Medical Billing Forum

General Category => General Questions => Topic started by: best biller on February 06, 2013, 04:54:58 PM

Title: charging a %
Post by: best biller on February 06, 2013, 04:54:58 PM
Today in a meeting with a doctor i told him that its  not legall for a provider to enter into fee splitting arrangement in NY, he answered me that it have nothing with NY state, its a national issue and in fact even the biggest billing companies like Athena health are charging a %, so its not a law to follow.
Title: Re: charging a %
Post by: PMRNC on February 06, 2013, 05:10:23 PM
Print this out for him. Indeed this is a STATE statute.  If you are a  PMRNC member you can dowload case precedences and other articles as well.  My attorney also gave me a letter which I carry in my portfolio which has this exactly for NY Physician.    Keep in mind, it's not illegal for YOU, if HE disregards the law and your contract is ever challenged, it's basically worthless (Null Void)    I do have to ask, do you have other pricing means for NY Physicians ready? If so does he have a reason for challenging it? If a provider questions me about this (I don't offer % based contracts anymore) I simply tell them I don't price that way, hand them the letter from my attorney and then I tell them the way I price comes out better for both of us.   I don't haggle over things like this, if they are just set on this I don't want a provider who's willing to disregard state laws like this. I have never had to argue, once I explain they are fine with it.   Even if it wasn't a state regulation, I would never go back to charging on a %. I like getting paid for my work.

Section 6530.19 - 19. Permitting any person to share in the fees for professional services, 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: charging a %
Post by: best biller on February 06, 2013, 07:44:18 PM
He didn't said there is not such a law.

He said that its a national law and because even such big companies like atena health are not following it its not an issue

Thanks
Title: Re: charging a %
Post by: PMRNC on February 07, 2013, 10:47:41 AM
Quote
He didn't said there is not such a law.

He said that its a national law and because even such big companies like atena health are not following it its not an issue

So basically he is saying because everyone else does it it's ok. hmm  Is he giving you hard time about it?
Title: Re: charging a %
Post by: RichardP on February 07, 2013, 02:18:05 PM
Can I gently remind all of the point made starting in Paragraph 3 of this link?

http://www.medicalbillinglive.com/members/index.php?topic=7097.0

There is a distinction between a law on the books and a law that is enforced.  My experience in California is that you can find lawyers who will tell you to obey the regulation, even tho it is not being enforced by the state, and lawyers who will tell you that it is OK to ignore the regulation, because it is not being enforced.  Legally, deciding whether to obey a regulaton is a bit more complicated than just it's OK to do it because everybody else is doing it.

Having said that, I would be curious to see what national law the doctor is referring to that governs fee-splitting.  I'm not aware of anything on the national level other than the rules against self dealing that apply to doctors who accept Medicare and Medicaid patients  (Stark Law, etc.).  There may be some words about fee-splitting in these regulations, but they don't (yet) pertain to restricting how doctors can pay their billers.
Title: Re: charging a %
Post by: best biller on February 07, 2013, 07:38:46 PM
Quote
He didn't said there is not such a law.

He said that its a national law and because even such big companies like atena health are not following it its not an issue

So basically he is saying because everyone else does it it's ok. hmm  Is he giving you hard time about it?

He will not take me anyway! he say that he is satisfied with his current company, only if I could offer better service he will switch, but i am honest and i cant beet his billing company in the stage i am now that i dont have any client yet.

but from our conversation i see that its not an issue for provider's to pay % even if its illegally.

Thanks

Title: Re: charging a %
Post by: PMRNC on February 08, 2013, 09:57:49 AM
Quote
lawyers who will tell you that it is OK to ignore the regulation, because it is not being enforced.  Legally, deciding whether to obey a regulaton is a bit more complicated than just it's OK to do it because everybody else is doing it.

Well, to each their own but if my attorney told me to ignore a reg because it's not enforced, (which BTW is not true in this instance, ) I'd find another lawyer. My own attorney would tell me right there that would be extremely unethical. But again, to each their own.

their are small numbers of cases but that is NOT same as not being enforced.  A billing company I know in NYC just got their contract thrown out and lost a case, the provider is up on additional charges of something else, but the billing company's contract was thrown out because it's null/void. The state will choose to enter that as a charge or not. Many times these contracts just don't get "CAUGHT".   

