How much am I getting paid?

March 15, 2010

When I ventured off on my own, and submitted my change of address and change of TIN to the insurance companies, I did so without really knowing what my contracted rates were and without knowing whether they would or had changed. Probably unwise on my part. But at the time, my only concern was being credentialed and getting paid something. Anything.

At my former job, as an employed physician, I didn’t really know how much I was getting paid for each patient encounter. Yes, we had a meeting with our billing department. I’m not quite sure why, since the bottom line was well, it is what it is, and the answer to any question was “I’ll run a report.” Yes, a report I rarely ever saw.

Oh, yes, I saw how much was charged each month and how much was collected and how much was written off. But I wanted more information. I asked on numerous occasions for a breakdown of how much we were getting paid for each E&M code. I asked for a breakdown of our contracted rates with each payer. Apparently, they could not tell me what the rates were per se, but they could tell me what percentage of Medicare “since that’s public.” Sure, they could. But they didn’t.

So when I ventured off on my own, and submitted my change of address and change of TIN to the insurance companies, I did so without really knowing what my contracted rates were and without knowing whether they would or had changed. Probably unwise on my part. But at the time, my only concern was being credentialed and getting paid something. Anything.

So I mentioned in my last post that my husband is my biller. And he feels I am not being paid what I should be. I figured, I will get the practice up and going and look at the numbers and see what payers are paying what, and then go back and renegotiate as needed. Well, he got tired of waiting for me, so he spoke to someone who negotiates insurance contracts. He said she gasped when she heard what I was being paid. Apparently, not enough.

But she needs a copy of my contracts. And guess what. I don’t have a copy of any but one. Yes, again, foolish on my part. I need to know at the very least, when they expire, because if we are going to renegotiate, we need to do so around the time I am supposed to re-up.

I am going to have to have someone (me, my husband, my staff) call the insurance companies and ask for a copy of my contract. I wonder how cooperative they will be. It’s always a challenge getting a human on the phone. We have all spent many frustrated hours being transferred, getting disconnected and trying to get these stupid voice activated systems to work. I’d swear they do it on purpose. My secretary thinks they listen in on her and laugh as she swears at the phone in frustration. I have a sinking feeling that getting these contracts is going to be like pulling teeth.