Medical Billing Forum
General Category => New! => : medauthor September 12, 2010, 01:05:40 PM
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Hi All,
I guess I will be the first to offer a comment on the new Contract E-Book regarding collecting a % on co-payments collected at the time of service. Personally, I disagree with this. I never have nor will I ever collect a % on co-payments. I don't think it is fair to providers as I did not do any work to collect that money. I have, in fact, warned potential clients that there are billing companies that do this, and I will never do this to you (potential client).
Again, I am speaking about co-payments collected at the TIME OF SERVICE! If I have to send out a patient statement for a co-payment or co-insurance amount due, then yes--that would be included in my %, but never, never when the patient pays at the office!
Do others share my feelings?
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I don't collect on copayments/deductibles/coinsurance at all, as I strictly do FLAT FEE billing and totally dislike that old age nonsense of % based billing. I include the cost of sending out statements to patients into my flat fee billing. It includes my cost of paper, stamps, envelopes & ink varying on the size of the practice. I have a set amount of statements that will go out, and if they are to include any verbal collections, that is a separate negotiated fee. I also have a collection company that I refer clients to for further actions on the accounts. I personally view collecting on copayments as "nickel and dimeing" the provider and view it in a negative way. I mean my copay is just 10 bucks, and at a % rate of 10 you are only making a dollar. You would have to do a lot of volume to make a huge amount of money doing this. How do you even keep up with what is being paid in the offices?? If I was a provider, there would be no way I would pay a billing service a % of the copays that my staff collects in the front office. That is double dipping to me and totally unprofessional and unacceptable in my opinion.
well i would say more, but this is a HOT topic to me so............exit stage left!!
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I personally view collecting on copayments as "nickel and dimeing" the provider
Charlene, I could not have said it better! That is my exact sentiment! ;)
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So you don't post, track, report and send patient statements? If so I would tend to agree with you. For those that are billing on a percentage, and tracking, reporting and sending patient statements I think it's bad advice to tell bilers not to charge for these! NOW if you have a provider who is 100% perfect on collecting copayments and coinsurance (OOP) up front..KUDOS to you and again I would agree I would cut provider a break also. Billers charging on a percentage are POSTING, TRACKING, REPORTING and sending patient statements .. bottom line if they don't bill the provider for those, they ARE losing money. PERIOD.that's a fact, not an opinion.
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I want to add that Michelle and Alice's book on contracts is AWESOME.. I admire their dedication to this really good topic. They earn my respect with this completely, they could have taken the easy way out and offered up a template contract with fill in the blanks like so many others before them..but they didn't. KUDO's GALS.. I LOVE IT AND WILL BE ENDORSING IT ALL THE WAY!!!
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huh?? the post asked about collecting on the money received in the office, so you are CONTRADICTING the post. You are not sending out a statement or tracking payment on something that has already been paid up front. I might agree with you on the work that you do in order to get money that you send out in statements for the provider. I PERSONALLY don't do % based billing because of that. When you think about it, I post an EOB (client gets hers in mail at same time). The EOB applies everything to the deductible. The client sends in the payment. I do statements once a month. Client has ALREADY paid the provider because she got her EOB. She gets my statement since provider has not notified me of the payment yet. He tells me patient paid a week ago.....do I get a % of that money??? Regardless of how I do my client billing, I INCLUDE everything in the flat fee. This is why a cost analysis is done of a practice before you quote a % or a flat fee. You have to include your time, efforts, and supplies into the cost. I PERSONALLY feel trying to get money from something that was done in an office is "nickle & diming" someone. Anyone can disagree, but its not what I promote. Getting paid for your time is. I get my fee regardless of how many copays are collected and or not. While others are out there sending statements for a 10 copay hoping to get 50 cent off of thier 5% commision, I have gotten my flat fee money up front!! This is how I get providers. I tell them my fee is all inclusive and other companies will do that "nickel & dime" you for everything you do. As an in-house biller you get paid for sending out statements included in your hourly pay.......being a provider I would think hum..... pay them 8% on the money they get in for me, and then money that WE collect in the office.....forget it, we will send our own statements....Thats my method of getting providers away from % based billers .......
off my box
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So you don't post, track, report and send patient statements? If so I would tend to agree with you. For those that are billing on a percentage, and tracking, reporting and sending patient statements I think it's bad advice to tell bilers not to charge for these! NOW if you have a provider who is 100% perfect on collecting copayments and coinsurance (OOP) up front..KUDOS to you and again I would agree I would cut provider a break also. Billers charging on a percentage are POSTING, TRACKING, REPORTING and sending patient statements .. bottom line if they don't bill the provider for those, they ARE losing money. PERIOD.that's a fact, not an opinion.
