Medical Billing Forum

Starting a Medical Billing Business => Starting Your Own Medical Billing Business => Topic started by: williamportor on April 23, 2014, 12:49:40 PM

Title: What constitutes a "claim"
Post by: williamportor on April 23, 2014, 12:49:40 PM
Hello Folks- This may be a silly question, but I've had several doctors ask me how much my company charges. I offer a 2 tiered pricing, either a set amount per claim (for claim submission only), or a percentage of the return to the doctor. May I ask...what is a "claim?" Is it one date of service, or one HICFA form (possibly 6 dates). I was leaning to one date of service, but I'm not sure now. Any thoughts?
Title: Re: What constitutes a "claim"
Post by: DMK on April 23, 2014, 12:57:38 PM
For MOST doctors, a claim will be one date of service.  For chiros and P.T. there may be multiple dates of service on one claim since the patients are usually seen a few times per week.  Then there's the hospital "global" claims which would encompass a "stay" for a procedure.
Title: Re: What constitutes a "claim"
Post by: Merry on April 23, 2014, 12:58:15 PM
Never a silly question.  That's why we are here.. To share.  I think a claim could be for multiple service dates as long as they are given to you at one time.  I also never put 2 months or years on a claim.  Of course you really can but for clients I would tell them,  if you give me up to 6 procedures at one time for the same month,  that is a claim.  No holding a claim for more days of service for the same month.  Looking forward to hear what others say.

Merry
Title: Re: What constitutes a "claim"
Post by: williamportor on April 23, 2014, 01:08:54 PM
DMK, Merry. Thank You! This was a Chiropractor asking. I told him 1 claim= 1 HCFA form (Max 6 lines).  This will work for me. This was really helpful. ;D
Title: Re: What constitutes a "claim"
Post by: DMK on April 23, 2014, 01:30:25 PM
Merry brings up the point I was going to make next.  How OFTEN will you be sending claims out?  In my office I determined that the most cost effective way for me to bill and to keep a reasonable cash flow was to bill every 10 days.  That way I have multiple visits on each claim (and I pay 44 cents per claim to my clearing house).  Each office will have different expectations depending on volume, practice practices, and overhead costs.  Some offices may only send the info to you once a week, others every day.
Title: Re: What constitutes a "claim"
Post by: Merry on April 23, 2014, 10:30:27 PM
From a billing service perspective I would never hold a claim.  Give it to me at one time.  Fine.  Let the office keep track.. Not you.  Ok ok.  Yup did it once. 
Never again.  There is enough to do
without having to keep a file of these
claims. 
Title: Re: What constitutes a "claim"
Post by: PMRNC on April 24, 2014, 08:30:02 AM
I don't like the per claim model because it does not allow for time management/tracking.. for example a claim can either take 10 min or it can take a week depending on the type of claim. In order to make a profit you would need MOST claims to be simple and charge upwards of 8-$10 per claim.  To me this model of invoicing just doesn't allow much in the way of getting paid for your time, especially if you are dealing with chiro's or mental health practitioners who have patients coming in once a week or more sometimes.
Title: Re: What constitutes a "claim"
Post by: supertaz93 on April 24, 2014, 09:26:05 AM
Instead of the word "claim", you might try changing your wording to "encounter" if you are wanting to charge for each date of service.  I define it as "per patient, per day".  If a patient is seen weekly, I get paid for each time the patient is seen whether the doctor sends me his billing daily, weekly, or monthly.  If a doctor sees a patient in the hospital day after day, I get paid for each day the patient is seen.  If a patient has an office visit and a procedure done in the same day or if the patient has a bunch of lab work done (even if it takes more than 1 claim form), as long as it is on the same day, it is one encounter.  If the doctor sees 20 patients in one day, I get paid for each patient.  This method has worked out great for me.  It is also very popular around my area.

The word "claim" or whatever word you use should be defined in your contract. 
Title: Re: What constitutes a "claim"
Post by: Michele on April 25, 2014, 06:12:37 AM
Also, it is important that you spell out what a claim is in your contract once you determine what you will be using.