a sonographer's guide to entrepreneurship

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Episode 25: Ultrasound Business Models Series: Mobile IDTF

This series is perfect for ultrasound techs looking to start their own ultrasound business as well as those who are current business owners excited for the opportunity to learn more about how they can add in services to their company to continue to diversify their income streams and increase their revenue. In this episode, we’re chatting all about the mobile independent diagnostic testing facility (IDTF) business model.

Transcript:

(00:00):

Grab a seat and a cup of coffee because you just enrolled in Ultrasound Business School. We are obsessed with all things ultrasound and are here to take you on a journey through the messy and the magical side of business ownership. Think marketing, contracts, vendors, admin, growth mindset, and that’s just the tip of the iceberg. This is the Talking Tech podcast, a sonographer’s guide to entrepreneurship. Here’s your host, Jennifer Lindsey.

Jen (00:31):

I’m back! Hello everybody. Oh my goodness, I have missed this podcast so much. I’ve missed chatting with all of you. I cannot wait to get back to it. It’s so much fun for me, and I know it’s incredible information for those of you starting and growing your ultrasound businesses. So I just want to say thank you for giving me some grace. We worked on some amazing projects that took my time away from recording, but I’m back. We’re ready to go. I’m so excited to start a podcast series on business models. I think it’s incredible to understand all the different ways we can initially start our businesses and, more importantly, how we can continue to grow by adding additional services. So I talk a lot about mobile ultrasound fee-for-service, where you’re providing services on a mobile basis in the physician’s practice, they bill insurance directly, and they pay you a service fee for that.

(01:40)
I talk about it a ton because that’s what we teach in our Ultrasound Business Academy. So I tend to focus there, but I just launched a new entry-level course, so I put the podcast on hold primarily to focus solely on creating a killer course. I think everyone in it will agree it is chock full of incredible information. It was so much fun and also so much work to put together, but it’s definitely the course I wish I had had when I was first starting. We talk a ton about business models there, so I want to break that down. Of course, we dive deep with our clients in that course, but I want to break down the options to start your business and then kind of an overview of each. So again, we dive deep into the course, but I think this can be so helpful to understand your options. And chatting about it in a high-level view in the podcast because one of the most important things I think to understand is you can start in one area or hybridize a couple of different business models. But, understanding that you can mix, match and add in other business models to continue to increase your revenue potential is key.

(02:49)
That’s what we’ve done and continue to do over the course of our business. Over the last almost 20 years, we’ve added additional divisions and different options and created a seven-figure business because of that. And I always have to say because it’s so important, as you know, a motivation that I’m nothing special. Guys, we started our business out with, I say all the time, shaky hands and a dream, okay? We legit had no idea what we were doing, but we had a dream, and by golly, we were determined to get there. The difference between me and someone else is that I didn’t stop. And I will tell you that can be the difference between you making or breaking it. Okay? That really is the big difference because we all, as business owners, especially when we’re starting out, over the course of our business, we all get down and discouraged.

(03:48)
Things happen in our business where we think, oh my goodness, I’m never going to get myself out of this. You know, this is not the way I wanted my business to go, or this specific thing happened, whatever it may be. What we have to do is understand we can be upset about something, and we can wallow in it for a hot minute, but then we have to put our big girl pants on or our big boy pants on and get out there and fix whatever the deal is or pivot or do the thing that we know is going to get us past that. So that’s what we did. That is the difference between people who make it or don’t, and we never stopped until we achieved what we wanted to achieve. And the fun part is we’re still dreaming. That really is the beauty of business ownership.

(04:33)
You never have to stop dreaming and growing and achieving. It’s an absolute high. I get goosebumps just thinking about it and how lucky I am to be in this position now; if I can do it, so can you. I just don’t want you to struggle like I did. Now, of course, there’s not an easy button. Owning a business always has its own struggles. But if I can help guide you with all our free content, the information, our posts on LinkedIn, Instagram, and Facebook, our podcasts, and the trainings that we do. Then, to dive deeper with my clients through our courses, advanced programs, and strategy sessions, we can take you from confused to confident. There just really is no better feeling for me. And there’s no better feeling for our clients and the people that we help through the free content as well.

(05:22)
You know, when you feel empowered to do something, and you have a knowledge gap, and you can’t find stuff on Google, we all know that’s a rabbit hole to go down when you’re trying to look for anything on starting or growing your ultrasound business, I love the fact that we can supply that. So anyways, that is my rant about the fact that if I can do it, you can too. And so, I am excited to get you started on a business model series. This will help anybody just starting out in their business, anybody just thinking about starting their business, and anyone who started a business and can look at the fact that you can add in additional business models to continue to grow your revenue opportunities. Okay, so I get asked a lot about mobile IDTFs from just techs that chat with me and my Ultrasound Business Academy clients as well because it’s a great addition to their fee-for-service business model.

