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Who to use for medical billing/coding?

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All - I'm looking at starting a new per diem position with a local wound care clinic.  As a non-hospital employee, I will basically be covered for liability ins and such, but no access to their coders/billers.  Who do you use to get claims submitted to insurance in a timely fashion?  What's the going rate for such services?



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loaded question


PAs can not direct bill insurance companies


You will have to incorporate, and if you bill medicare you need a 1% co-owner, and if you live in a state that prevents the corporate practice of medicine that 1% owner will need to be a Doc or NP (licensed medical provider)  


Legal expenses to do this > 5k


Ongoing headaches - numerous


Would be a good idea if you can clear $200,000+ per year so you can afford to pay all your taxes and insurance and pay your SP 5% of income.....


Then the billing company will take 5-8%


Then you get to pay both sides of the employment taxes (15% but only 7.5% extra over regular income)


Then you get to pay you own health insurance ($12,000 per year for famiy)


CME $2500


PTO - doesn't exist so need to make $$$$ when you are working so you can afford to take some time off

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Guest Paula

If you are an employee why are you responsible for your own billing and coding?  Do you mean that the employer wants you to fill out the super bill and then they will send it in for reimbursement?  If that is the case, find a super bill that outlines all the procedures or diagnoses and use that.


We contract with a podiatrist and optometrist at my clinic and they each have their own superbill, fill it out and hand it off to our billers, who submit it.  The DPM and OD get paid a per-diem contracted amount but are not employees.  


Not sure how this works for a PA though as you will still need a SP.  Are you an employee?  

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I will not be an employee of the hospital. They will provide an SP who agrees to "supervise" me in this fashion. As such, I am responsible for all of the financial side. But whatever I collect, I keep. It will be 10-12 wounds to take care of and 2-3 hyperbaric patients to monitor. I'm looking at being able to bill $1200-1500 per week. Factor in all costs and I would take home somewhere between $200-500 which is $9600-24000 per year. Malpractice and legal fees on top of that...

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Alright - here is what I've found for expenses related to this:


My malpractice will be about $3,773 (I am in the level 2 category because I assist in the OR on occasion).

Establishing an LLC is approx $1,200 up front, no idea what it will cost in the long run.

Billing service will be 10% (I won't have a high number of claims to bill, so they'll want more)

Self employment tax is 12.4% with an additional 2.9% medicare tax.

Income tax will be at least 15% given my tax bracket with two jobs (and if I don't withhold this, I'm screwed come tax season).


The SP will be provided by the hospital - we fall under the surgery service and one of the surgeons has agreed to do this. I have not yet been able to clarify what his fee will be for doing this.


Are there other expenses that I'm missing?


And where can I go to learn more about the restrictions I'll be under for medicare? Also, I'm assuming I will not get the optimum medicare and medicaid reimbursement rates given the fact that I'll be an independent contractor even though I will be working out of a crticial access hospital. Is that correct?


The hospital is opposed to having me as an employee since I will not be working enough hours for them to justify it - they want at least 20 hr/wk, which I cannot give them. I will be working approx 12 hr/wk. I have proposed bringing me on as an employee - unbenefited - at a reasonable hourly rate. We shall see.


If any of y'all have more thoughts on this, let me know. This is new ground I'm breaking and I'm unsure of what hidden costs lie in the shadows.

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wow, critical access hospital get better reimbursement....  It is INSANE that they will not bring you on - make them an offer to work of productivity - based on RVU production.  they have everything all set up - and honestly it would be a lot  better!


You malpractice rate is likely just a teaser rate that will mature after 3-5 years - make sure you know what the full rate is, and that you either get occurrence or have the expense of the tail incorporated into it.


Have to have another 1% owner to bill medicare - need to find out if it can be a non-physician in your state (law that prevents the corporate practice of medicine)  if it needs to be a doc you will have a very difficult time finding one, due to liability


Need to have workers comp insurance - if you get hep C or HIV and you do not have a WC policy you are out of luck - remember you have to be an employee of the corporation, and the doc is also supposed to be a part (but I have heard people doing work arounds on this point)


Need to have a general liability (BOP) - you are a business and someone could sue you and insurance is not that expensive


Need a payroll company - I use one that is associated with the accounting software that I use (oh yeah you should have that too - Peachtree or Quickbooks) and they charge $80 per payroll and I pay monthly


Account to do you taxes - mine is about $500/year


I love being my own boss, but the $$$ side if very difficult, and I am unsure the set up you are proposing is viable




A question for you

If the facility that is trying to hire you doesn't want to hire you as 'it is not worth it' in spite of them already having a lot of these items set up and provided in house i am unsure you are going to come out ahead...  If you are generating ~75k (1200-1500/wk) then the hospital can afford to support you!  If you are an employee they have some responsibility to you - but if you are not their employee I can see them not appreciating you - and basically only giving you work when it suits them, with disregard to the fact you need steady income.

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