Quote
but from our conversation i see that its not an issue for provider's to pay % even if its illegally.

Then why do people even ask? LOL  Of course it's not an issue if you don't care about following laws. I've never had a provider fight this, in fact they are QUITE grateful for the heads up, which is a positive move for me.   So all the ones that want to ignore it whether it's enforced or not. .be my guess but if you already have it in your head to do it anyway, why waste the time asking about it?   

Now Richard .. YOU are indeed picking on me.  THIS time I GAVE a legal source/citing so your on to the next level which is saying it's not same as being enforced <sigh>  I myself have 14 case precedences that say it is enforced (when caught) for just NY.  I have even more for the state of Florida.   
Title: Re: charging a %
Post by: RichardP on February 08, 2013, 10:50:30 AM
I will try to be more careful in the future.  I was not intentionally picking on you.  I was giving best biller a different perspective why some doctors say it is OK to ignore a law - other than just because everyone else is doing it (their lawyers tell them to ignore it because it is not being enforced - which is the case with some of my clients).  I was trying to add to what you said, not replace what you said.

And I am impressed with how you have stepped up your game.  Good job.  That might sound patronizing.  Please don't take it that way.
Title: Re: charging a %
Post by: PMRNC on February 08, 2013, 12:59:39 PM
Quote
And I am impressed with how you have stepped up your game.  Good job.  That might sound patronizing.  Please don't take it that way.

LOL. I have thick skin..   I've been researching fee-splitting laws for years. I have talked with several lawyers from several states. I have a folder full of information. When I was in NJ I billed on a percentage, I later moved to PA and even though it wasn't illegal for providers there, I moved out of %. I'd NEVER go back. I like getting paid for ALL my time.
Title: Re: charging a %
Post by: best biller on February 10, 2013, 02:51:14 PM
Quote
Then why do people even ask? LOL  Of course it's not an issue if you don't care about following laws. I've never had a provider fight this, in fact they are QUITE grateful for the heads up, which is a positive move for me.   So all the ones that want to ignore it whether it's enforced or not. .be my guess but if you already have it in your head to do it anyway, why waste the time asking about it?   

I asked about that because i tried to convince him to change his billing company so i mentioned that its not legal for him the way he is currently paying for his billing company!
Title: Re: charging a %
Post by: Billergirlnyc on February 10, 2013, 03:36:59 PM
I can't say I've never had a provider fight my pricing structure. Most I encounter are thankful for the information, but understand that what's on a state's statue and what's industry standard are 2 different things (in their minds). Those of us who don't use a percentage-based pricing system are often fighting an uphill battle. I mean ethics aside, set-fee's (at this time) isn't industry standard, and that's what I believe this particular doctor you were meeting with was referring too. I can't sit here and say I've never had a percentage-based contract, I have. I've moved away from them.  I too like getting paid for all my services and my set-fee based pricing structure works perfectly for me and my clients, but in the past it was definitely a point of contention with certain clients. You will more than likely encounter more than just this doctor who pushes back and believes that industry standards supersede any state or federal statue. This is why I have stated and Linda have stated having an attorney is your best bet especially when structuring your contracts and the rules on the books for your state.
Title: Re: charging a %
Post by: RichardP on February 10, 2013, 05:23:02 PM
He's pushing for the language to be clearer ...

Edit:  That quote was in Billergirlnyc's last paragraph before she edited it.  It is not there now, but I'll leave this here anyway.  /Edit

I like the language in the California Code.  It makes things quite clear.

b) The payment or receipt of consideration - for services other than the referral of patients - which is based on a percentage of gross revenue or similar type of contractual arrangement shall not be unlawful if the consideration is commensurate with the value of the services furnished or with the fair rental value of any premises or equipment leased or provided by the recipient to the payer.

From here:

http://www.medicalbillinglive.com/members/index.php?topic=7131.msg21583#msg21583

You will more than likely encounter ... [those who believe] ... that industry standards supersede any state or federal statue.

