Paneling with a few major payors - how long until filled?
I'm taking cash pay and have a few patients lined up so far. I am going to continue to grow this and also take a select few insurers. Can anyone give a ball park in terms of how soon one might expect to fill when they get credentialed with a few big payors - largest in my area are BCBS, Aetna, Cigna. I'm in a major city in CA. I am planning to take patients from outside my immediate metro area though too, if that makes a difference.
Hoping to build a panel of ~150 patients. I think I can...
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Source: Student Doctor Network - September 2, 2023 Category: Universities & Medical Training Authors: BiscoDisco Tags: Psychiatry Source Type: forums
Does anyone know if it costs money to become uncredentialed by insurance companies?
I am changing jobs from a practice where I am credentialed with insurance companies to a fee for service practice. To drop insurance companies, is there a fee associated with that? I just want to make sure before finishing contract negotiations.
Thanks! (Source: Student Doctor Network)
Source: Student Doctor Network - August 10, 2023 Category: Universities & Medical Training Authors: Roy Williams Tags: Dental Residents and Practicing Dentists Source Type: forums
Transitioning commercial RFA to Medicare
There are several insurance companies that cover 3 joint bilateral RFA in my state (Cigna, UHC, and Aetna)
Medicare no longer does, as we all know.
I have recently seen several patients just before Medicare age (63yrs old, for example) with facets bad enough that they would benefit from 3 joint bilateral RFA and so I’ve done that for them with great results.
The question is how to handle the insurance side of things 2 years later when they transition to Medicare as Medicare only covers...
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Source: Student Doctor Network - June 24, 2023 Category: Universities & Medical Training Authors: bedrock Tags: Pain Medicine Source Type: forums
Do commercial insurers and Medicare require psychiatrists to complete treatment plans?
I apologize if this question has already been asked and answered, but I couldn't find much on a quick search of this forum or reddit. Do Medicare and commercial insurers require documented treatment plans (and, if so, does it matter if the patients sign them - I send it to them electronically, but not all of them sign it)? Are treatment plans considered the standard of care? I remember doing them all the time as a resident when I worked at a clinic that served a large population with...
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Source: Student Doctor Network - June 11, 2023 Category: Universities & Medical Training Authors: geripsyched Tags: Psychiatry Source Type: forums
Received an insurance fee schedule, it was much worse than expected! (is this normal?)
Hi, everyone! I'm transitioning to private practice and working on getting credentialed with a couple of the "good" insurances from my area. With one of the large insurance companies, it has been going very well. However, I just received a contract/fee schedule from another insurer. Here were their approximate rates for a level 5 new intake (99205):
Physician: ~$160
NP/PA: ~$190
MSW: slightly higher(?!) than the physician rate
Any idea what is going on? I know other psychiatrists get paid...
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Source: Student Doctor Network - May 19, 2023 Category: Universities & Medical Training Authors: geripsyched Tags: Psychiatry Source Type: forums
Scaling a Practice
I was curious, how could one add new providers to form a group practice? Having recently become paneled with 3 insurance companies, United advised me that in order for me to apply to them as a group practice, I would need 5 independently paneled providers in my practice to qualify for an application as a group panel. With that being said, my hopes were to bring on new providers so that as referrals come in more frequent and steady (that's the hope), that I can add a new provider to take on...
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Source: Student Doctor Network - April 4, 2023 Category: Universities & Medical Training Authors: texanpsychdoc Tags: Psychology [Psy.D. / Ph.D.] Source Type: forums
1 year WFH and feeling isolated - what would you do ?
Hello, guys, in some other threads , I’ve mentioned that I worked retail for 9 years and left last April . It took me 2 months to find a new position and since then I’ve been WFH for an insurance company/PBM doing patient consultation taking calls everyday for 8 hours a day . In this position, I use more of my knowledge and interact with patients addressing their pharmaceutical concerns - it is essentially a call center job. At first, I really looked forward to this role working from home...
