Running a small, private medical practice has always been a balancing act. Doctors juggle patient care, staffing, office overhead, and constantly shifting insurance rules, all the while trying to stay financially viable. But lately, that balance is tipping, and the challenges for independent practices are mounting. From rising costs to increasingly complex billing requirements, many small practices are struggling to keep their doors open.
One of the less obvious but increasingly impactful pressures comes from insurance companies and the practice of “downcoding.” Essentially, insurers sometimes pay less than what doctors billed, claiming that a lower-level service was provided even when it wasn’t. This practice is highlighted in NBC News’ article “‘Guilty until proven innocent’: Inside the fight between doctors and insurance companies over ‘downcoding,’” it’s become increasingly difficult for small, private medical practices to thrive.
The share of doctors working in private practices has plummeted in recent years, driven in large part by the desire for better reimbursement rates.
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