Author Topic: Breakdown of Doctos  (Read 5306 times)

cflorez

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Breakdown of Doctos
« on: January 27, 2014, 12:03:09 PM »
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.

shanbull

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Re: Breakdown of Doctos
« Reply #1 on: January 27, 2014, 12:13:22 PM »
This is the official CMS taxonomy of provider types: 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.

RichardP

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Re: Breakdown of Doctos
« Reply #2 on: January 27, 2014, 01:53:26 PM »
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.

PMRNC

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Re: Breakdown of Doctos
« Reply #3 on: January 28, 2014, 12:18:26 PM »
Quote
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%
Linda Walker
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cflorez

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Re: Breakdown of Doctos
« Reply #4 on: January 28, 2014, 12:52:19 PM »
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.

DMK

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Re: Breakdown of Doctos
« Reply #5 on: January 28, 2014, 12:55:47 PM »
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?

Michele

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Re: Breakdown of Doctos
« Reply #6 on: January 28, 2014, 01:29:02 PM »
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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shanbull

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Re: Breakdown of Doctos
« Reply #7 on: January 28, 2014, 04:16:50 PM »
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.

cflorez

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Re: Breakdown of Doctos
« Reply #8 on: January 28, 2014, 04:49:37 PM »
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.

Merry

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Re: Breakdown of Doctos
« Reply #9 on: January 28, 2014, 04:55:48 PM »
Get whatever you can to start..and one at a time.

RichardP

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Re: Breakdown of Doctos
« Reply #10 on: January 28, 2014, 06:52:59 PM »
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.

Michele

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Re: Breakdown of Doctos
« Reply #11 on: January 29, 2014, 08:30:00 AM »
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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rdmoore2003

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Re: Breakdown of Doctos
« Reply #12 on: January 29, 2014, 08:49:54 AM »
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.
Regina

tallmanusa

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Re: Breakdown of Doctos
« Reply #13 on: January 29, 2014, 12:04:54 PM »
Mental Health is best specialty.
Some times you can get a group of 20 or more providers; that sure would keep you busy.

PMRNC

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Re: Breakdown of Doctos
« Reply #14 on: January 29, 2014, 12:24:04 PM »
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.
Linda Walker
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www.billerswebsite.com