Considerations When Contracting with Physician’s Office

Questions to Ask When Contracting with Physician

 *Billing and payment
What insurance are they contracted with?
Are all HCP’s contracted with all insurance?
Do they accept medicaid or other state insurance for low income?
What percentage of low income will you see? Can you set limits on that?
What is no show policy? Will you still get paid? Who tracks down the $$?
What happens if insurance doesn’t pay? Will you still get paid?
Can parents see you in office cash pay? You will need to negotiate that rate.

*The consultation
How much time will you get for dyad? Initial visits? Follow ups?
What about twins?
Can you do back to work consults? Breast pump consults? Weaning consults? Can you work with bottle feeding problems?
How many dyads can you see in a day?
Do you want/need breaks in between dyads or can you see them back to back?*Clinic role
Will they need to step in with each dyad? Or just oversee chart?
Do they want to increase their ped #’s?
How will they advertise their services?
Who is responsible for making appts? Faxing reports?
Can you make your own appointments?
How does communication work in the practice?
How does physician/biller interact with you?
How accessible are physicians if you need a consult?
Are physicians willing to prescribe domperidone? What about other meds if needed?

*How does physician interpret various components of “incident to”
Can you see outside patients? Or only patients from practice?
Can you bill for 2 patients? Or just 1 per visit?

*Your practice as a whole
Does your contract allow you to continue to do home visits?
Will you have access to charts?
Can you block out time on your schedule for home visits or other meetings?
Can you rent pumps or sell pumps in office? What about other retail?
What about herbal supplements?
Can you refer to your preferred providers for additional support? Or must you use their resources?

*Charting and coding
Who do you go to for questions about coding? About scheduling?
Do they use EMR or paper charts?
There are things you will need to learn! Will there be training provided in charting?
Will you have input in charting considerations?

*Physical space
What furniture is in the space you’ll be using? Are they open to getting different furniture?
Is there sink in your space?
Does clinic give formula samples. If so are they visible?
What’s on the walls? What type of magazines are present?
Is breastfeeding welcome in the waiting area?
Who provides gloves, scale, kleenex, etc.
If they provide scale, how sensitive is it?
Do you feel good in the space?
Is it close to your home?
What about traffic?

Things to Consider:

Finding the right fit is important and it might take some time.
Get involved in community!
Knock on a lot of doors!
Think about…What do you need to make per hour? Per month?
Are they knowledgeable about tongue tie? Body work for infants? Open to learning?
You are there because someone wants you there. That could change. Have contingency plan.

Learning curve!

Be flexible—expect some discomfort in new environment
It can take months or longer to really get in a good flow with a new situation
Learning to think like a physician is not easy
Charting is for purposes of insurance and physician as well as for your own records and is permanent record.
Your charting needs to be detailed enough for the supervising physician to know what happened in consult.
Some autonomy is lost with collaboration. That can be difficult.