I have a possible new client. Dr of internal medicine. I will meet with him next Tuesday. New practice and all. Please tell me what it is that I need to ask of him. He says he going to be out of network, does he need to be credential for any insurances like at least Medicaid & Medicare? He says he looking into using Kareo, does that have a PM and EMR? How would you charge a new practice. I am in NY so we can't do percentage.
Thanks to all, I said Kareo, because the physician said thats what he wants to use. I have brought many of the books and have read them all. I was just asking as a new biller and you have to start somewhere. Everyone was a new something. Your bluntness was well taken, but you will not discourage me in asking questions. He stated that he doesn't want to work with insurance companies, he wants to do all out of network. I use office ally and I claim. This forum was for us to ask questions. I have 30 years experience in the medical field, but I only did the superbill end, I was a medical secretary. But I appreciate all the input whether you are critical or not. I rather ask, then not ask. Why should he participate in insurance, I didn't see any of your books on that.Thanks to all, really appreciate it.
I'm not really understanding why he thinks he would want to be out of network for every insurer. Medicare is one thing, but private plans are another. Out of network rates charge patients more money - both the coinsurance and deductible will be higher. Most people have no interest in seeing a doctor that is out of their network, especially not a primary care doctor. I certainly wouldn't. Insurance companies also discourage members from going out of network. It would be one thing if he were planning to operate on a cash only basis, there are people who wish to do that, but registering out of network could severely impact both his client population and his revenue. Since he is a new provider, he would benefit from establishing a client base. This is going to be incredibly difficult if he is out of network for everything. Another issue is that if he opts out now, there is a mandatory waiting period of years for most insurance companies before he would be eligible to be in network. So if he changed his mind after choosing to be out of network, he couldn't make the switch for a while. Dealing with insurance companies is a lot of red tape, but it could be worth it for him to be in network with at least some of the major plans in the area. Yes, he would receive less reimbursement per patient, but if he sees 10 times as many patients because he's in network, he will end up with a bigger paycheck. If he's not interested in that at all, he would probably be better off finding patients on a cash-only basis. Then he would definitely not have to deal with insurance.