(06:22)
So I want to chat about what it is and what it entails. So an IDTF is an independent diagnostic testing facility. Now that can be a mobile IDTF; it can also be a fixed or standalone IDTF. A lot of imaging centers are standalone IDTFs. When you are a mobile IDTF, you are billing insurance directly. So instead of going in as a mobile fee-for-service, which I’ll talk about on another podcast where the doctor’s billing, you’re providing the service and invoicing your physician. In a mobile IDTF business model, you are billing insurance, and then you are allowed to pay your physician a rental fee for the space you’re utilizing. Now Medicare has a very specific calculation for that because they want to make sure it’s fair market value, but that’s how that would be set up.

(07:24)
So in this scenario, some pros are that to your physician’s office, it’s a free service for them. The patients are saving money just like they would if the doctor was billing as opposed to going to the hospital, where obviously we know that they are charged a lot more than coming into the physician’s practice. The amount that you’re billing to their insurance company is going to be similar to what the doctor would be billing as well. So it’s definitely a huge patient savings, and it’s a free service for the practice where you can also rent their space, so they have an offset of their mortgage or lease for the space by having you come in. We all know the benefit to the patient because they’re coming back to the place where they already feel comfortable. They don’t have to go to the hospital, fill out a bunch of extra paperwork, try to figure out where to park, all of those types of things.

(08:14)
It’s a huge benefit having the patient come back into the space where they already feel comfortable. You can also usually make a higher revenue stream than your hourly charges as long as you’re billing patients out and still setting things up where you know you’re having a set half-day or full-day session in the practice; they are booking out your schedule with the charges. Usually, you can make a higher revenue stream than just billing your physicians in the fee-for-service model, where you’re charging an hourly rate. Now the benefit to the fee-for-service model is that you’re charging an hourly rate no matter what the doctor is getting paid. Yes, they’re making additional revenue, but you don’t have the whole backend side of billing, and all the other things that you have to do that come with actually billing insurance directly.

(09:02)
So yes, you’re making higher revenue potential, but you also have a little more work. You then have more control over the billing process when you do it in-house or through a billing company because you’re seeing everything that’s coming in and making sure it’s getting billed out right away. You also have the ability to work with those physicians that just don’t want to deal with the billing. I think this is a great hybrid model for fee-for-service. Adding in additional options where you know, for your fee-for-service, you’re working with the doctors that don’t mind doing the billing because they’re going to create a revenue stream in their practice. Obviously, they make more billing than they would if you’re just paying a rental fee for their space. So it’s kind of like that vice-versa thing.

(09:44)
It’s a great hybridized model for those that are doing the fee-for-service. Now some of the cons, it is an absolute pain to get credentialed; it can take forever. The paperwork is confusing, and it is a little bit crazy. I suggest setting up your business, even if you only have a client or two, billing insurance directly and invoicing them for your service while you’re getting credentialed. And I say that because you have to purchase your ultrasound machine ahead of time in this scenario because you have to put the serial number on the Medicare paperwork. So if you started out with this model initially, you would have to buy everything and have your machine sitting in your basement or your spare bedroom collecting dust while waiting on the credentialing process.

(10:46)
I have seen it take 30 to 60 days. I have seen it take a year; honestly, every insurance company is different, and there’s no way to know the timeframe. That is one of the major cons of this business model. So like I said, have it set up where you have other streams of revenue come in. Whether it’s mobile ultrasound fee-for-service, which I suggest because that is setting up a long-term contract with a physician or doing some screening services or staffing services while you’re waiting, those types of things. Having some revenue stream coming into your company so that you’re covering the cost of your ultrasound equipment while it is sitting there doing nothing is going to be a good business decision for you. I suggest hiring a billing company to help with your credentialing.

(11:35)
Usually, they will charge a set fee for filling out your paperwork for you. They’re the experts. I would highly suggest having them do it instead of you doing it alone. The drawback to doing it on your own; yes, you certainly could figure that out; however, it’s difficult. Every insurance company is different about where you’re supposed to get this paperwork and what paperwork you’re supposed to turn in. If you mess up one line and you turn it in, and they don’t get to the paperwork for three months, they might say, oh, you filled out number 12 on our application incorrectly; we’re going to send it back and have you redo it and resubmit it. Now you’ve lost X number of months in that process. If you work with someone who knows what they’re doing, it’s always better to invest in working with people who have been there, done that so you don’t have to reinvent the wheel and try to figure it out.