Linda,
Did you read what I wrote? I stated TWICE that I was talking about co-payments that are collected at the time of service! I said I DO collect a % on those in which I send patient statements. So, what bad advice are you speaking of?
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Linda,
Thank you for your kind assessment of our book. We appreciate your support.
Alice
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As I didn't purchase the contracts book, I can't state one way or the other how it was. I wish you much success on it though. Currently it isn't a book that I'm interested in buying i am assuming it is more geared towards newbies. If not I'm ok with my contract writing abilities. Also as most know the PMBA does operate as an affiliate for your books so I'm sure its as good as the others posted up there. I did offer up my comments to Michelle's post, so I am assuming again, there is something in the book regarding collecting a % off of copays. I give you credit for asking for feedback on the book, because it is a hard thing to give as well as receive. Michelle allowed me a while back to see some of the reviews on her book (she is helping me with the ones that I am writting), and OMG they remarks were on opposite ends of the spectrum. There was one lady that showered her with praise and only used her book to teach, while another one was very critical. The issue isn't how well the book is written, but the use of the book for the purposes that THEY need it for. I can read your book, any of them and give it poor reviews simply because they may not be a benefit to me at my level of billing, but someone else in the forum could love it because it was good for them. When I finish my books, I know the hardest part for me will be the critiques of it, but in order to put out quality work and give my best I have to do it. The people that care the most will probably be your worst critiques.
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OK - I'm going to chime in here...I have a billing service that still charges based on a % and I DO charge my clients for the copays that are collected at the time of service.
Here's the reason, in the daily batch of superbills that are sent to us they include their daily payment log so that we can make sure all copays were applied to the patient's visit. Our policy is that any money that we post to a patient's account we get paid on. So far, I've never had a client refuse to accept those terms - they understand the importance of keeping the patient's account accurate and that is part of it.
To comment on the deductible side - even if the patient pays for the deductible at the time of the visit, the claim still needs to be filed and tracked with the insurance company - so we get compensated for the work tha is involved there.
Just my two cents...
~ Charity
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Well said Char...
What she is speaking of is the revision for my textbook....when writing a textbook, your book is reviewed at every stage---the proposal, the sample chapters, the rough draft, the final draft.....I have to be open to criticisms, as it helps me put out a better project...my acquisition editor and I discuss every comment in the reviewing process.....feedback is imperative. As an author, you can choose to heed what your reviewers are saying or you can ignore it....but what you can't do is take the feedback personally..... ;)
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OK - I'm going to chime in here...I have a billing service that still charges based on a % and I DO charge my clients for the copays that are collected at the time of service.
Here's the reason, in the daily batch of superbills that are sent to us they include their daily payment log so that we can make sure all copays were applied to the patient's visit. Our policy is that any money that we post to a patient's account we get paid on. So far, I've never had a client refuse to accept those terms - they understand the importance of keeping the patient's account accurate and that is part of it.
To comment on the deductible side - even if the patient pays for the deductible at the time of the visit, the claim still needs to be filed and tracked with the insurance company - so we get compensated for the work tha is involved there.
Just my two cents...
~ Charity
Maybe your provider isn't really "counting" what you collect v/s what they do. They may trust your company and feel that when you state you "collected" via filing claims for them 1500, that that is totally insurance payments. The % fee covers your work. I can bill for a DME and a Chiro. If I charge 5% across the board, I will make out big on the DME, but suck totally on the Chiro because the reimbursements for him is so LOW!! My % fee for him will be HIGHER basically because I KNOW I need to charge him more to get the fee I deserve. In order to do correct billing & payment posting (full practice management)...YOU MUST post the payments, file the claims etc etc. Its all of the process. So JMO asking to get paid off the money they collect isn't right. MOST every Billing service state "we don't get paid unless you do", which is untrue to a degree because you can get paid off of copays/deductibles the provider collects, but your claims don't bring in money. I do "understand" the concept, and if it works for you, keep doing what you do. We all have our own way of doing the same job, and there is no "right" way to do it. My book on % fee v/s flat fee billing speaks a lot about the advantages of both. I personally promote flat fee, but there are certainly some advantages of the %.
