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Is anyone doing this?  I have been approached by a company based in Houston.  I would be paid on a 1099 at 38% of the 85% reimbursement rate seeing 10 patients per day.  After reading the topic on 1099 here I am reluctant to take the offer.  I have practiced for 29 years.  This would be part time.  Appreciate any input.  Thanks.

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Jeff is doing this in the Berkshires. He posts here all the time and is a moderator I believe. Though it seems he is on his own without corporate sponsorship.

http://berkshiremobilemedicine.com/Home_Page.php

 

I think you have to take a hard look at the company though.

http://www.medscape.com/viewarticle/810281

 

You could potentially make a reasonable living from this though several things to consider.

There is improved reimbursement through medicare for house calls.

Since you will only be getting a percentage, there is incentive to bill at the highest level.

To bill at the highest level means a visit in excess of 60 minutes?

So will you work a 10 hour day plus travel time to justify your coding?

What I could figure out is from minimal research is that an established pt billed at the highest level is about $170 for a house call, you get 38%, math = $65 per pt, $650 for 10 pt day, but that is at highest level?

 

The 1099 thing has been kicked around here recently. You would have to figure out travel costs and other expenses. Have you talked to your tax or accountant type person?

Does this company offer you malpractice? More things to pay for that you could deduct but you have to pay for them first.

I see on your profile that you are 70 and I assume on medicare. Can you deduct a supplemental?

 

I assume the hook this company has is that they take care of scheduling and provide you with an EMR to access. Do they schedule you with patients that are in close proximity?

 

I think this sort of thing would be worthwhile for a few individuals to do on their own in a community. Flexible hours, work as much as you want. Could write off a lot in terms of transportation. Would be a great model if supervision statutes were less restrictive.

 

Let us know what you do and how it goes. Interesting concept.

 

G. Brothers PA-C

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I know a pediatrician who does house calls and charges $75

 

If you like house call medicine, you should just do it on your own and not use a corporate conglomerate.  They take all your money and provide little in return.

 

That is likely his "trip fee" and he still bills insurance - so his actual pay is far higher!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

38% of collections is a horrible rip off and truly insulting - if you want to work for that come to MASS and I will hire you for that in a heart beat
 
Then add in this is a 1099 position and you might as well volunteer
 
 
 
I would say an straight employee using all their equipment and laptops and supplies and office staff should be in the 40-55% of collections range
 
As a 1099 I would say in the 80% range!!! yup 80% - all they are providing to you is the billing and collections (5-7%) and supervision (5-7%) and small profit (5%) so you should get 80% of collections for ALL the expenses YOU have to pay for.
 
 
Interestingly enough - if you sent you schedule and use your own supplies this might be the one time that you might be a 1099 in the correct sense - you control your schedule, you have your own supplies, and you don't get any office suppport.
 
 
BUT you need to be essentially DOUBLE the offer for a 1099 position
Malpractice is 5-7k
miles will cost you 3-5k per year
supplies will be another $2-5k
 
looking at 10-15k just to open the doors - - 
 
yeah, no thank you on a 1099
 
 
Counter with an 80% of collections as a 1099 - that is fair - and let them know this is not a figure pulled out the sky, but instead from me- and feel free to have them talk to me
 
 
As an employee I would counter in the 55% range - but they have to also pay your miles as driving eats up a lot of gas and wear and tear on your vehicle....  anything in the 45-50% range as an employee with full beanies and miles paid is fair
 
pm me for more details, or call me for a longer discussion
 
 
 
 
NOTE to other PA's
this type of robbery offers needs to be turned down immediately when offered with a bit of a statement like "that is an insulting offer and now where near what is fair"
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I know a pediatrician who does house calls and charges $75

 

If you like house call medicine, you should just do it on your own and not use a corporate conglomerate.  They take all your money and provide little in return.

 

No he only charges a flat fee of $75, he doesnt bill insurance.  

 

Besides, if you bill insurance you have to follow their rules, and their rules state that you can only charge the standard copay, not a separate fee for "convenience" factor.  So if he wanted to bill insurance, he would have to lower his fee to 20 or 30 or whatever the patient's copay is.