And a biller may be from a state with a regulation on the book that is not being enforced, and the doctor's health care attorney has told him this.  That is one of the several reasons why it is good for medical billers to have access to their own health care lawyer for opinions.
Title: Re: charging a %
Post by: PMRNC on February 10, 2013, 07:05:07 PM
Quote
Those of us who don't use a percentage-based pricing system are often fighting an uphill battle.
  No, actually not at all. I think the majority of the industry is just so stuck on the whole <yawn> marketing of "We don't get paid till you get paid" they have not sat down to look at it from an alternative payment method. I don't use fixed pricing. I have a monthly flat billing structure which takes into account time, expenses, hourly wage. NICE and simple. Just ask a doctor who else they split fees with, not their transcription, not their coder.. so why you?   MY stand is this. I don't ever get into a negotiation about HOW I charge. You wouldn't call your mortgage company, your utility companies or even your babysitter to price haggle, so why would I?  Generally I have only been ASKED "Why don't you charge a % of receipts?"  That's a fair question and usually my answer is sufficient to them, it's never gone beyond me just telling them, I prefer to get paid for all work I put in, my guarantee of timely and quality service is what they are getting in exchange. If it is a NY client I will just simply tell them also about the fee-splitting law (YES, sorry Richard it is indeed enforced here) and I've always been received great by that .. especially if other billing companies have quoted them a % or they used a service that billed on a %. To them it says I CARE about their license.

Quote
He's pushing for the language to be clearer ...

Edit:  That quote was in Billergirlnyc's last paragraph before she edited it.  It is not there now, but I'll leave this here anyway.  /Edit

No fair.. if someone edits a post, there is a reason. so I don't feel addressing something that's not there in an edited post is called for. JMHO

Title: Re: charging a %
Post by: Billergirlnyc on February 10, 2013, 08:05:29 PM
Quote
Those of us who don't use a percentage-based pricing system are often fighting an uphill battle.
  No, actually not at all. I think the majority of the industry is just so stuck on the whole <yawn> marketing of "We don't get paid till you get paid" they have not sat down to look at it from an alternative payment method. I don't use fixed pricing. I have a monthly flat billing structure which takes into account time, expenses, hourly wage. NICE and simple. Just ask a doctor who else they split fees with, not their transcription, not their coder.. so why you?   MY stand is this. I don't ever get into a negotiation about HOW I charge. You wouldn't call your mortgage company, your utility companies or even your babysitter to price haggle, so why would I?  Generally I have only been ASKED "Why don't you charge a % of receipts?"  That's a fair question and usually my answer is sufficient to them, it's never gone beyond me just telling them, I prefer to get paid for all work I put in, my guarantee of timely and quality service is what they are getting in exchange. If it is a NY client I will just simply tell them also about the fee-splitting law (YES, sorry Richard it is indeed enforced here) and I've always been received great by that .. especially if other billing companies have quoted them a % or they used a service that billed on a %. To them it says I CARE about their license.

I agree about what the industry is stuck on, but it doesn't negate what I've experienced, which is how I was answering her question. Some doctors in NY just don't want to work with any other pricing structure. And my response to the original OP is so she doesn't think this is odd (the pushback I mean), because I don't think it is, well not based on my experience and what I hear from fellow billers in my area. Also acknowledging the issues I've run into helps her understand why she MAY have seen this doctor pushback on her knowledge and her terms. Of course you don't have to negotiate your pricing structure with anyone, but that's not what I'm discussing. I'm acknowledging that I've dealt with doctors like the one she has. It's clear this doctor knew about the rules but still refuses any other pricing terms than percentage. It's also clear that no matter how she framed her pricing structure or why this doctor wasn't interested, even if he was looking to change billing companies. I believe she was trying to figure-out why he was saying what he said, and I hope she has some insight into that now.

Quote
He's pushing for the language to be clearer ...

