Medical Billing Forum
Starting a Medical Billing Business => Starting Your Own Medical Billing Business => : williamportor March 27, 2014, 05:21:17 AM
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Hello Everyone,
I could use some input here. I use a large clearinghouse (hewedi.com), they have a large payer list, have been very responsive to my needs, and I'm very happy with their service. This clearinghouse charges me $40.00/mo/client. All paper claims are free. The only problem is 2 of my smaller clients are mental health providors, and though they accept many different insurance plans, they frequently submit only 5-10 claims per month through me since they are semi retired, which means I'm losing about $10.00-$20.00/mo on each. These were my first two clients, they've been very easy to work with, and one even wrote a glowing letter about my excellect services. I don't want to lose these 2 ladies, but I'm having a hard time justifying losing money each month on them. With my 2 larger accounts I net about $1400.00/mo (and growing). My question is: Would I be justifyed in insisting a 15 claim minimum each month to cover my clearinghouse fees?
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Since the two smaller accounts are so small why not just print them to paper yourself? You would have a little cost in printing, forms, envelopes and postage but it wouldn't be $80 per month.
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I agree with Michelle - or consider submitting the claims directly through to the carrier if they allow it. For that small number of claims you wouldn't spend $80 worth of time entering them...
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A few years ago I changed my model of business. I don't contract directly with clearinghouses or software vendors. Makes my life SO much easier and I can concentrate on what I'm being paid to do.
With that said, I can see where I would agree with Michele and Heidi, but from a business point of view I would approach both and let them choose the model and at their cost. It sounds like your billing on a %? If so perhaps a change that way might help you as well. I don't charge a % so my revenue is not dependent upon provider reimbursement but rather the work that I do, the time it takes, etc. My clients pay for their own software licenses and subscriptions so they pay ONLy for my services and that makes them happy and me happy. I have a few small accts similar to the one your speaking of, and this is where it really benefits me. You should not lose money over a small acct. J M H O
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Office Ally is a free clearinghouse if governmental claims (Medicare, Medicaid, etc...) make up less than 50% of claims volume in any given month. If governmental claims are more than 50% in a month, the fee is $19.95.
You can use their PM software or upload claims from your own PM software.
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Good point Christy! We use Office Ally (Clearinghouse portion only) and we are very happy. Didn't think of that. You may want to consider using the free software just for the two smaller clients so that you can keep them without the cost.
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Michele, Christy, PMRNC, Heidi - Thank You everyone, that helped :)!