billing one more procedure is insignificant.

While you may have found some doctors that will give you 50% off for cash it is not anywhere close to an industry norm.

[Lexi44]

The average practice pays any where from 5.5% to 20% of their billed accounts as fees to billing agencies. A Good biller can easily make 100K or more per year. Some busier multispecialty offices have two or more billers. Cost add up. If you are getting paid cash front:
.

Oh my. In my area, certified coders make between $35-45K, not 100K. RCMs - revenue cycle management firms, what you call billing agencies - will take between 3-8% around here, not 20%. The trend is to outsource to India where wages are lower. It's been my experience that in-house coders and collectors give a better ROI than RCMs, but YMMV.

insurance where it is a joke to when the money will actually come, if ever Not quite. Medicare, for example, is required to pay interest if they haven't paid a claim within 30 days.

I agree that providers will offer discounts for cash up front. If someone has a $5k deductible, sure, paying out of pocket might make sense - but not always. If another medical issue arises later in the year, those OOP payments aren't counted against the deductible, resulting in more money OOP than needed.

[ebayuser]

Many medical offices have in house staff that do billing so the incremental expense for billing one more procedure is insignificant.

While you may have found some doctors that will give you 50% off for cash it is not anywhere close to an industry norm.

Huh? Where did you come up with that? Billing and coding is one of the most expensive overheads/costs in a medical office. Like I said a good biller/coder makes $100K a year or more. Yes, for one procedure the saving is minimal. However, when you run an all cash business like Dr. Smith the savings are tremendous.

Many doctors will give you a tremendous discount for cash up front. 50% may not be all the cases all the time, but it is not unheard of and happens quite frequently specially based on specialty. b

[Lexi44]

Huh? Where did you come up with that? Billing and coding is one of the most expensive overheads/costs in a medical office. Like I said a good biller/coder makes $100K a year or more. Yes, for one procedure the saving is minimal. However, when you run an all cash business like Dr. Smith the savings are tremendous.

Many doctors will give you a tremendous discount for cash up front. 50% may not be all the cases all the time, but it is not unheard of and happens quite frequently specially based on specialty. b

Show me a job posting where a biller/CPC can pull in $100K. Please. I've worked in medical admin for close to 30 years, and I'd LOVE to go back to claims and appeals for that kind of money.

[ebayuser]

Oh my. In my area, certified coders make between $35-45K, not 100K. RCMs - revenue cycle management firms, what you call billing agencies - will take between 3-8% around here, not 20%. The trend is to outsource to India where wages are lower. It's been my experience that in-house coders and collectors give a better ROI than RCMs, but YMMV.

100% agree with in house vs. out sourcing. 20% is an estimate average of the total cost of collections for an in house setup (i.e. salaries, benefits, follow up, mailing, collection agency, etc. cost as a portion of practices income). RCMs here generally take 5-7% based on specialty. I don't think I have seen any as low as 3%. The average coder here makes 40k to 50K but a real good one (who can show improved ROI) can make 100K. Plus as you are probably aware the salary is only half the story of in house coder. There is also employer taxes, benefits, insurance, liability, etc. etc.

insurance where it is a joke to when the money will actually come, if ever Not quite. Medicare, for example, is required to pay interest if they haven't paid a claim within 30 days.

Maybe you guys have a 100% collection from insurance on first attempt but here multiple attempts are required and we have a small but significant percentage of claims that are permanently denied.

Medicare actually pays very promptly - however, everything else about them sucks. Including the reimbursement rates.