Edit:  That quote was in Billergirlnyc's last paragraph before she edited it.  It is not there now, but I'll leave this here anyway.  /Edit

Quote
No fair.. if someone edits a post, there is a reason. so I don't feel addressing something that's not there in an edited post is called for. JMHO

Thanks, as I feel the exact same way.
Title: Re: charging a %
Post by: RichardP on February 10, 2013, 11:49:40 PM
No fair.. if someone edits a post, there is a reason.

OK.  I get that.  In this instance, I quoted what was there, wrote my comment, and posted it.  Apparently, the edit was made after I copied the quote but before I posted my comment.  It was only by chance that I later reread the post I copied from to find the re-write.  Seems like this can happen any time folks are posting close in time to each other.  Or not.  Anyone can go delete from their post something that someone else has already quoted and commented on.  If that someone else doesn't ever go read the edited posting they quoted from, they won't ever know the quoted material was deleted.  I don't see a good way of preventing that potential problem. 

Let me know if I should delete the quote in question and my response to it.
Title: Re: charging a %
Post by: PMRNC on February 11, 2013, 08:44:05 AM
Quote
I agree about what the industry is stuck on, but it doesn't negate what I've experienced, which is how I was answering her question. Some doctors in NY just don't want to work with any other pricing structure. And my response to the original OP is so she doesn't think this is odd (the pushback I mean), because I don't think it is, well not based on my experience and what I hear from fellow billers in my area.

Of course I can't dispute what you have run into, but like I said, I think it's the way we are educating our providers that is the key. I think doctors like all other humans just simply think something they know is the way to go (hey that rhymes) and they like many others have  resistance to change.   Perhaps it is the WAY the other billing model is being presented. When I present my flat fee, and the sliding scale, and a provider gets to sleep on it, they quickly realize this is a better deal. I do NOT think providers are thinking the way those billers are marketing .."Yeah.. they don't get paid unless they get me my money". I don't think I could insult physicians intelligence that way, whether they are businessmen or not. They usually can't argue with the information I give them in common sense terms. What if their accountant charged them on a percentage? Yikes.. but hey on a good note, they won't get paid till he gets paid?    MANY times my flat fee comes very close to an average percentage just by happen anyway. And also once they realize if they are not satisfied they get an out.  THAT is my incentive.   

A while back I sent out a newsletter to both current clients and to my marketing database of various providers. In that newsletter I addressed the fee-splitting laws. I included a comment from my attorney, reference to 2 case precedences, and a direct quote from a lady from the NY State Education Department, office of the professions, directly related to the NYS and we cited a quick reference to a couple of case precedences. Incidentally ONE of the cases was a radiologist who contracted with his OWN son based on a percentage of collections to which he charged his father a percentage of collections.  Anyway, the article definitely spiked interest as I remember getting calls for MONTHS about it. The calls were all a bit different. Some wanted to know more and some even wanted proof even though I provided all legal citing s, references and even case precedences. My own attorney got a plug out of it and would you know he only got 2 calls to my MANY?  That told me a LOT about my market at the time. I did not do it to "grab clients" though that ended up happening anyway.  So it was worth the time I put into it. I've been researching this topic for YEARS and I learn more and more about it. Those who continue to do it because "everyone else is" could end up in another newsletter somewhere I guess.   I've decided to do another one of these on a different topic hoping for same results <g>

Bottom line, you may encounter some physicians resistant to change, take the time to educate them and give them something to back it up and show your concern for their well-being. MAYBE they won't hire you right there, but give them enough to remember you for the future. :)
Title: Re: charging a %
Post by: Billergirlnyc on February 11, 2013, 03:21:30 PM
I think essentially we're saying the same thing. I've said in tons of topics on this forum that educating a potential client is the best move anyone can ever make, but there will still be doctors who are resistant even when you educate them. I doubt anyone on here is in the business of trying to lose business. I'm more than sure that folks are doing their very best to perfect their pitch. Mines is damn good but it isn't foolproof especially on those who are hellbent on believing in the myth of "we don't get paid until you get paid" pitch.

To Richard P, it's not a big deal you don't have to remove your comments, but I edited my comments because I wanted to come back with a link to the article when I got one, as it's a very interesting court case -- one I'll be watching closely.
Title: Re: charging a %
Post by: PMRNC on February 11, 2013, 03:41:42 PM
NY has the most interesting cases of all states I researched. Florida runs a close second. There are quite a few cases of just fee-splitting but the ones I have found to prove my point best are the ones where there were billing companies involved in the fee-splitting arrangement.