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This one paragraph in our 82 page book was taken entirely out of context. We state many times in the book that we are not suggesting what terms a person should put in their contract. We are only stating the different situations they need to cover and determine how they want to approach that particular situation. It is, as we mentioned many times, each person’s decision on how they want to cover each situation.
I believe medauthor’s problem with this one paragraph is that she is looking at it from being a teacher of billing not a biller.
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I don't collect on copayments/deductibles/coinsurance at all, as I strictly do FLAT FEE billing and totally dislike that old age nonsense of % based billing.
Charlene,
We entirely agree with you on the flat fee billing and in fact wrote a whole chapter on pricing your service in our new contract book. In it we state that though percentage billing is the most popular method of billing providers there are many reasons to choose another option and I list them. We write that percentage billing is our least favorite and we much prefer flat fee and we explain why. Being that we were covering the topic of pricing your service in this book we felt that we would be remiss if we didn’t also cover percentage billing. But we certainly did state our reasons for percentage billing not working well.
Alice
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OK - I'm going to chime in here...I have a billing service that still charges based on a % and I DO charge my clients for the copays that are collected at the time of service.
Here's the reason, in the daily batch of superbills that are sent to us they include their daily payment log so that we can make sure all copays were applied to the patient's visit. Our policy is that any money that we post to a patient's account we get paid on. So far, I've never had a client refuse to accept those terms - they understand the importance of keeping the patient's account accurate and that is part of it.
To comment on the deductible side - even if the patient pays for the deductible at the time of the visit, the claim still needs to be filed and tracked with the insurance company - so we get compensated for the work tha is involved there.
Just my two cents...
~ Charity
Charity,
We agree with you and Linda entirely. I think that unless you have been in this situation and realize how much work is involved in tracking patient payments both in the office and by sending out statements you don’t understand the concept. Thanks for your comment.
Alice
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As I didn't purchase the contracts book, I can't state one way or the other how it was. I wish you much success on it though. Currently it isn't a book that I'm interested in buying i am assuming it is more geared towards newbies. If not I'm ok with my contract writing abilities. Also as most know the PMBA does operate as an affiliate for your books so I'm sure its as good as the others posted up there. I did offer up my comments to Michelle's post, so I am assuming again, there is something in the book regarding collecting a % off of copays. I give you credit for asking for feedback on the book, because it is a hard thing to give as well as receive. Michelle allowed me a while back to see some of the reviews on her book (she is helping me with the ones that I am writting), and OMG they remarks were on opposite ends of the spectrum. There was one lady that showered her with praise and only used her book to teach, while another one was very critical. The issue isn't how well the book is written, but the use of the book for the purposes that THEY need it for. I can read your book, any of them and give it poor reviews simply because they may not be a benefit to me at my level of billing, but someone else in the forum could love it because it was good for them. When I finish my books, I know the hardest part for me will be the critiques of it, but in order to put out quality work and give my best I have to do it. The people that care the most will probably be your worst critiques.
Charlene,
You are entirely right about this subject. Both Michele and I tend to be rather sensitive and no matter what you do in life some people will criticize you. I always take the criticism rather hard at first although I must admit we really haven’t had that much. But we then use that criticism to see what we can do to improve the product. We have had two instances that I can think of where readers came back to us and felt we should have covered something they were particularly looking for in purchasing a book from us. We took those suggestions and revised our books adding sections on those topics. Then we sent newly revised copies of that book to everyone who had purchased the book in the past six months. I have found that the two times we did get complaints, the same day or soon after we got a very nice email or letter from someone else thanking us for all that we do to help billers so that usually eases the pain.
Alice
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I think that unless you have been in this situation and realize how much work is involved in tracking patient payments both in the office and by sending out statements you don’t understand the concept.
I do understand the concept, because I do track patient payments both in the office and from sending out patient statements. I do post the co-payments received at the same time I am posting the charge for the day. I do post patient payments when they are mailed in from my statements........
I still don't believe in charging for co-payments collected up front....I think it's wrong....that's all, it's how I feel.....my opinion....that's all...nothing more, nothing less....
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Ok, yes monies collected in the office.. so let me ask again... ARE YOU NOT POSTING and TRACKING and REPORTING on these? If not... who is? If you are and not charging the provider, that's fine, it's your time and time = money.
For example, If Mrs. Smith is a perfect patient and comes in every visit and pays her $10 copay, you never have to send her a statement, who's tracking her payments? Are their reports showing her payments?
