Author Topic: Percentage Billing  (Read 3743 times)

kwardbilling

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Percentage Billing
« on: February 04, 2011, 11:48:54 AM »
Hi Everyone:  I was wondering if anyone can direct me to a place where it is documented that you can't percentage bill for your billing services in the state of MA?  I don't percentage bill, but I have lost business to several billers locally that do.  I am happy with the way I bill,(flat rate) but was wondering if anyone knows where I can find this documented.  Do you think it's appropriate to send an email to the clients have lost to other billers and tell them I hope they are happy with their choice in a billing service, but if for some reason they aren't I hope they consider calling me.  I was also going to mention that I wouldn't be able to accommodate their hope for me to percentage bill as it's against the law in the state of MA......does anyone have an opinion on this tactic?

thanks, as usual, for any advice
Karen

PMRNC

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Re: Percentage Billing
« Reply #1 on: February 04, 2011, 07:24:25 PM »
many years wiser, when this question comes up I always Have to ask.. WHY would you want to bill % anyway?  Get paid for the time you put in, businesses in all walks of life do business and make money for all their time spent, lawyers, accountants, etc..

BUT if you have to know..

The states that have anti-kickback statutes separately identifiable from federal rules are California, Florida, Georgia, Massachusetts, NJ, North Carolina, and Texas Where it gets sticky is that some of states I mentioned have some gray area.. others are very straight forward in the fact that it is considered an "illegal fee splitting arrangement" to receive a percentage of revenue.. PERIOD. Then you have the ones that have their OWN law that pretty much is VERY clear (aside from Anti-kickback) that a physician cannot enter into a fee-splitting arrangement as such.  Those states are Florida, North Carolina, & NY, Illinois was one of them but it was overturned...however that is on re-appeal as we speak..awaiting a decision.   

NOW.. I know I did not answer your question....

Quote
I was wondering if anyone can direct me to a place where it is documented that you can't percentage bill for your billing services in the state of MA?

The answer is No there is no such documentation that says a billing company cannot charge a percentage of collections. Why?  because it's not illegal for the billing company, but for the provider to "enter an arrangement that would constitute a fee-splitting arrangement" Mass is one of those states where there is a very gray area..my best advice would be to NOT do it. My motto:  "Better safe than sorry".  But if you want a better answer, I have to refer you to seek legal advice and even a second opinion for this.  But as I asked before.. Why would you want to?  Most answer this by saying "the provider wants it"  to which my response to them is to ask them if their lawyer charges them on a percentage, his accountant? I think not. Once you explain to any potential client that you are in business for financial gain as well as to be compensated FAIRLY on the time you spend working. If a provider's response is "But everyone is doing it"  Well I give them the old "Well if everyone was jumping off a bridge I sure wouldn't" If they are worried about your work, remind them that your reputation is online as well as future referrals, common sense :)


And if that doesn't work, here's the deal breaker:  " Violations of fee-splitting laws may subject a physician to disciplinary action by a state's licensing board, in addition to other sanctions." Usually that does it :)

Someone can come along and find you documentation that you could interpret to mean it can be done, others will provide the same information and interpret it to mean the opposite. I would better trust my gut first and then my attorney. And again, remember it's the doctor who would get into legal trouble.. YOU however could find yourself with money owed to you by the provider and your contract in those states with those fees, is NULL & VOID.. Yes it's no good, don't go to court, don't pass go and use your get out of jail free .. in other words your S.O.L  And I have seen billing companies suffer such a loss.  NOT worth it.

JMO :)   
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Alice Scott

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Re: Percentage Billing
« Reply #2 on: February 05, 2011, 07:31:23 AM »
Linda,
Thank you for clarifying this confusing topic.  Your knowledge is very valuable.
Alice
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kwardbilling

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Re: Percentage Billing
« Reply #3 on: February 05, 2011, 08:25:32 AM »
Hi Linda:  As I had said in my post I DON'T HAVE ANY INTENTION OF BILLING PERCENTAGE.  I guess my biggest question was, "is it appropriate to respond to the two clients who recently hired another billing agency, just because they percentage bill" by sending them an email telling them why I bill the way I do, which is flat rate.....!  In your response, I'm thinking it's probably most appropriate to tell them the reason I flat rate bill is number one it's much easier to keep track of and both my clients and myself know, can anticipate what the monthly expense will be, but mostly because it's not legal for a provider to pay a biller percentage...

I guess my biggest reason for this post is because I've noticed recently have have lost two clients (very close to signing with me), but went with someone else because of the way they bill.

Thank you for your response though.  I was anticipating that if I emailed the clinician they may ask where they can find that information......I'm sure they don't realize it.