Quote
I think essentially we're saying the same thing. I've said in tons of topics on this forum that educating a potential client is the best move anyone can ever make, but there will still be doctors who are resistant even when you educate them. I doubt anyone on here is in the business of trying to lose business. I'm more than sure that folks are doing their very best to perfect their pitch. Mines is damn good but it isn't foolproof especially on those who are hellbent on believing in the myth of "we don't get paid until you get paid" pitch.

I agree. Though it is hard to educate when some have already made up their minds.. because "Everyone is doing it"  ::) ??? :-\
Title: Re: charging a %
Post by: RichardP on February 11, 2013, 04:12:35 PM
Billergirlnyc said: ... you don't have to remove your comments ...

OK.
Title: Re: charging a %
Post by: Billergirlnyc on February 11, 2013, 04:21:45 PM
NY has the most interesting cases of all states I researched. Florida runs a close second. There are quite a few cases of just fee-splitting but the ones I have found to prove my point best are the ones where there were billing companies involved in the fee-splitting arrangement.

Yep. The case I was mentioning was in a trade newsletter for Physicians that one of my clients sent over to me. A NY doctor is suing the Dept of Ed over the wording in their statue about fee splitting. He's actually fighting that medical billers/coders shouldn't be a part of it. I thought it was interesting because here was a doctor who wasn't under any kind of investigation who was challenging the statue. He's hoping that it will be changed like the it was in Illinois ----> http://www.mcdonaldhopkins.com/news.aspx?id=dhm8QN3p4E-cNV1SJUT8KA (http://www.mcdonaldhopkins.com/news.aspx?id=dhm8QN3p4E-cNV1SJUT8KA). He wants special provisions made for medical billing companies and coding companies. That's the gist of the article. As soon as I find a link where anyone can read it, I'll post it.

Quote
I think essentially we're saying the same thing. I've said in tons of topics on this forum that educating a potential client is the best move anyone can ever make, but there will still be doctors who are resistant even when you educate them. I doubt anyone on here is in the business of trying to lose business. I'm more than sure that folks are doing their very best to perfect their pitch. Mines is damn good but it isn't foolproof especially on those who are hellbent on believing in the myth of "we don't get paid until you get paid" pitch.

Quote
I agree. Though it is hard to educate when some have already made up their minds.. because "Everyone is doing it"  ::) ??? :-\

LOL, so true. So very true!  ;D
Title: Re: charging a %
Post by: PMRNC on February 11, 2013, 04:55:28 PM
I think I have info on the case your referring to.. I'll see what I have but meantime here's some more interesting reading:

The NY Bar Asso has had several requests for the verbiage change. This one in particular is a response to them from the NY Medical Society which I think really drives home clarification because this issue has been before the courts before.  With Illinois the law was more grey so they had more wiggle room to change. I don't think you will see NY change.. but what do I know.

 http://www.nysba.org/AM/Template.cfm?Section=Health_Law_Laws_Regs_and_Opinions&Template=/CM/ContentDisplay.cfm&ContentID=28915

Pg. 3:    By it's terms, section 6530(19) appears to prohibit arrangements which compensate a management service organization or billing company on the basis of a percentage of the income or receipts of a physician's practice. In addition, physicians and billing companies should be aware that courts have generally concluded that compensation arrangements between physicians and lay persons based upon a percentage of the income or receipts of a medical practice are void and unenforceable. See, e.g., Hartman v. Bell, 137 A. D.2d 585 (2d Dept. 1988); United Calendar manufacturing v. Huang, 94 A.D. 2d 176 (2d. Dept. 1983); Toffler v. Pokorny, 157 Misc. 2d 703 (Sup. Ct. Nassau Co. 1993).
Title: Re: charging a %
Post by: PMRNC on February 11, 2013, 05:23:41 PM
I have this one in my giant folder too though I cannot locate a source:  This is a Practice Management/billing company IN Florida (also state that prohibits physicians from fee-splitting contractual relationships, though that is NOT relevant, just a coincidence) who was suing a NY chiropractor for payment.. but OOPSIE... he's in NY so contract was null void.

