December, 2009

Over on PedSource, we just ran an in-depth piece about the effects of the recession and the Swine Flu on our clients from 2008 to 2009. 

The bottom line: it looks as though the average PCC client has similar overall revenue in 2009 vs. 2008, but it took a lot more visits to do it.  The reason?  Many of those summertime well visit slots were taken up with sick visits.  I'll show off the diagnosis impact of the swine flu, but it's impressive.

Anyway, enjoy the article.  There's a lot of subtle data in there.

I had grand plans to keep track of all the different payers and publicize/shame many of them, but by the time the data came in...it was too late.

Still, how have PCC clients fared with the new H1N1 administration code? 

Better than I would have guessed.

The bottom line is that PCC clients averaged $14.90 from insurance companies and $16.73 from patients when they billed for the H1N1.  That's actually higher than our clients average for the 90465 or 90471, at least when I looked at it last year. 

Of course, the variance is large, but not entirely the fault of the payers.  I might look at a state - like AZ - and see that 1/2 of our clients are using the Medicare Code (G9141) and getting paid a penny because they charged a penny...while their neighbors use the 90470 and charge $25 and get paid $20.  Same procedure, two very different billing methods.

However, there are clearly some super-lame payers out there. A payer in NY - let's call them United - might pay $25+ to one practice and then $7 to another in the same county.  

The clear "winner" for our clients is Tufts, available to folks in Massachusetts, often paying is excess of $40 per H1N1 admin.  Many of the payers in New England paid higher than the rest of the country, no question.  $25-35+.

Interesting stuff.