Author Topic: How much to charge  (Read 6531 times)

noahdog17

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How much to charge
« on: August 08, 2009, 07:29:07 PM »
Starting a new home based billing biz, but i cant seem to find the going rate for the Orlando/Tampa area. I have a friend who charges by the hour. I would like to charge by the percent. Is there anyone out there that can lead me in the right direction.

PMRNC

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Re: How much to charge
« Reply #1 on: August 08, 2009, 08:57:58 PM »
In Florida, healthcare providers are prohibited from entering into a fee-splitting arrangement.. yes yes I know "But everyone else is doing it" But yes it is illegal for the PROVIDER to enter into any type of fee-splitting arrangement.

There are many ways to charge for your services, mainly you don't want to create a "shop n stop" type of style. Instead it's more professional and more efficient to base your charges on each individual client. Since each client will be different, so will the work, the amount of work, and the time involved on each account. There's hourly, monthly flat fees, with/without sliding scales, etc.
Linda Walker
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noahdog17

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Re: How much to charge
« Reply #2 on: August 10, 2009, 08:15:41 PM »
So I guess per claim is considered fee splitting also.  :(

Michele

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Re: How much to charge
« Reply #3 on: August 11, 2009, 07:06:21 AM »
No per claim is not fee splitting.  That is a set fee for a form, not dependent on the prices for the services, or the amount received by the insurance carrier.

Michele
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Steve Verno CMBS, CEMCS

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Re: How much to charge
« Reply #4 on: August 11, 2009, 07:33:47 AM »
A provider in the Orlando area paid his billing company, $10 per claim.

The same provider paid me 35% andof what I collected. on the AR work and $200 per hour for the non A work.  This is not typical. This was special.   He fired his billing company because they stopped everything once they sent the claim.  There was no follow up by the billing company. So, tons of money sat rotting.  He had almost $3,000,000 in outstanding revenue.  He did sue the billing company and won. 

I wasnt doing his billing. He hired a full time staff member whom I trained.  I was there to do contract negotiations, AR clean up, provider enrollment and appeals.  Most of the claims I worked were very old where some would condider as uncollectable.  But, the original claim was sent.  SO, to me, there was hope.  If this violated the fee splitting law, I dont know, I'm not a lawyer.  It took me 3 years to clean it all up.  When it was done, he sold his practice. 
I'l have a double chubby chuck, a mexicali chilibarb, and two cherry cokes
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PMRNC

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Re: How much to charge
« Reply #5 on: August 11, 2009, 08:55:30 AM »
I'd have to see the case to decide, but my guess is that he won because there was no contract, it was considered null/void. I'm in the process of continuing my research but it looks like we have a few more states out there that have had the law on the books just resurfacing. Fee-splitting doesn't have to be a negative, it can be a marketing positive. I don't hesitate to tell a provider here in NY about the provision and I give him the statute. Yes I have to clarify that the billing company isn't doing anything wrong, it's him/her that is. It's his/her ass on the line. Providers can be sanctioned, and so far they have been in a few states and I suspect we are going to see MORE of this. 
Linda Walker
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Michele

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Re: How much to charge
« Reply #6 on: August 12, 2009, 06:19:46 AM »
Wow!  $10 per claim, what type of provider was it?  Surgery I hope.  I don't understand the services out there that rake these providers over the coals like that.  If you are getting $10 per claim, you certainly should be doing more than just initial submission!

We went into an office once and in a very short time determined the office manager (also responsible for the billing) not only did NO follow up (there goes 35% off the top!) but also didn't bill any inpatient hospital visits (3 docs all went to hospital daily) or nursing home visits (1 did 4 NH's).  The 35% was because there PM system was in rough shape, bad insurance info, bad patient info, etc. 

Very long story short, she still works there   --   we don't.   What is the matter with these doctors!  I went back to visit and he was crying the blues to me about how he was losing $40000 a month since I stopped working for him and I started laughing.  He said "don't laugh at me".  I said "I can't help it, you could stop it right now but you chose not to."  That was 18 months ago, he's still losing $40000 a month!

Michele
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Steve Verno CMBS, CEMCS

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Re: How much to charge
« Reply #7 on: August 12, 2009, 11:50:20 AM »
He was a pediatrician and that seemed to be the going rate in Orlando as other providers I met also paid the same to their coder and biller.  There are companies out there that i call "code it, bill it and forget it companies"  They pride themselves on how many clients they have. They just code it, bill it, and dont follow up, hence the forget it.   I dont mind as they keep me busy.  They are fired and I am called in to clean up the mess. 
« Last Edit: August 12, 2009, 11:52:29 AM by Coding4aliving »
I'l have a double chubby chuck, a mexicali chilibarb, and two cherry cokes
Left hand Blue, Right Leg Green
You got your peanut butter on my milk chocolate.
Dont cut the blue wire! 
I love spam.

