When starting a physicians group, there are a number of decisions which need to be made. In the beginning it may be a couple of doctors who have worked together in another office or a couple of physicians who studied at the same med school and did their degree in same or similar fields of medicine.
In gathering together a larger group of physicians to work together, there are many decisions which must be agreed upon prior to opening your doors. In fact, many of those decisions will determine where your doors will be in the first place! Here are some of the most common decisions you will need to make.
First a word about Obamacare
While all United States taxpayers are required to buy health insurance, not all doctors are required to accept insurance providers that signed onto the Affordable Care Act and not all insurance providers are required to participate in the ACA.
As a result, one of the biggest decisions a physician’s group will need to make is in terms of payments accepted. Will your group be signing onto an ACA plan or will you be direct billing your patients?
In any case, this is just the beginning of payment options and if you intend to run a lucrative practice, you should take time to investigate all payment options available to you so that you receive just compensation for the services you provide.
On choosing service funds
You can choose between three types of payment options but you will need to understand something called service funds. These are really nothing more than how you will charge for your services. There are three basic types which include:
- FFS (Fee-for-Service)
- Incentive Payments
In simplistic terms, FFS is fairly self-explanatory. You set an amount that you feel a service is worth and that’s what you charge each and every time for that particular service. If you are with an insurance provider, they will set the fee for those services and you can take it or leave it and move on to the next insurer.
Capitation involves setting a total price payable to you based on the volume of patients you will be expected to care for. The insurance company takes on risk because you’ll get paid the same amount whether you serve 100 patients or 1,000 patients.
This is highly oversimplified but gives you enough substance to understand that getting paid is not as simple as sending a bill and getting paid.
You could lose big if you make the wrong choice in service funds or you could get overpaid and be subject to an overpayment audit and collection attempt!
More choices than you have digits!
How you will receive payments is just one decision you will need to make when starting up a clinic or physician’s group. Your group will need to agree upon location, personnel, hours of operation, medical equipment and a seemingly infinite number of other things necessary for your medical practice.
You would need to count on the fingers and toes of everyone in your physicians group to tally the number of decisions you’ll need to make and even then you may not have enough digits to count keep track of all you need to decide!
Even so, getting paid is a biggie, so once you’ve decided on which of the service funds you are comfortable with, everything else pales in comparison. Like every other industry on earth you will be in business to make money so make the right choice and success is all but assured.