Although I haven't posted in a while, I am still in business. In fact, I've had to close my practice to new patients for the past 2 months because I am having trouble keeping up with the amount of administrative work. I started my solo-solo practice about 2 years ago as an experiment to see if I could create a low overhead, low volume practice that maximized patient contact time. If I could keep my expenses down, the thinking was that I wouldn't need to see 20+ patients/day in order to survive.
The experiment is over for me. While there are energetic doctors out there who have the discipline and fortitude to keep up with medical billing and other administrative tasks, while also taking care of patients and chart documentation, I've learned that I'm not one of them. I think a practice like this (solo physician, no employees) could succeed in the right environment. This is very doable for a part-time or a cash-only practice.
Medical billing by itself is not hard. 90-95% of the time the electronically-filed claims get paid without a hitch. But the 5-10% of claims that get rejected take more time and energy than I have. Last week I waited on hold 30 minutes to speak to a Pacificare agent to ask why a claim was denied. She said they were waiting for a certificate from the patient because of a "pre-existing condition". Of course, when I called the patient, he didn't know anything about any certificate and said he would call Pacificare back. I will call again next week if I don't hear anything. But I don't have time to do this kind of chasing down unpaid claims.
So I plan to hire someone in the next few months to help part-time with billing. I am not ready to go to a cash-only model, or start charging a retainer or administrative fee, although I haven't ruled them out yet. Let's see if my fledgling practice can grow up a little so that I do less administration and more patient care. Hopefully then I can start adding new patients again.