How much difference is there b/w billable and actual receivable insurance payments for a medical office?

Question

I'm trying to figure out how much is actually coming in to the practice if billable is 500K and what a fair salary is based on my billable income

Answer 1

The difference is most likely quite large. Let's suppose a given office procedure "X", with a reimbursement rate from your local Blue Shield provider of $40. If there is another insurance company however that will Pay $60. for that same procedure, you're going to bill at least $60, and probably more, to ensure that you capture every possible dollar that the insurance companies are willing to pay.

Your agreement with Blue Shield however requires you to accept their reimbursement as payment in full. You can't bill the patient for the difference, and it becomes unrecoverable. If three quarters of your patients are covered by Blue Shield, you're going to see a gigantic difference.

Bottom Line: Your billable charges are a polite fiction, and are not a sound basis for determining a salary. Look at receivables minus overhead, and you will avoid digging your practice into a hole.

Answer 2

It depends on the agreements with insurance companies. If a regular office visit is $125 and Aetna has a contract with the doctor that they'll pay $85, then that's what the billable amount is. So if my copay is $20 then the insurance pays the other $65.

Answer 3

It's just pocket change!!!!