PMRNC

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Re: How much to charge
« Reply #8 on: August 12, 2009, 02:57:43 PM »
I was going to respond but wanted to wait for Steve to clarify as If I do the math.. $10 per claim really isn't high at all for many types of practices, I think we resort back to that old info on the web of $3-$5 per claim <g>  This might be why a per claim fee when you can't do % might not be optimal. A flat fee/sliding scale might work better appearance wise. If I took one of my clients monthly fee and did the math it comes out to about $9 per claim.. (shhhh)
Linda Walker
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Michele

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Re: How much to charge
« Reply #9 on: August 13, 2009, 08:26:04 AM »
We are in a pretty rural area and I know the locals would fall over if I told them $10 a claim, but you are right Linda, when you figure a way to bill them that comes out more like a percentage, they don't realize they are paying close to that.

Michele
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Steve Verno CMBS, CEMCS

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Re: How much to charge
« Reply #10 on: August 13, 2009, 10:51:26 AM »
In Miami, the fee is more. usually around $12-$15 per claim.

A billing company i worked for couldnt bill Medicaid on a percentage bases based on FS 409 and the Medicaid manual, so we took our percentage and compared that to a per claim fee.  Came out the same in the end.   But, my fee is still a percentage. 

If I were in Iowa, like Michele said, the doctors would do handstands at $10 per claim. 

My last job paid $13 per hour.  The job before that was $50 per hour, but I was in a high cost area. Rent for a small 2 bedroom house was $2500 per month.  NO beach or water view unless you take the bathtub as water.
I'l have a double chubby chuck, a mexicali chilibarb, and two cherry cokes
Left hand Blue, Right Leg Green
You got your peanut butter on my milk chocolate.
Dont cut the blue wire! 
I love spam.

Pay_My_Claims

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Re: How much to charge
« Reply #11 on: August 13, 2009, 11:34:52 AM »
Because of the differences in states regarding fee splitting Steve, I have actually changed my policy regarding billing providers. Instead of the percentages, I have moved to a flat-fee or a per claim charge. It also helps IMO when providers decide to terminate the contract. When I evaluate the client, I will have to look at the average monthly receivables, the number of claims submitted, and also whats is on the current AR. Factor in other variables to come up with a fee to charge. Let's say I have a Pediatrician and I charge them a flat fee of $2,000 per month to do their billing. If her average revenue is $20,000 a month, then I am making about 10%. If her revenue increases to about $30,000 per month I will be only making 6.5% commission, however I have increased her revenue, therefore after the 6 months we can review the fee. If her revenue was to be below the estimated 20,000 then I am making a higher percentage. Most people would not like this because they are concerned about the extra 200.00 they lost that month because they didn't do a percentage, but its really been an issue for me learning more and more about fee splitting. There are disadvantages no matter how you charge, but for me this suits me best

PMRNC

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Re: How much to charge
« Reply #12 on: August 13, 2009, 01:21:36 PM »
 
Quote
but its really been an issue for me learning more and more about fee splitting. There are disadvantages no matter how you charge, but for me this suits me best

In the long run we should all be moving away from percentage based billing. Yes it is change and with change comes questions and concerns. I'm in NY, what I have done is to actually make this a part of marketing/sales pitch. What doctor wants to know that the three other billing companies he wants to do business with are steering him into an illegal situation?
Not to mention the ones that are using another company already charging them a percentage, not only can I go in lower if I want the account and think it will be beneficial but I can sell them on the fact that they will be getting out from a possible legal mess or worse sanction.

Charlene.. make sure in your contract you leave wiggle room for growing practices. For example if you determined a group practice should pay $1000 a month, this should include verbiage to allow for growth of the practice as well as added work/services on your part. In other words you don't want them to grow their practice w/out you being compensated for your part in helping them grow, they might increase their patient load by more than 20% and in turn you want to adjust that monthly fee to fit their growth and yours.  I use a sliding scale, and because I am in NY I have to be careful the actual charges are not even "perceived" as being a percentage of any reimbursement.. so what I do is charge additional fees Per every 10 new patients.  This allows me to make more money, the practice grows, I grow and above all I'm compensated fairly for the additional work those additional patients bring.
Linda Walker
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www.billerswebsite.com

Pay_My_Claims

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Re: How much to charge
« Reply #13 on: August 13, 2009, 01:32:41 PM »
Thanks Linda, I am having that done as well. No way will I work and the business doubles in growth, volume and revenue and stay the same. This is why reports are so important for the provider as well as yourself.  I have my views on fee-splitting and I personally think certain things are "gray" areas, but the more I researched, the more Linda posted, the more I read.......I had to come to a conclusion that I need to readdress some things. What may not be clear to me, may be clear tomorrow. I don't want issues with Uncle Sam, so I know just as you can and have to bill differently in certain states because of the law...why not just implement it now. Its not the best or the worst, but what I feel will ease my mind and be beneficial to my company.

margemib

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Re: How much to charge
« Reply #14 on: August 19, 2009, 07:03:21 AM »
Hi Linda,
How often do you make adjustments when you use a sliding scale?
margemib
Margie Finlay CMRS