Some may say that maybe the provider is tracking all self-pay's or payments in the office..that actually is a BAD idea because any financial expert, accountant or tax adviser will tell you its NEVER a good idea to have two sets of books. That means SOMEONE is posting, tracking and reporting.. NO?
I might agree with you on the work that you do in order to get money that you send out in statements for the provider. I PERSONALLY don't do % based billing because of that. When you think about it, I post an EOB (client gets hers in mail at same time). The EOB applies everything to the deductible. The client sends in the payment. I do statements once a month. Client has ALREADY paid the provider because she got her EOB. She gets my statement since provider has not notified me of the payment yet. He tells me patient paid a week ago.....do I get a % of that money??? Regardless of how I do my client billing, I INCLUDE everything in the flat fee. This is why a cost analysis is done of a practice before you quote a % or a flat fee. You have to include your time, efforts, and supplies into the cost. I PERSONALLY feel trying to get money from something that was done in an office is "nickle & diming" someone
Based on what you said above.. I have to ask So who's posting these payments?? Are they not a part of your practice management" Is your agreement with the provider that they will be the ones to track these patient payments? Is he just tracking them and you are tracking everything else.. that's two sets of books..that's a dangerous red flag.
It is NOT nickle and diming a provider because that's what you are supposed to be doing "practice management"
Since you stated you charge on a monthly fee then this of course is moot for you right? Does that mean your flat fee does not include your "TIME"? Because my flat fee is BASED on my time and out of pocket expenses. Charging a percentage is another means of charging but that doesn't mean you are nickle and diming because you charge for a service that still includes your time to post that and report it.
Here's the reason, in the daily batch of superbills that are sent to us they include their daily payment log so that we can make sure all copays were applied to the patient's visit. Our policy is that any money that we post to a patient's account we get paid on. So far, I've never had a client refuse to accept those terms - they understand the importance of keeping the patient's account accurate and that is part of it.
Bingo..thanks Charity, this actually explains it better than I did :) I am wondering if maybe those that are NOT charging maybe are not posting and that sounds off an alarm to me to have two sets of books for any doctors office is a VERY bad idea.
BTW.... the topic of the original post topic was review of the contract book..I saw that but I really didn't see the original poster mentioning this as direct criticism, then later on someone else started mentioning the PMBA books.then another one chimes in mentioning THEIR book.
And another thing.. I've been in this industry for over 25 years. The contract book is NOT for a "newbie" in fact I found it to be quite interesting and above the newbie level!, I went back to school for my paralegal specializing in contract law and there's nothing about contract law that could be construed as "newbie" ..newbie language would be if they said..here's a template. go to it. and fill in the blanks. Also if we are going to talk about THIS book.. the criticism here is about a billing "METHOD" not a contract item. And also I'm sorry but after 25 years in this business.. IT IS THE NORM to be compensated on ALL work you do, in ANY business! If your not tracking it then fine, your not working it. But again..NOT good idea to have a practice with two sets of books. Ask any accountant, lawyer, tax advisor!
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First off, let me get this CLARIFICATION done. I HAVE NOT read the contract book, so my replies have nothing to do with the book. I am only replying to a QUESTION that Michelle posed. From what I read, her post has nothing to do with the book, except for something she obviously saw in there and asked our opinion of it. She made no remarks as whether the book was good, bad or ugly. Just because I don't agree with you Linda does not mean that my methods are wrong. As I said to Charity, JMO I don't like it, nor do I agree with it but if it works for her....do what you do. As far as following up on payments, you are NOT on my staff nor do you know what I do. One thing that I do is bill 90% of my clients out of their system. I save MONEY on using their software as opposed to using my own. The providers office post 100% of their copays and I send the statements from their system. What is collected in their office is posted in their office. This keeps me from having to deal with that part, plus posting payments. I don't do client calls regarding payments. The system they use statements are sent through their system electronically!! Misys will also let you know how many statements are sent and the collection status so the provider can determine what to do with it after that. I HATE statements, so therefore I choose methods to avoid them. I have one client (DME) that I bill out of my system (well sorry 2). I do her statements and hate doing them. I have to depend on the provider's office to tell me when they pay so my system can be updated. I also notice that you FLIP FLOP depending on the post whether you are for flat fee or against it, which is your prerogative. I offer % fee billing because that is what providers are used to but ALL my providers prefer flat rate, and I do include my time. Does your time to send a statement, balance out when you charge 7% and obtain .70 cents on a 10.00 copay? Does it cover the stamp, ink, envelope you send out????
