Medical practices are continuing to see a drop in their earnings with flat rates for their rendered services. To increase revenue, many providers in the US are stepping into a new domain of patient care known as “concierge medicine”. In this, patients pay a small monthly or annual premium or membership fee to visit their primary care physician or specialists, in exchange for additional benefits and privileges.
If you are considering adding this to your practice, this blog offers some of the best insights you should know before stepping into this personalized segment. We will see how a practice can use it to their advantage, especially as reimbursement rates are declining every day. Let’s discuss this in detail.
What Is Concierge Medicine Billing?
Concierge medical billing involves a process where patients are billed according to subscription charges, monthly, or annually. Besides monthly or annual billing for patients, these practices also use a hybrid model for charging insurance companies for facilities like labs, procedures, and hospitalization etc.
Concierge medicine is also known as “boutique medicine” and offers various benefits to patients, where they receive tailored care and extended providers’ time. Moreover, providers offer the same or next-day appointment facility and 24/7 access to a physician. The membership fee typically covers visitation charges, and procedure charges are billed separately to insurers.
Types of Concierge Practice Models
There are many types of concierge medical practices entailing
Membership only
In the membership exclusive type, patients only need to pay a monthly, annual, or bi-annual fee to take advantage of the plan. Patients can take full advantage of the medical care and pay up-front cash for the medical care they receive.
Hybrid concierge model (membership + insurance billing)
This is the most common type, where providers charge the members with subscription fee as well as for related services separately billed to insurance carriers. Billable services include diagnostic lab, medicines, and minor surgeries for cuts, puncture wounds, burns, etc.
Why Providers Are Shifting To Healthcare Concierge Services?
In recent years, we have seen a big shift in healthcare facilities. Now the majority of practices are transitioning into full-scale concierge medicine care centers due to various reasons. Let’s discuss them one by one.
No claim denials
In concierge medicine billing, providers don’t need to charge the claims amount to insurers. This feature helps them in lowering their claim denials that are usually caused by coding error, billing mistake, etc. The membership fee strengthens the revenue, allowing physicians to keep the full amount without the fear of unfair deduction by payers.
Better patient / physician relation
Tailored medical care to patients help medical professionals create better understanding and treatment plans. This enables them to offer more time to their clients, improving the quality of life and lowering the effect of disease symptoms.
Streamline revenue
Concierge medicine enables medical institutions to strengthen their revenue cycle by streamlining the financial channels. Membership fees are recurring, support providers if revenue is dropping or inconsistent from insurance companies.
No lengthy paperwork
By choosing concierge medicine care, providers in the US get to reduce the filling the lengthy paperwork required for claim submission. Membership fees are paid upfront as direct pay primary care, reducing the burden on in-house billing staff to fill the claim and wait for the reimbursement.
Better control on revenue cycle
Healthcare clinics have more autonomy and better control on their revenue cycle in offering concierge medicine to patients. Practices also don’t need to update their coding and billing protocols to meet strict payer criteria for reimbursement.
Less administrative burden
One of the prominent reasons for healthcare practitioners to offer concierge care services to patients is the less administrative burden they get by treating a small group of people. By focusing on quality rather than quantity, many providers find it peaceful and gratifying by seeing fewer patients that in turn lowered the administrative on their clinic.
Difference Between Concierge and a Regular Doctor
There’s no major difference between a concierge and a regular doctor. They both are licensed, trained, and have similar academic backgrounds. The difference lies in the size of their practice or patient pool. Regular doctors treat a variety of illnesses and patients age between adolescents to adults of all ages.
On the other hand, concierge providers only treat a small minority of patients who have taken the exclusive membership of their clinic. The fee is paid in advance and physicians offer the patients more than 30 minutes of consultation time in contrast to typical 10-15 min time for a usual medical examination.
Cost of Concierge Medicine
The cost of concierge medicine varies between payers and according to their specialty. Typical low-cost membership charges range between $2000-$10000 per year and some high-end membership may cost between $20,000 to $100,000.
The variation in pricing can be due to many factors like panel size that varies from provider to provider. Doctors with small panels may charge more than big panels having more patients. Moreover, concierge medicine treatment facilities offer 24/7 personalized care where physicians stay connected with their patients for after-hours services. Together all these factors play a key role for a high-pricing model for this membership option.
What Factors You Should Consider
As a licensed clinical practitioner, you should consider these following factors before partial or complete transition to concierge medicine model for implementation.
Patient demography
Understanding the demography of your patients helps you measure the expected outcomes of transitioning to a concierge model. In areas where the population has lower average income, patients will not be choosing membership options for extended medical check-ups where they are getting satisfactory results from common 15-min medical evaluations.
Different compliance levels
State, federal and local laws vary considerably in the US, leading to many unintentional breaches. Providers should ensure their practice is following all the regulatory and statutory regulations before offering the concierge medical treatment model to patients.
Staff training
One of the most important and critical factors is staff training and readiness for patients requiring special attention through membership options. In-house nursing and patient care teams should be trained to handle longer visits, medical checks and consultations for appropriate clinical outcomes.
Telehealth
Most of the concierge practices in the USA leverage the use of the latest technology for staying connected with their patients. Medical professionals must set-up telehealth or other online platforms for virtual consultations, medicine prescriptions and other therapeutic interventions.
Conclusion
Concierge medicine models offer various benefits to providers. On one hand providers are not bound by the insurance company’s mandated time for each patient, and on the other, they get to make highly personalized treatment plans for their patients. The final outcomes are satisfactory for both physician and their patient. After considering the above-mentioned factors, providers can easily improve their revenue cycle and increase patients satisfaction.
Medheave is a HIPAA-compliant medical billing company based in Boston, Massachusetts. Our revenue cycle management services increase collections and minimize denials for hybrid concierge medicine facilities across all states.
