Medical Billing Forum

Starting a Medical Billing Business => Starting Your Own Medical Billing Business => Topic started by: jcbilling on June 29, 2009, 09:09:55 AM

Title: Billing in NY
Post by: jcbilling on June 29, 2009, 09:09:55 AM
I have a prospective client in Plattsburgh, NY. Can someone tell me what the rules are for charging a percentage for billing services in NY. I have never done billing for this state and not sure how it differs from others? But it seems like I have read something about fee-splitting arrangements and I don't know how to draw a proposal if that's the case.

Title: Re: Billing in NY
Post by: PMRNC on June 29, 2009, 10:02:48 AM
Plattsburgh is right in my backyard.

Yes in NY it is illegal for a provider to enter into any percentage based fee splitting arrangement. NY is one of the states in which I have over 5 attorney opinions and there are also a few cases on the books.

Section 6530.19 - 19. Permitting any person to share in the fees for professional
other than: a partner, employee, associate in a professional firm or corporation,
professional subcontractor or consultant authorized to practice medicine, or a legally
 authorized trainee practicing under the supervision of a licensee. This prohibition
shall include any arrangement or agreement whereby the amount received in
 payment for furnishing space, facilities, equipment or personnel services used
by a licensee constitutes a percentage of, or is otherwise dependent upon,
the income or receipts of the licensee from such practice,
except as otherwise
provided by law with respect to a facility licensed pursuant to article twenty-eight
of the public health law or article thirteen of the mental hygiene law

Title: Re: Billing in NY
Post by: jcbilling on June 29, 2009, 12:04:32 PM
So then what are my other options for charging for my services?

Per claim or flat rate? How do you handle this?

This practice is looking for full service with a lockbox service.

Any suggestions?
Title: Re: Billing in NY
Post by: PMRNC on June 29, 2009, 12:59:38 PM
There are a few different ways you can charge. You will of course want to do a full practice analysis so that you can come up with a figure/estimate that is fair to you and advantageous to the provider. I usually go back and analyze a full year of A/R.   I have clients in NY right now I'm charging a flat fee with a sliding scale that can be adjusted up or down according to the work. For another I am charging a per claim fee and that per claim fee takes into account all services included. You really have to look at the practice in whole because a per claim fee for some practices would not be beneficial. There is also an option of hourly rate as well, I have a proposal in to a provider here in NY that wants to pay on an hourly basis, for them and me this will be beneficial.
Title: Re: Billing in NY
Post by: jcbilling on July 13, 2009, 11:52:01 PM
Since I have only charged a percentage of collections, I am having trouble figuring what is fair to the client, yet profitable for our company.
Forgive my detailed explanation, but I'm trying to give an accurate proposal without running off a client, but still coming out on top  ???

Here are the services the prospective client is requesting:

Verification of Benefits
Entering Demos & Charges
Claim Submission
Posting & Follow-Up
Denials & Appeals
Patient Statements & soft collections
Monthly Reports
Remote access given to provider to all billing info (using web based software)
Appointment Scheduler
Lockbox Service

Basically - the whole 9 yards!!!

On a monthly basis, the practice sees approx 1100 patients and submits approx 2800 procedures @ $40 per procedure.

We would be responsible for all the expenses associated with the account - which I figure will be close to $1000, without figuring labor cost for all the data entry and time spent working the account.

I originally thought of 8.5 % - which would net $9520, if every claim was paid - so approx $8700 to be safe.

So, do I propse a flat rate or $8500 or $9000, or is $8 a claim more reasonable? Should I offer both options and let them choose which method is better for them. 

Any suggestions?

Thanks so much,

Title: Re: Billing in NY
Post by: PMRNC on July 14, 2009, 06:26:21 AM
What type of client is this?
Also I wouldn't include credentialing in your billing fees. JMO, that is more a consulting service and should be separate.
What types of insurance are they submitting, what approximate reimbursement is there by insurance plan? Do they have WC, PI, etc. Those are some of the additional things I would need to know before submitting a proposal.
Title: Re: Billing in NY
Post by: Michele on July 14, 2009, 07:59:16 AM
I agree with Linda (feel the love, all this agreeing going on :) ).  Credentialing should be considered separate.  I've learned that the hard way.  Also, if they need credentialing does that mean they are not already established with insurance carriers?  That could affect your receivables in the first few months. 

Title: Re: Billing in NY
Post by: midwifebiller on August 02, 2009, 12:55:11 AM
Are there any other states that prohibit fee splitting?  Would you share your NY attorney opinions and cases with us, please?

Thank you!
Title: Re: Billing in NY
Post by: PMRNC on August 02, 2009, 10:29:46 AM
There is NY, Florida, and Illinois which are pretty cut and dry, there are a few cases from Illinois and Florida.
The statutes can be found by searching "fee-splitting". There are also a few states  in which there is some 'Grey" area.
The key is to remember this is not an illegal billing procedure for billing companies it's a matter of it being illegal for the provider to "enter into" a fee splitting arrangement and the three states I mentioned all have different verbiage in the rulings. When other billers say "well everyone else is doing it" it's usually because they research and look at this as though they are doing something that could be illegal..from their own angle and not from the provider angle. The provider when they enter into these types of contracts are the ones that are not acting within the law.. Where you come in is if you ever have to go to court over your contract or the provider ever gets into a situation where your contract is challenged and then it really becomes "null and void" for you in a court of law in those three states because it was entered into illegally (again, by the provider).   When I get a potential client in NY I usually don't go into this subject unless it comes up, and a provider asks me why I don't charge on a percentage, and then I explain to them. Only once has a doctor asked to see the statute and that was because he was paying his old company on a percentage, he spoke with his attorney who told him I was correct and he thanked me because he was unaware.  Doctors usually don't have a problem with it, in fact if they are looking at other companies that bill on a % and I bring this up, usually it lands me the client.
Title: Re: Billing in NY
Post by: midwifebiller on August 03, 2009, 09:47:02 PM
Very good information to know--thank you.