This is what I've seen too. The monthly premium is usually 3-6% of the benefit amount. So if you're getting $5k per month from DI, then it would be $150-300/mo depending on which riders you get.
At what point/time can you start billing 99417 during a new encounter?
My understanding is at 75 min you can add 1x99417 and after that point, every additional 15 min is another 99417. This applies to non-face-to-face time as well on the same day.
Absolutely, that's our plan. Should be canceled in 10 years or so.
The different sources of these data present a confusing picture. Insurance companies make it seem like you have high odds of using the policy. But, as someone else pointed out, averaged over the typical lifetime of DI policies, back-of-the-napkin math would be that people only use their policy roughly 3% of the time (in other words, for 1 year out of paying for it for 30 years.) Otherwise the plans would be insolvent (there are fudge factors for early cancellation but retained investment assets and subsequent returns but I doubt that skews the math to a large degree.) At the same time, I came across this data from the SSA which seems to say that roughly 17% of men will become disabled (use disability insurance--that's the rough definition in that paper) from age 20-65 with only appx 1.7% recovering (10% of disabled). Those numbers seem really skewed from what you'd expect from other statistics. For example, the fact that most periods of disability are short-lived--IIRC about 9 months was the average but it's been a few years since I did a deep dive on the available statistics. For that reason, with the common delays (3mo or 6mo) before disability policies kick in, they often don't pay out much because you've recovered before they would have to.
I’ve looked into this on more than one occasion and, for a solo practitioner, TMS does not make sense from a numbers or logistics perspective. I have a couple solid TMS clinics in my area and just refer there when needed.
My practice is similar in that my initial appointment is 90 minutes and follow-ups are 60 or 30 minutes depending on the clinical presentation and need. Sometimes the ‘intake’ is more than one appointment with more complex situations but, generally, most patients fall into the 90 minute timeframe. I have a psychotherapy heavy practice and this arrangement works well for me.
Have a family member who does their intake this way. 3-4 hours, 450 per hour.
This is why getting specialty-specific definition in addition to own-occupation isn't crucial in non-procedural specialties like psychiatry. It's also why psychiatry has a more favorable insurance tier status as a specialty. Doesn't have to be white collar vs blue collar, but within medicine the amount of manual labor is different.
You say $500 for a follow up which is presumably 30 min and then $2k for an initial evaluation which takes presumably 1 hour. By this math, you should be making over $2 million dollars per year working a standard 40 hour work week. Is this what you are making? Have you filled your practice? Are you recommending new residents who are just graduating start a private practice and charge these rates?
You can hire people to do cash same way you can hire people to take insurance. I have a coresident who works at her mentor's clinic and was enabled to charge a high cash rate by getting patients who are seeking out that practice for the name built by the original doc. I've seen other similar clinics where the new docs (or even midlevels in come cases) will (obviously re: midlevels) charge a lower cash rate than the founder.
Besides the mistakes already pointed out, the "standard 40 hour work week" doesn't mean 40 hours of patient care time per week. That's a quick way to burn out and to not be available to patients for various things that come up between visits (and if you're not available they may not find your OON fees not worth it). It's hard to be 100% full all the time anyway. Also, you have to build up your caseload to fill that time, so until then you'd be making less.
Very common. When a cash practice fills, you want to have a good referral source to send friends and family of current patients
That’s actually not true. Totally doable in a rural area as a recent grad from a non prestigious residency. It just depends on your niche,how you market your niche, and how much of a demand there is for it in the state.
Your overhead is also going to be 50 percent while cash will be 20 percent, much different net income in those two scenarios
$250 per follow up as a new grad doesnt seem unreasonable at all.
I hope you're exaggerating, because I've never heard of a well-functioning psychiatry practice with an overhead that high, in either category
This is so completely inaccurate, I don't even know where to begin. Even if we accept cash overhead is 20%, why in the world is insurance based 30% more?
at most 5-8 % more for the biller or if done in house.
This is correct, though I charge more for 30 min visits ($300). That is based on hourly weekly visits being more of a financial burden than say monthly 30 minute visits, so I charge less for those longer regular visits. Brings more professional satisfaction for me to be able to focus on psychotherapy and easier to fill up hours.