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No he only charges a flat fee of $75, he doesnt bill insurance.  

 

Besides, if you bill insurance you have to follow their rules, and their rules state that you can only charge the standard copay, not a separate fee for "convenience" factor.  So if he wanted to bill insurance, he would have to lower his fee to 20 or 30 or whatever the patient's copay is.

 

 

not really true

 

A trip fee is recognized and accepted by medicare (And actually encouraged as it tends to limit house calls to when they are really needed)

Medicaid tends to follow medicare guidelines so in many if not all states this is accepted.

 

To be safe you get a signed ABN prior to doing the visit.

 

 

I could see a doc doing a house call for $75 every once in a while, just as a community service.  doesn't make any money, and in fact at $75 he looses a fair amount of money, but it is the right thing to do (And why house calls are making a come back!)

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I would not take it based on the fact that once you calculate the time it takes to get to a house, do everything the visit involves, chart, then drive to another house and repeat, and look at what you are actually getting paid after taxes and everything  is accounted for, and subtract for expenses including milage, gas, etc, that the hourly rate would make it too low to be worth taking.  Not to mention the hassle of driving around all day.  If you really want to do house call medicine I'd probably ask to shadow or talk to a PA and see what their hourly comes down to.

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  • 9 months later...

A couple or random thoughts because everyone has covered this pretty well. If you take a percentage of the fees you are fee splitting or at the very least could appear to be which is a big no-no. I did house calls as part of a rural family practice for years and I took a flat rate per visit regardless of the level of billing to avoid this very issue. I sat down with my doc and crunched numbers. We looked at the typical patient fee and how many were might and low and settled on a number. Every 6 months or so we would do it again and make adjustments. 

Being on a 1099 puts a lot of tax burden on you that would normally be shared by an employer. The number I charged was 65% of what we estimated was the net per visit...flat rate.

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  • 2 years later...
On 9/18/2015 at 10:56 AM, sas5814 said:

A couple or random thoughts because everyone has covered this pretty well. If you take a percentage of the fees you are fee splitting or at the very least could appear to be which is a big no-no. I did house calls as part of a rural family practice for years and I took a flat rate per visit regardless of the level of billing to avoid this very issue. I sat down with my doc and crunched numbers. We looked at the typical patient fee and how many were might and low and settled on a number. Every 6 months or so we would do it again and make adjustments. 

Being on a 1099 puts a lot of tax burden on you that would normally be shared by an employer. The number I charged was 65% of what we estimated was the net per visit...flat rate.

Scott, did you leave the practice or did the practice drop the house calls?  If they were dropped, based on what reason?

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Remember that if you 1099 with any job, you will not get medical offered to you.  Having been 1099 for two years and paying my own medical insurance for the family in Texas, I can tell you it was really tough.  $8k per family member and $14k per family deductible.  Only HMO offered and most places wouldn't even take it.  All for $1100/month before subsidies.  

If you get your medical through some other source then it is a viable option for sure.

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Cideous- I feel your pain. Currently paying around $1700/mo for medical only for a family of 3. would go back to W2 in a heartbeat if it was an option in my current job situation. Fortunately I have some side jobs that help pay for all the things not covered by my employer. 

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Cideous- I feel your pain. Currently paying around $1700/mo for medical only for a family of 3. would go back to W2 in a heartbeat if it was an option in my current job situation. Fortunately I have some side jobs that help pay for all the things not covered by my employer. 


Even though my hourly salary dropped a HUGE amount by taking a W2 Job, having insurance with a new baby was much more important to me. Sadly....I feel like I'm paying more out of pocket half the time then I did without insurance [emoji17]
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17 minutes ago, ajnelson said:

 


Even though my hourly salary dropped a HUGE amount by taking a W2 Job, having insurance with a new baby was much more important to me. Sadly....I feel like I'm paying more out of pocket half the time then I did without insurance emoji17.png

 

I have W2 options, but none as good as the solo coverage 24s 1099 job I have now...

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