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Source: Student Doctor Network - March 30, 2023 Category: Universities & Medical Training Authors: DoctorRx1986 Tags: Pharmacy Source Type: forums
Cigna QZ modifier change
Cigna starting to reimburse 15% less for qz modifier with other insurance companies expected to follow suit… what’s everyone’s thoughts on this? Ultimately pretty good for our profession. Wonder if the rural hospitals allowing crna only care will make a shift. More crnas moving to plastics? (Source: Student Doctor Network)
Source: Student Doctor Network - March 11, 2023 Category: Universities & Medical Training Authors: amyl Tags: Anesthesiology Source Type: forums
CIGNA to cut CRNA QZ Reimbursement by 15%
Other insurers to follow suit?
https://centercare.com/_uploads/Reimbursement-policy-updates-Jan-2023.docx (Source: Student Doctor Network)
Source: Student Doctor Network - March 6, 2023 Category: Universities & Medical Training Authors: DesiredMemberName? Tags: Anesthesiology Source Type: forums
Medicaid insurance and new solo private practice
Hello! I am in the process of opening a solo psychiatric practice this summer and currently getting credentialed with some of the commercial insurers and Medicare. During this credentialing process, a blue cross blue shield agent said, "If you choose not to accept Medicaid Managed Care members, this would be for all health plans, not just for BC/BS. NYS doesn’t allow for providers to pick and choose what MMC policy they can and cannot accept, as it is all or nothing."
To my...
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Source: Student Doctor Network - February 17, 2023 Category: Universities & Medical Training Authors: geripsyched Tags: Psychiatry Source Type: forums
Thoughts on outpatient job
1099. I can set my own schedule, no requirements on number of patients to see. The group handles everything from office space to billing, good front desk support. Option to be fully tele or hybrid. Good collaboration between providers with regular case conference. About 12 docs and 3x that in phd level therapists. They target higher income patient population.
For all of this they give 60% of collected billing. They only take a single insurer and have been with them for a long time. No...
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Source: Student Doctor Network - February 11, 2023 Category: Universities & Medical Training Authors: surfguy84 Tags: Psychiatry Source Type: forums
ChatGPT from OpenAI
Write a Christmas story about cancer patients, radiation oncologists, and preauthorization in the style of George Lucas.
Once upon a time in a galaxy far, far away, there were cancer patients and radiation oncologists. The cancer patients were in need of radiation therapy, but they couldn't get it because their insurance company wouldn't authorize it. The radiation oncologists were trying their best to help the cancer patients, but they couldn't do anything without authorization from the...
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Source: Student Doctor Network - December 17, 2022 Category: Universities & Medical Training Authors: yesmaster Tags: Radiation Oncology Source Type: forums
neurosurgeons doing pain medicine injections
Holy crap!
I did anesthesia today in a surgicenter for two neurosurgeons who did a bunch of spinal injections.
I was blown away. One of the guys did two level bilateral transforaminal epidural steroid injections, all with an AP projection, no lateral projection - and 4 blobograms. He also did a lumbar sympathetic nerve block for leg pain (no contrast was used), and a bunch of facet injections with needle placements all over the place.
It is no wonder that insurance companies get...
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Source: Student Doctor Network - December 3, 2022 Category: Universities & Medical Training Authors: epidural man Tags: Pain Medicine Source Type: forums
Failed child boards, now what?
I'm board certified for general psychiatry, but just got my results for child boards and failed. Not distraught, but not sure what this means practically for my career. I see child patients regularly. Frankly, I didn't take the test seriously. No excuses. I'm planning on taking it again next year. (any recommendations? I used BTB and Spiegel qbanks, and did well on them, but didn't find the real thing to be all that similar). My contract with insurers when I signed it required that I be...
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Source: Student Doctor Network - December 2, 2022 Category: Universities & Medical Training Authors: Voxylife Tags: Psychiatry Source Type: forums
How does wRVU works for Inpatient consultation?
Let's assume that I did full initial interview (99255) , and wrote 4 follow-up notes (I could not find CPT) for one consultation, will this considered as 1 wRVU or 4wRVU or 0wRVU?. I have heard that medicare and many private insurance companies have eliminated the use of CPT for consultation all together... (Source: Student Doctor Network)
Source: Student Doctor Network - November 9, 2022 Category: Universities & Medical Training Authors: Batman's Underwear Tags: Psychiatry Source Type: forums
