Medical Billing Forum
General Category => New! => : cflorez January 27, 2014, 03:03:09 PM
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Does anyone know of a website where I can go to gather some information. Here's what I am trying to find out. 1) what are the categories of doctors speciality. 2) what procedure codes are used by each speciality. ( to become familiar with the codes for that particular speciality) 3) average claim submitted per doctors speciality.
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This is the official CMS taxonomy of provider types: http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Downloads/TaxonomyCrosswalk.pdf (http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Downloads/TaxonomyCrosswalk.pdf)
As for which procedure codes, they tend to be related to a specific specialty (e.g. a psychiatrist will bill a 60 minute psychotherapy session which is 98037). I doubt there is an exhaustive list anywhere but you might be able to find the most commonly used codes.
I doubt average # of claims per specialty is a useful piece of data simply because each individual doctor's average has so many factors that are unrelated to specialty, such as geography, the type of facility, the patient population, etc. Averaging everything is likely to give you a really blurry picture.
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The taxonomy codes will tell you what general part of the body the doctor specializes in. These procedure codes are categorized according to the part of the body being worked on.
http://www.icd10data.com/ICD10PCS
That is the top-level link. You will need to open subsequent links as you bore down to detail in your target area of the body.
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I doubt average # of claims per specialty is a useful piece of data simply because each individual doctor's average has so many factors that are unrelated to specialty, such as geography, the type of facility, the patient population, etc. Averaging everything is likely to give you a really blurry picture.
I agree 100%
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So, If I wanted to view which Doctor's specialty generates, on average, a dollar claim amount. There is no where to find this information. Let me explain my position. One of my instructors indicated that podiatry produces on average a claim amount of $540.00 where as chiropractor generates, on average, a claim amount of $125.00. I am wondering where this instructor would have generated this information.
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Sounds like your instructor was trying to create a hypothetical situation for the students (and you would have to pull some somewhat random figures out for a "for instance" situation). There are far too many variables to come up with the "site" you're looking for, not to mention that doctor's would have to provide the information, and why would they?
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So, If I wanted to view which Doctor's specialty generates, on average, a dollar claim amount. There is no where to find this information. Let me explain my position. One of my instructors indicated that podiatry produces on average a claim amount of $540.00 where as chiropractor generates, on average, a claim amount of $125.00. I am wondering where this instructor would have generated this information.
Besides these numbers seem off, and I bill for both podiatry AND chiropractic. Of course I don't know what part of the country you are in. :)
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So, If I wanted to view which Doctor's specialty generates, on average, a dollar claim amount. There is no where to find this information. Let me explain my position. One of my instructors indicated that podiatry produces on average a claim amount of $540.00 where as chiropractor generates, on average, a claim amount of $125.00. I am wondering where this instructor would have generated this information.
Just want to clarify here, we're talking about the amount charged rather than the amount reimbursed, right? We know a lot more about reimbursement rates than charge rates because charge rates were not required to be reported prior to the ACA, and even now I think only hospitals need to report this data.
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Yes. The amount charged.
Let me ask this of you veteran medical billers. I heard of many medical billers say that mental health industry (as an example) was a pain for them. To much work for so little reimbursement. As a new medical biller how do I know what provider specialty is the better ones to be in.
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Get whatever you can to start..and one at a time.
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Yes. The amount charged.
If, as a biller, you charge a percent for your services - you will get paid a percent of what is paid to the doctor, not a percent of what is charged.
Most of our clients get paid from 50% to 70% of what they charge - consistently. The rest gets written off. They could charge more in line with what they know they will get paid by the Insurance Carriers, but they don't. Ego? Who knows.
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I heard of many medical billers say that mental health industry (as an example) was a pain for them. To much work for so little reimbursement. As a new medical biller how do I know what provider specialty is the better ones to be in.
Personally I don't agree. Mental health to me is easy billing. Very few codes, repeat patients. I don't agree that reimbursement is little. We have many mental health providers from LCSWs to MDs (psychiatrists) that make very good money both full and part time. I wouldn't limit yourself to mental health but I certainly wouldn't avoid it. In fact we have often targeted mental health providers when we've marketed.
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I agree with Michelle. I have billed for pediatrics, infectious disease, urgent care, etc. Mental health is by far the easiest and the reimbursements are better than in some other areas I have billed for.
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Mental Health is best specialty.
Some times you can get a group of 20 or more providers; that sure would keep you busy.
