Canned from the pill mill...I mean, pain clinic. Starting my own clinic, need advice!

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I'm relieved, actually. I was fed up with the drama and poor oversight. I was assured it wasn't my fault, but the bottom line was they had a PA with a lot more experience. They assured me they loved me, I was great, I could always count on a stellar referral, blah blah blah.

I want to open a small primary care clinic and any pain management will be done for a VERY select few. Since this was a cash clinic, I have no certifications to bill insurance.

I am in touch with a supervising MD, and have found a prime location. I have been searching for a way to get an ID number so I can bill Medicare, Medicaid and other insurances. My question is, what steps do I take, who do I contact, so that I can start billing insurance? I know I need to hire someone to process the claims, what do I look for in an employee and what is the average pay?

Thanks so much.

BirkieGirl

306 Posts

Has 25 years experience.

though I am still a NP student, i would suggest to get in touch with the manager of billing departments for large practices around your area. network through them and find out about the certifications your biller must have to be really good at their job, then question them specifically do they know of anyone out there looking for a billing position...i am sorry you are facing the cut, but it will lead to great things for you! good luck

anh06005, MSN, APRN, NP

1 Article; 769 Posts

Specializes in Cardiac, Home Health, Primary Care. Has 6 years experience.

I started my first job about 5 weeks ago and I still don't think all of my numbers have come through. I'm seeing people only because private insurance will pay retroactively from what I understand.

Medicare and Medicaid are taking a while. I hear Tricare does too so it may take a little while.

Good luck to you though! I love the small clinics with just a nurse, secretary/billing and a provider

mountainaireNP

44 Posts

I'm learning a bit here and there. From what I'm understanding,m I can get unemployment, which I think would help me buy some time while I get the clinic set up. I also hear that a lot of doctors contract their insurance claims out to companies that do the billing for them, so that might be an idea. I've got my accountant on board to take care of the bookkeeping.

I'm looking at used office furniture and medical equipment. I'm feeling pretty optimistic right now. I guess I'll just have to play by ear and find out info. wherever I can.

jer_sd

369 Posts

How will your practice be set up under your name!e and number or corporation. This will determine if you use your SSN and npi or an alternate number.

Register for a NPI number, free and fast. Hold onto conformation number.

Apply for medicare such as cms855i, apply for medicaide in your state

Insurance credentialing with ppo and HMO plans can be painful but worth it.

Malpractice, general liability, how will you do billing in my area billing companies take 6-9% of collections.

Create a superbil for easier use. What supplies will you need. Clia license for point of care testing.

Marketing, how will you capture patients and referrals.

There are a lot of little steps you will need to take but good luck

Jeremy

BirkieGirl

306 Posts

Has 25 years experience.

SO happy and proud of you for moving bravely forward! take advantage of unemployment for a moment, which will help clear your head AND allow you to focus on your clinic. i agree, get the NPI, still look at options for billing recruitment, also start looking around quietly for a ROCK STAR medical assistant who will prove priceless. these days, most MA programs also train in billing, secretarial, scheduling, phlebotomy, etc. wishing you the very best of luck.

mountainaireNP

44 Posts

Got my NPI number, but I understand I need numbers for Medicare and Medicaid as well. The office space I hope to get is in a fairly large town and is on the 3rd busiest street in the city, next to a chiropractor and across the street from a dentist.

Hi2Jenn

43 Posts

One of the pediatricians I did clinicals with opened her own practice. She was working with a consultant who helped her set all that up. Not sure where you are, but based on your current knowledge base, I would say that would be invaluable to you. There are so many little things to think of. For billing, I would contract it out until you become large enough. Consider whether you even want to take Medicaid. I know, in Florida, it doesn't pay for your time and they are horrible about approving service and then denying the billing afterwards. Medicare only takes about a month. Tricare is a nightmare. You need to negotiate with each insurance company and some won't contract with NPs. I would start by creating a business plan and go from there. I understand jobs are hard to find where you are, but a start up takes a lot of time and money.Good luck.

2814

15 Posts

Everyone here is right. Make a plan. I seem to remember that Medicare will pay retro-active, but it took almost 6 months to get my number. Once I received that I could then apply to Medicaid and private insurances. Remember that there is a lot of Medicaid providers that refuse to pay retro-active. And getting a billing company is a must. You can go with a big firm, or find a small one working out of their home. There is no way you will be able to see the number of patients that you must to make a profit, and do the billing yourself. And remember 40% of what you bill will be written off as uncollectible, 40% will be paid but will take up to three months, and the last 20% will come from patients monthly billing so you will only see minimal payments, if your lucky. Keeping the cash up front model is the better option.