Chicago is a hospital town, and the hospitals have been shopping. Northwestern Medicine, Rush, University of Chicago Medicine and Advocate all employ large numbers of physicians, and the independents who remain are mostly specialists with their own surgery centers: orthopedics, gastroenterology, dermatology, ophthalmology and pain. Primary care has thinned. Outside the city, Naperville, Schaumburg, Oak Brook, Orland Park and the North Shore are where new practices open, and they open next door to hospital-owned clinics with a bigger brand and a bigger marketing budget. The groups that own their own surgery centers keep facility revenue the hospitals would like to have.
The payer mix is easier to describe than to bill. Blue Cross and Blue Shield of Illinois dominates the commercial market, so one plan's prior authorization rules and edits shape a whole office's denials. Most Medicaid patients sit in managed care plans, each with its own portal and its own idea of timely filing. Medicare Advantage keeps growing in the suburbs, and Cook County Health carries a safety-net population that never touches most private offices. Credentialing is slow with every one of these payers, and a new physician can wait a long time to see a first paid claim. Independent groups with a surgery center bill twice, professional and facility, and the two need separate tracking. Front desks turn over fast, and a month of unworked claims becomes a month of write-offs.
On the form, give your specialty, your EHR, whether the practice is independent or part of a larger group, which plans you are credentialed with now, and roughly how many claims go out each month. If you own a surgery center, say so. Facility and professional billing are different jobs, and the billers who do both will tell you.