(12:27)
I think that’s key. So having an insurance company help you with credentialing is going to be, I’m sorry, a billing company help you with credentialing, I think is going to be key. I have seen, on average, them charge around a hundred dollars or so per insurance company application. Let’s say you find the five main insurance companies in your area that house the most percentage of patients. If we’re looking at a hundred dollars, that’s only 500 bucks as an investment in your company to have someone who knows what they’re doing fill out the paperwork. Because it’s not just filling it out, they have to send it in; they have to check in on a regular basis, and they have to send in multiple items. So usually, they have all kinds of things they need for your interpreting doctors or medical director.

(13:13)
All of those things have to be turned in as well. So honestly, I think a hundred dollars is a pretty low charge for them to charge. However, they usually do that because you will be using them for billing after the fact. So actually submitting your claims to the insurance company, I definitely suggest hiring a billing company for that as well. In the beginning, we did that for our business. Since there are not many CPT codes for ultrasound, we felt it was worth having someone who knew what they were doing in the beginning to get all of that setup. Then we just watched and paid close attention to what was happening so that after they ran that, we brought it in-house after about a year or two. You may never bring it in-house if you don’t have an employee that’s there doing other things where you could easily add that on as a responsibility; it may not make sense to bring it in-house.

(14:07)
But once you start billing and you’re paying out, usually about 5% to 6% of the actual collection, so the amount they’re actually bringing into the company. It behooves them to do a great job billing because they are paid based on the actual money coming back into your company from the insurance payments, and that’s usually around 5% to 6% of the total reimbursement collections. So that’s how that part works, and I definitely suggest hiring a company, in the beginning, to do that just to make sure you’ve got someone that knows what they’re doing. And then again, if you decide that’s something you want to bring in-house later, that would be something to take a look at once you understand how that works. Insurance billing itself can be a little bit of a pain. Usually, ultrasound is pretty easy to get paid for as long as you code it correctly.

(15:00)
And so I know we’ve seen with our business every once in a while we’ll have to resubmit a claim for this or that, but for the most part, usually, we are getting paid on a regular basis fairly easily unless, for some reason, the coding was off. The other thing that I would put on the cons list is in a mobile IDTF; you must have a medical director or a supervising physician interchangeable terms there. The reason is that you are not a physician yourself. And so you’re setting this up as an entity that needs some physician to oversee what you provide as a non-physician tech. So that can be a little bit difficult to find sometimes because I believe, as I’m making this podcast today, supervising physicians or medical directors, again interchangeable term, can only be supervising physicians for, I believe it’s three entities.

(16:06)
And so you’ll have to make sure that you find a medical director who can actually supervise you. So you can’t just go find an internal medicine doctor who doesn’t know anything about ultrasound to be your supervising physician because they actually need to be able to supervise what you’re doing. So usually, your supervising physician is also your interpreting doctor. So that is something to think about. If you’ve got a local radiologist or cardiologist that you’re working with, you can usually speak with them and say, hey, I’m going to start my mobile IDTF; I’d love to chat with you about potentially becoming my medical director. And really, it is kind of a paperwork-only thing they can definitely help you with, like QA and that type of thing, because they’d have access to all of your images. I would definitely put something together of that nature together.

(16:58)
A quality assurance program where you’ve got that listed, maybe they’re looking at X number of studies per month as your medical director just as a QA protocol that you would have for your business. One of the other things that you need to think about is that you do need to have a medical director, which can be a bit hard to find sometimes. Now if you want to see what’s required, that is the bird’s eye view of a mobile IDTF and some basics on what is required. If you want to see the details on what Medicare asks for, you can head over to Google and type in cms. So Center for Medicare Services, CMS-855B, that is the form you would fill out as a mobile IDTF. So CMS-855B, and you can peruse that up so you can find out specifically what they ask for. And then, most of the insurance companies will ask for something fairly similar. That’s the overview of a mobile IDTF. I can’t wait to come back in another podcast to continue on this business models series. And until then, you know it, I’ll be cheering you on,

(18:12):

Ready to see what it takes to start your own mobile ultrasound business? Grab our completely free startup guide and learn how you can make a thousand dollars a day with your own business. Head to our website, www.aic-ultrasound.com, to check it out.

your strategy-obsessed ultrasound business coach.

I'm Jennifer -

Welcome to the Talking Tech podcast, where we answer your questions about legal, marketing, admin, sales, and so much more. After nearly 20 years in the industry running our own mobile ultrasound business and helping techs across the country do the same, I'm so excited to bring you industry insight, mindset, productivity, business tips, and inspiration to help you design the business of your dreams.

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