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A lot of billers starting out waste so much time figuring which specialty is best, what to price.. bottom line is to not go crazy with those until you start talking to practices and you have an idea of what that practice is bringing in, what their ratio is for managed care, etc.. like everyone said, there's too many variables to know these numbers before you even talk to the potential client. Also you have to remember that experience is a part of knowing what to charge. If you have no experience you will not be able to provide a justified higher rate as someone with experience can. Everyone starts somewhere. Don't look at specialists, let the specialty find you, there's no way to really pick a specialty when your first starting or you'll wait twice as long to get that first client. I let my specialties find me after a while.. only one specialty I won't touch is chiropractic. No amount of money will get me to touch that specialty. Mental health can be a bit "tedious" but it's not harder. There's more phone time and more paper and sometimes patients can be a bit tricky to deal with over patient balances, but all in all it's a pretty easy specialty.
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Mental health can have low comparative reimbursement for the providers (although it's really not too bad), but it's one of the easier specialties to bill for. I am employed full time by one clinic, and the specialties I bill for are:
- Chiropractic (easy once you know all the rules)
- Acupuncture (a bit harder, more rules than chiropractic)
- Physical Therapy (harder now that functional limitation reporting is required, lots of mutually exclusive procedure rules)
- Internal medicine (usually not hard but once in a while a real conundrum)
- Psychotherapy (easy)
- State Medical Home program (awful, it took a software patch and 6 months to get this billed properly)
- Cardiology assessments (tricky due to diagnosis requirements for Medicare)
Mental health billing is a good specialty to get some experience in. It's not likely to overwhelm you with technicalities. I get paid the same amount per hour regardless of what happens, so I would highly recommend charging a flat hourly or per claim fee. That way what you make isn't directly tied to how much or how little the provider makes.
only one specialty I won't touch is chiropractic. No amount of money will get me to touch that specialty.
:P Curious to know why? There are so many potential reasons why someone would not go near it.
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:P Curious to know why? There are so many potential reasons why someone would not go near it.
It's my own opinion based on experience talking with many billers and chiropractors, the risks are higher of fraud.. may seem like a stereo type but this is just what I've seen. Knowing the rules is one thing.. getting chiropractors to play by them seems to always be a headache. JUST MY OPINION!!!
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:P Curious to know why? There are so many potential reasons why someone would not go near it.
It's my own opinion based on experience talking with many billers and chiropractors, the risks are higher of fraud.. may seem like a stereo type but this is just what I've seen. Knowing the rules is one thing.. getting chiropractors to play by them seems to always be a headache. JUST MY OPINION!!!
Actually I agree, we just received another letter today getting yelled at for billing too many 3-4 region adjustments compared to 1-2 region adjustments (by a ratio of 9:1). Of course they also just gave this provider their highest rating and don't even make him request prior authorization. So they're both threatening to kick him out and giving him the highest rating they have within the same month ::)
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I can honestly say I've NEVER had the privileged of speaking to an HONEST chiropractor! My insurance guy even told me that malpractice and E/O for chiropractors are higher.. gee wonder why?
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Thank you all for that dialogue. Your right, when your first starting out there are so many questions whirling in your head. It's hard to know which one to solve know or later. But, you have no idea how helpful these forums are. You all are appreciated. Thanks
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Just piping in regarding chiropractors. It is NOT true that their malpractice is higher than other medical providers. It's among the cheapest. Don't know about the E/O comparisons though. There are a lot of dishonest ones out their. But there are a lot of honest, hard working, caring ones out there too. The billing shouldn't be complicated at all. The rules are pretty straight forward. Unfortunately, the one's out there for the money, not the care, are learning bad things from the seminars showing them how to bilk the system. Avoid the "cash" practices and the pre-pay practices like the plague. A good chiropractor should have some result within 5 visits or refer you out.
And shanbull, if the record supports a 3-4, don't worry about it. If the record and diagnosis doesn't support it, it shouldn't be billed....period.
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I agree with DMK. I have had the pleasure to work with many very honest and caring chiropractors. I have also met some of the not so honest ones. I don't actively seek them out or market them because they can be more difficult. They get asked for notes often. The NYS comp laws have crippled them. I understand why comp needed to change but they went from one extreme to another. Now patients are being denied necessary treatment and I'm not strictly referring to Chiropractic. A good friend fell at work and had a complex fracture in her arm. She was denied OT under the new WC laws.