On April 2, 1991, the Florida Circuit Court for Pinellas County granted a request for summary judgment made by a New York chiropractor who is being sued by PMA in Florida. The court ordered that:

    "The practice starter agreement is null and void under New York law (Education Law S6509-A, McKinney's Consolidated Laws of New York, Annotated) because it constitutes illegal fee splitting."


While the Florida court has found the PMA contract void for all New York chiropractors, PMA has argued that it still should be paid for the value of the services it provided to its client (quantum meruit). In order for PMA to receive any payment on its contracts with New York chiropractors, PMA will have to prove in court the actual value of its services.

PMA has appealed the summary judgment. The appellate court probably won't hear the case before November 1991.

According to Jean Simons, Esq., a Florida attorney who represents over 120 PMA clients as well as the New York chiropractor who won the summary judgment:

"New York has strict fee-splitting statutes which have been well supported by the New York courts. The Florida court has recognized the right of New York to regulate medical practices within that state by granting this summary judgment declaring the PMA percentage contract invalid for a chiropractor who practices in New York."
Title: Re: charging a %
Post by: PMRNC on February 11, 2013, 05:26:22 PM
Not beating a dead horse just trying to help. THIS is the lead article I give potential clients.  GREAT marketing article:

http://articles.submityourarticle.com/how-illegal-fee-sharing-may-cost-you-your-new-york-medical-license-51893
Title: Re: charging a %
Post by: Billergirlnyc on February 11, 2013, 05:52:10 PM
I don't think you're beating a dead horse, but the truth is since this effects this doctor's license he's allowed to fight the language or waste his money doing it. It won't change how I do business, but I will definitely be watching to see what happens. Maybe they'll do the opposite of what he's asking and specifically state third-party medical billing companies. Who knows.
Title: Re: charging a %
Post by: PMRNC on February 11, 2013, 06:30:01 PM
Quote
I don't think you're beating a dead horse, but the truth is since this effects this doctor's license he's allowed to fight the language or waste his money doing it. It won't change how I do business, but I will definitely be watching to see what happens. Maybe they'll do the opposite of what he's asking and specifically state third-party medical billing companies. Who knows.

I agree. I'm actually glad to be away from % based billing. The clients I have had that switched over with me have not ONCE complained. Their invoices are pretty comparative. I get paid for all my time as I deserve to be. I would never go back to a %. I think eventually the entire industry will be subject to similar laws that will in general prohibit fee-splitting PERIOD.  I kind of hope so because it better serves us to be held in a higher standard. Make sense? 
Title: Re: charging a %
Post by: Billergirlnyc on February 12, 2013, 11:33:23 AM
Quote
I don't think you're beating a dead horse, but the truth is since this effects this doctor's license he's allowed to fight the language or waste his money doing it. It won't change how I do business, but I will definitely be watching to see what happens. Maybe they'll do the opposite of what he's asking and specifically state third-party medical billing companies. Who knows.

I agree. I'm actually glad to be away from % based billing. The clients I have had that switched over with me have not ONCE complained. Their invoices are pretty comparative. I get paid for all my time as I deserve to be. I would never go back to a %. I think eventually the entire industry will be subject to similar laws that will in general prohibit fee-splitting PERIOD.  I kind of hope so because it better serves us to be held in a higher standard. Make sense?

Agreed and I think so too.
Title: Re: charging a %
Post by: QueenAlicia on February 12, 2013, 04:54:33 PM
My clients are on a flat fee.  The ones who want to be on a % have a minimum attached to it.  I don't feel it is an up hill battle. Either you want my services or you don't.  I know the value of what I my services are.
Title: Re: charging a %
Post by: DMK on February 13, 2013, 10:42:29 AM
Bravo!  Any doctor who wants to railroad you isn't someone you want to work for because there will be more trouble down the road.  Evidently there are some billers <wink wink> who just bill what they're given and will take any and all contracts.