Author Topic: Looking for advice...  (Read 1238 times)

KathyG

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Looking for advice...
« on: November 29, 2010, 12:07:30 AM »
Could anyone who has done mental health billing give me some idea of an average flat fee if you are billing per encounter, rather than per claim, under various situations?  What would be an average fee to charge per encounter if you are simply submitting a provider's claims?  What woulf be the average fee to charge per encounter if you are submitting and tracking a provider's claims?  How much would you add for other services, such as getting preauthorizations and/or verifying eligibility and benefits?  What amount would you add to this flat fee if you are sending monthly statements to clients for balances due?

If someone who hase been doing billing for a while could break these services down some way to an average rate per encoounter, it would be extremely helpful to me and probably other who are just starting up a business.  I'm also wondering who usually handles keeping track of the need to request additional sessions from a payer so those sessions will be covered and paid by their insurance carrier?

Thanks you so much!

Kathy G.

PMRNC

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Re: Looking for advice...
« Reply #1 on: November 29, 2010, 04:25:54 PM »
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Could anyone who has done mental health billing give me some idea of an average flat fee if you are billing per encounter, rather than per claim, under various situations?  What would be an average fee to charge per encounter if you are simply submitting a provider's claims?  What woulf be the average fee to charge per encounter if you are submitting and tracking a provider's claims?  How much would you add for other services, such as getting preauthorizations and/or verifying eligibility and benefits?  What amount would you add to this flat fee if you are sending monthly statements to clients for balances due?

I bill based on a flat monthly rate which is derived from an hourly rate and expenses/overhead. As for a rate per encounter, I think it really depends on where you are located, a per claim encounter is not a very practical way to start out in my opinion as it is sort of branding your service as "new". That's just my opinion. If I had to guess based on my years of doing MH billing I would say an average per encounter would be $2-$5 each, but if you are going to do full practice management from VOB, auth's etc..I would build up the fee to be inclusive, again, but it's JMO that nickle and diming the provider screams "I am NEW". 

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  I'm also wondering who usually handles keeping track of the need to request additional sessions from a payer so those sessions will be covered and paid by their insurance carrier?

It depends on how you setup your contract with the client. I do mostly only full practice so my fee covers everything from the beginning to the end. For the patient's first visit I obtain the initial authorization needed, mark it/track it in my PM software and then a report is generated for the provider when the patient is in need of an OTR for further visits. I do NOTHING clinical. All of my MH clients are responsible for getting their own OTR's out for additional sessions. When the new authorization arrives, I mark it and track it in the PM software.  Whatever you decide you want to make sure it's crystal clear in your contract!

Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

KathyG

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Re: Looking for advice...
« Reply #2 on: November 29, 2010, 08:14:56 PM »
Thanks, Linda!

Okay, could you give me an idea of the hourly rate you use to determine your flat monthly rate? I was looking for a breakdown, because I just envision some providers won't want to "go" for the full practice management option.  If the average encounter rate would be between $2-$5 without full practice management, what would you say the average per encounter rate would be if I "build up the fee to be inclusive?" 

I'm hoping I can come up with an easy way to determine an average rate per encounter, so that I can calculate the number of encounters/counseling hours a clinician averages per week and multiply it by the appropriate rate. 

Thanks for the information regarding the OTR.  I know that the clinician needs to handle that, but I just wanted to inquire as to whether the provider's staff generally keeps track of the number of sessions or if it fell on the biller to track the sessions.

Take care...

Kathy G. :)

PMRNC

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Re: Looking for advice...
« Reply #3 on: December 04, 2010, 09:47:45 AM »
Kathy, I really have to ask..why are you determined to bill PER encounter? I just ask because it is just my experience that providers don't appeal much to this method (especially mental health)

I can't give you a guideline on hourly because it's not the same as going for a job interview and requesting an hourly rate. I have over 20 years experience so my hourly rate is never really divulged in my flat fee. If you have less experience your hourly rate might be lower..hence the reason why the hourly rate is merely only meant for YOUR purposes of calculating the monthly fee.

What is your experience? How long have you been in business?  Generally providers can spot those just starting out by the way they charge..  many startup's offer the per claim method and fail to specify what exactly a claim is..hence mental health providers can easily be scared off with that method. I'd have to say the same could be said about per-encounter. I know that none of my mental health providers would want to pay per encounter  ???

In a nutshell the rate per encounter is going to depend on your experience, what's included..etc. really no way to narrow that down for you in that manner.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

KathyG

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Re: Looking for advice...
« Reply #4 on: December 04, 2010, 10:54:15 AM »
Linda...I'm just starting out.  I've been doing mental health billing as a volunteer for a non-profit for the last year and a half. I'm doing electronic billing, all self-taught, and have had a good track record with regards to payment of my claims.  I'm not going to charge clients per encounter, I'm just looking for some type of figure to use in determining what I will charge providers.  I was told by someone who does billings here in NJ, other than mental health, that they charge 6%-7% of the insurance receivables.  If the percentage method works for mental health, it would be fine.   It just seems that when you're billing for LCSW's, rather than psychiatrists, income would be limited, since they're appointments are 45-60/mins. in length, instead of 15/min. intervals.  It just seems that LCSW's will be hesitant to pay much for this service.  Again, the encounter breakdown is only for my own use in determining what I'll charge individual providers.  Any thoughts or advice you might have would be really appreciated:)