1500-2000 depending on complexity, sometimes more. This includes record review and report preparation. Sometimes I break it up into multiple hour long session as well. It is a more affluent area but not everyone who sees me is wealthy. You wouldn't drop that money if you were able to get services elsewhere. I have a very specialized practice, not general psych so I don't see pts with depression anxiety ADHD as primary diagnoses. I do prescribe controlled meds but I advertise that I do not lol
In my area, 1 in 3 patients have medicaid, 1 in 6 have medicare, 1 in 4 have kaiser (including their medicaid and medicare plans), and 1 in 9 have Blue Shield which is absolute garbage in this area so almost no psychiatrists accept it. Aetna, one of the insurances solo psychiatrists do accept, wouldn't let me join claiming they were "at capacity". So actually, the network of people who have other insurances is much smaller than you might think (though obviously there are more people who would like to use insurance than pay privately). Your math is wonky. If I were seeing 2 pts an hour, that would be $600, and if I saw 3, it would be $750. But yes, many people can make similar or more in insurance based practices as they can in cash practices. However, facts are facts. Half of all psychiatrists don't accept insurance because insurance companies frequently fail to reimburse fairly or play by the rules. One of the major insurers in my area (Anthem) can take a year to pay up and frequently puts psychiatrists on prepayment review. They also use threatening tactics like auditing psychiatrists who bill more than 3 99214s in a 6 month period (which is utterly insane since 99214 is the default f/u code), and reduce payment for 99214 to 99213 levels if they think you are using 99214 too frequently. I would not be able to sustain a solo practice like that.
Being compared to psychiatrists seeing 50+ patients/day is the only way that makes a semblance of sense.
These are two completely separate jobs in my opinion. Some people can have a very successful boutique solo private practice, working 20-30 clinical hours a week (I don't know anyone in private practice seeing patients 40 hours a week) while making a handsome amount, saving up for retirement, taking plenty of vacations, spending time with loved ones, mastering hobbies, etc.
You must be new here. Splik sees neuropsychiatric cases which is niche and not many people do this in the area let alone the country. You can have this type of practice with addiction, reproductive psychiatry, CAP, integrative psychiatry, and much more.
I have taken this approach and have sought out extensive reproductive psych experience during residency. In a niche such as this (or the others you listed), do you think very high rates right out of residency are to be avoided? When I start practice later this summer, do I go for the high hourly rates right away? I know that I do good work and bring something to the table a lot of psychiatrists in the area lack (and thus refer to our repro psych clinic for), but I'm worried how fast I'll be able to attract patients with four-figure intakes.
OBGYN, FM, NPs, and other psychiatrists that don't want to touch reproductive psych with a 10-foot pole.
Yeah fair points. Just recommend cold calling and offering to meet over lunch or the like?
When they get pregnant you refer them to the academic center down the street
As I mentioned, you should set your rates based on how much you plan on earning, how much you plan on working, accounting for expenses. You should then look at the typical rates for your area. It would be foolish imho for you as a new grad to be charging way more than well established people. For a repro psych practice, you would do well to network with other reproductive psychiatrists (they might pass your name on if they aren't available), OBGYNs (bear in the mind the hospital based ones may have their own psychiatrists who accept insurance to refer to), and therapists specializing in reproductive mental health. You might want to list yourself on the PSI directory. I would also suggest having a general psych practice with a special focus on reproductive psychiatry or women's mental health. There seem to be a lot of people who market themselves as doing perinatal/reproductive psychiatry in my area and the ones who struggle to fill either have exorbitant rates or only want to treat those with problems of living. If you want to have a successful practice, don't charge more than you are worth, more than people who are more experienced, and accept patients who have problems like bipolar disorder, psychosis, personality disorders, and substance use disorders. There are patients with such diagnoses who are appropriate for a solo private practice (though one must be discerning and decline the ones where they need more than you can offer).
is 99205 only time based?
No but the E/M documentation requirements may be hard to meet for most private practice outpatient psychiatrists for most intakes.