We all are entitled to our opinion. So, hummm. let me think. My provider is posting the copays, They can run reports out of their system, what do I bill them for again???????
I agree Michelle did not state anything about the book and YES MY NAME IS CHARLENE and I did post about the PMBA and I did post about MY BOOK, and I did post that the PMBA does promote their books. You are totally being silly and ridiculous about this entire case as you usually do.
I know I can no longer be a part of this continuous childish mess that goes on in this forum. Alice & Michelle asked for an opinion on their book, and although Michelle never gave out one, her post has created a mess that should not occur amoung adults. First off they should NEVER ask for opinion if they are not able to deal with what people have to say. You Linda, see I can say your name, has an issue with people who disagree with you. I respect the forum, so I choose to no longer deal with chaos, so I respectfully decline to continually post
Be Blessed
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Linda,
Seriously..you need to chill out. Why must you create such drama? You are utterly RIDICULOUS! YOU are the reason why I waited so long to join this forum...and YOU are the reason why I will no longer be posting...
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Charlene, there was NO question posted by Michelle. The TOPIC was titled "Feedback on the New Contract E-Book" to Which Michele pointed out a billing method she didn't agree with.
I don't flip flop with % based billing. I said in more than one post on the subject this is moot if we are not talking about % based billing. I don't bill on a % and switched a long time ago, but there are still many billing companies using that method and that's what the post was about. Michelle offered her opinion, and I offered mine. I'm sorry but I don't think I have found any provider who wouldn't logically expect to pay for percentage of all revenue's as noted in most contracts. Maybe billing companies starting out can offer such a freebie of time, but it's not the norm.
Michelle, don't tell me to Chill out. Grow up, expecting to post YOUR opinion without expecting some one else to share there's seems a bit naive to me. I'm perfectly "chill" It's very clear you have taken on the role of mother hen.
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Ladies, I read and re-read this thread to try to figure out where it went sour. I'm totally lost. :-\
Please, please don't quit posting! You all have such valuable insight, even when opinions differ.
I don't know if the moon was full and everyone was having a Midol moment, but I have no clue where it went bad. Deep breath.......glass of wine.......Calgon take me away! Tomorrow is another day!
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Please don't stop posting. All of you. I enjoy reading your posts and value your opinions. There are a lot of us here that value from your input which is the reason this forum was started. Let's agree to disagree and the wine is on me if you come through Illinois. ;D
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Ok, you said the wine was on you.. I wasn't leaving but I will and come back if the offer of the free wine still stands :)
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Absolutely! I joined a wine of the month club trying to find the perfect sweet wine. Let's just say I have a lot of bottle to get through even though I found it. ;)
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Well count me in. I'm going to go through the e-book again later tonight and tomorrow I am going to post a thorough review in this thread.
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White or red? :D
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Red of course :)
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Red for me too. ::)
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I love wine, but it doesn't like me.. one glass is all I can do or I'm asleep and wake up with a horrible headache! LOL
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Man, a wine tasting with all you guys/gals would be a hoot! I'm SOOO in! Just don't get us started on insurance company reimbursements! ;D
Dina
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Wow that would be funny to see us after a few glasses talking about that.. LOL
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I am laughing just thinking about it. We would have to film it so we can see ourselves afterwards. :)
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You bring the wine and I'll bring the chocolate!
Many of us have strong opinions--I think we have to be hard-headed to be in the business that we are in.
Don't stop posting!
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Chocolate too!! I'm in heaven. :D
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Dark chocolate only though, white chocolate is just a tease!
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I agree - the chocolate makes all the difference.
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OK I hate to be a party pooper but I don't like chocolate.
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Wow.. a woman who doesn't like Chocolate?? that's like Cookie Monster not liking Cookies girl!
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I know I know! I teach Sunday School and I have a 21 yr old guy who helps me. He bought me a big box of chocolates for my birthday! Good thing he's not a forum member. I wouldn't want him to know! LOL
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So, maybe a lovely cheese? Cheesecake? Cake? What would be your yummy moment?
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OMG love CHEESECAKE!
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Count me in on the cheesecake - it doesn't matter what kind :)
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OK then--there are a few things we can all agree on. :)
Have a great weekend!
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As long as it's not chocolate cheesecake. ;)
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I'll eat her chocolate cheeseback! :-*