PMRNC

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Re: Percentage Billing
« Reply #4 on: February 05, 2011, 09:25:47 AM »
Quote
Hi Linda:  As I had said in my post I DON'T HAVE ANY INTENTION OF BILLING PERCENTAGE.  I guess my biggest question was, "is it appropriate to respond to the two clients who recently hired another billing agency, just because they percentage bill" by sending them an email telling them why I bill the way I do, which is flat rate.....!  In your response, I'm thinking it's probably most appropriate to tell them the reason I flat rate bill is number one it's much easier to keep track of and both my clients and myself know, can anticipate what the monthly expense will be, but mostly because it's not legal for a provider to pay a biller percentage..
.

I would definitely tell them that these billing companies do not have their best interests, unlike yourself :)  Out here in NY have taken a few clients like that :) 

Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

kwardbilling

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Re: Percentage Billing
« Reply #5 on: February 05, 2011, 12:48:42 PM »
thanks, I just wanted someone to confirm for me that it was good business practice to do that.  I did send a quick email, just saying basically, good luck and if it doesn't work out contact me and just a little  FYI, the reason I bill flat rate the way I do is to take into account the well being of my clinicians, as it's again the law in MA for a clinician to split fee (percentabe base) the fee they pay to their biller.  Hopefully will make them think alittle bit about this.  Don't expect to hear from the two of them.  Oh well.....just have to keep being persistent with the marketing.  Things are going well, but still have room for more :) 

Take care everyone and thanks for the advice!

PMRNC

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Re: Percentage Billing
« Reply #6 on: February 05, 2011, 01:11:56 PM »
Quote
I did send a quick email, just saying basically, good luck and if it doesn't work out contact me and just a little  FYI, the reason I bill flat rate the way I do is to take into account the well being of my clinicians, as it's again the law in MA for a clinician to split fee (percentabe base) the fee they pay to their biller.

Perfect!  No, sometimes it doesn't work and usually the doctor has to go ahead and disregard the law simply because "everyone is doing it" and that's ok.. if they are that cavalier about something serious like that.. can you imagine some of the things they might want you to do. That's how I look at it. 
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

kwardbilling

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Re: Percentage Billing
« Reply #7 on: February 05, 2011, 01:30:53 PM »
This is sooo true.  I also am finding out that many clinicians have no idea about the billing end, what's appropriate and what isn't.  The clinicians I am working for (5 of them), tell me all the time, how much they appreciate me keeping them informed.

I really enjoy this website and all the information contained in it.  It's nice to know when you do have a question there is someone out there that might have some good advice for you!

thanks again this was helpful.

Karen

midwifebiller

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Re: Percentage Billing
« Reply #8 on: February 10, 2011, 07:43:32 PM »
Providers "having no idea about the billing end"?? How true! Excuse me while I get this off my chest...we lost our largest client last week, and I believed it was in part because they are a new practice, don't understand the billing and basically didn't think we were doing a good enough job for them. Two months after they opened their doors, they were complaining to me, "why aren't we seeing a profit yet?" and "why don't we have more insurance payments?".   Oh well, we terminated the contract and are now in our 90-day runout period.

This week, another one of our clients forwarded me a new post from a business group.  The post was a provider complaining about her "new billing service" not doing things the way she thought they should be done.  I looked at the signature line and it was.....our old client.  Her complaint was one I had heard several times, but I'm sure she thought I didn't know what I was doing.  I was irritated and pleased at the same time--which I know is not very professional.  I hope the new billing service can keep them happy. It is a steep financial loss for us right now, but my stress levels have drastically reduced!

Pardon the rambling...
Kelli Sugihara, CPMB
Midwife Billing & Business, LLC
www.midwifebilling.com

DMK

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Re: Percentage Billing
« Reply #9 on: February 11, 2011, 12:19:47 PM »
I have 1st hand knowledge of providers not knowing about the billing!  Practitioners are focusing on PRACTICING!  They have enough on their plate to keep up on current medical conditions, drugs, and methods.  Billers can sell their services by stating that during their presentations!

Also, by explaining how LONG it can sometimes take to get paid, how much the insurance companies reduce the bills, and how important it is to have a payment policy and GOOD front desk personnel, you help their business and allow them to focus on being a great doctor!

Don't let the practitioners snow you!  They don't know all they need to know about the billing.  My husband defers to me to find that out (I'm the biller!)  But educate them well so that they know that you know your stuff!!!!!

PMRNC

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Re: Percentage Billing
« Reply #10 on: February 11, 2011, 01:41:15 PM »
Quote
I also am finding out that many clinicians have no idea about the billing end, what's appropriate and what isn't.  The clinicians I am working for (5 of them), tell me all the time, how much they appreciate me keeping them informed.

Yes, we take on yet another role aside from billing and practice management, we also become educators which is VITAL to staying in business!
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com