Author Topic: Deductibles  (Read 2221 times)

Cherylwilli

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Deductibles
« on: February 09, 2011, 04:23:09 PM »
I'm a biller to a few providers for whom I don't post copays or bill their patients.  My question is: Can I bill the providers for patient deductibles?  It seems logical since I've done all the work.   Or, if the provider gets paid at some point for the deductible, are they obligated to inform the me?  I bill %, not flat fee, so not billing on deductibles really adds up.

Thanks for your help!

PMRNC

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Re: Deductibles
« Reply #1 on: February 09, 2011, 04:57:07 PM »
What does your contract state?  If your contract says you will collect X% of all practice revenue's then yes. If it says you will collect 7% of insurance payments than no, likewise, no if it also states: you will collect X% of all practice collections (because then you are not entitled to anything you don't bill for)  Your contract has to be specific.
My take on this is that if you are seeing the claim all the way through, then yes you should get a cut. It takes you time to post payments and also those payments are included in the reports given to the provider. Some billing companies will only charge for insurance payments and not post anything else or run statements but to that I ask? Are their two sets of books then? That would be a big problem!

When I billed on a % of collections, my contract stated "HRS, will collect __% of ALL practice revenue's"  Covered me for everything. My time=Money
Linda Walker
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www.billerswebsite.com

Pay_My_Claims

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Re: Deductibles
« Reply #2 on: February 09, 2011, 08:24:17 PM »
@ Cheylwilli, this is why since day one with everyone talking about % billing, I have NEVER done anything other than flat rate billing. If you google flat rate billing, you will come up with nothing even close to what I have been doing since I started my business. When I started over 2 years ago, and joined a couple of the forums, percentage was all that was spoken, except for those that did the per claim because of the "fee splitting states" More providers are becoming keen to billing services (home based). They know how competitive it is and seeking the lowest estimate. As far as the deductibles are concerned everyone's opinion is different. If you file the claim, and it goes to the deductible and you subsequently "collect" via statements phone calls etc then you should get your %. Copays are the exact same thing. Why should a biller collect money off of a copay that was collected BEFORE a claim was filed?? What about an established patient who forgot and they stated bring it in next week, should the biller get a % off of that? I saw the flaw in % years ago because of that specific scenario. I still have people debate the % because they focus on the penny they may miss because the provider made 100 bucks more this month than last. The provider I interviewed with on Tuesday, her biller only charges 3% and the other company 4%. Since they are not doing her billing consistently, because she has a facility she bills for as well making big $$ off of them, she considers my flat fee high because of what she is currently paying. However, because of the services I offer, they are considering paying my fee. Even if you put it in your contract be cautious and fair as well. I bill for Opthalmology, and they sell glasses in the office. This is a cash business, and according to the wording "% of all practice revenue" I would be entitled to that as well. Change over to flat-fee billing!!

PMRNC

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Re: Deductibles
« Reply #3 on: February 09, 2011, 08:39:22 PM »
Yeah I would say flat fee kind of got a better appeal a few years ago but I think it's mostly because there was worry of the states that prohibited physicians to fee split. The good thing about flat fee is that it's very simple, there are a few formula's very straight forward and it's not as hard of a sell as many think. I have only had ONE provider question the flat fee and when I simply explained the concept of someone getting paid for all their hard work, he actually said "yes, that does make more sense!"  It's also a great marketing tool if you don't mind playing a little dirty pool. I have gotten a few clients right here in NY where they were either paying a billing company a percentage OR looking at other companies that do. When I show them and explain the fee-splitting information they are usually stunned and a little miffed that other billing companies in NY have never mentioned it.

I do have to say that switching right from a percentage to flat fee isn't easy you have to be a little careful on how you do it and when you do it. Make sure your contract allows for changes like that.

Sorry.. I know you didn't ask for our input on going from flat fee to percentage.  :o
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Cherylwilli

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Re: Deductibles
« Reply #4 on: February 10, 2011, 07:48:04 AM »
Unfortunately, my contract states I will charge % of all payments received. If I track and post copays, deductibles the % also applies.  So I guess I answered my own question :(

Based on your responses, I can understand how it makes sense to do flat fee billing.  But how do I change over?  As we all know people don't like change.  I've had my business for 2 years and some my providers I've had from the beginning.  Of course the first thing that comes to mind about changing is that I'll lose providers. 

Thanks for your responses.  I'll research flat fee billing to get a better understanding.

Cheryl

Pay_My_Claims

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Re: Deductibles
« Reply #5 on: February 10, 2011, 08:27:59 AM »
you can always speak to your providers about moving over and showing them the advantages of it is. Your contract allows for a quarterly or yearly review doesn't it?  If your average % fee you receive is 1300 a month...why would they object??

Cherylwilli

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Re: Deductibles
« Reply #6 on: February 10, 2011, 08:44:13 AM »
My contract doesn't call for a review, but states I have the right to change the rate of compensation with 30 days' notice to Provider.  I'll have to research and figure this out.  Thanks, Charlene. 

PMRNC

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Re: Deductibles
« Reply #7 on: February 10, 2011, 09:49:12 AM »
Quote
My contract doesn't call for a review, but states I have the right to change the rate of compensation with 30 days' notice to Provider.  I'll have to research and figure this out.   

I would talk with your attorney, you may be able to say that "rate of compensation'" could mean rate of anything really. When I changed over I sent a letter to all my clients which I picked a date where all contacts would be either renewed or reviewed. I explained the process very simply stating that effective ___/___/___ I would be changing the method to which I was compensated.  I did not go into any further explanation. The attorney I have worked with for years taught me right off the bad that as a business owner the less you try to "explain" your methods and reasons, the less credibility you have and the vulnerable you are. When your mortgage goes up or you cable goes up, they send you an explanation that is very simple, straightforward and to the point, telling you NO more and no less than they need to. Same with YOUR clients.  You do not have to go into the "why's" with them. Don't tell them it's because your not getting enough money or that the economy is bad.. everyone can say that. You state what you are changing and when it will change. They have a chance to ask you questions but again you do NOT have to explain why. Sure you can answer on a case by case basis..but do so with confidence and not act like this is a negotiable change.   

If your provider's contract is open ended, (meaning no renewal date...) you should speak to your attorney about adding an "addendum" An addendum is simply an extension of an already created contractual agreement. The provider will have another opportunity to sign or not to sign. He may advise you to FIRST do an addendum that will allow your contract to state something like:  Billing company reserves the right to review, change or modify this agreement at any time with 30-60 days notice.  Once your clients agree to that then you can prepare to change over a month or two later on. I seriously doubt providers would deny that addendum, they may want to modify it but that's where you have your attorney come in and he can advise you better legally.

Don't be afraid to make moves and changes in your business that you need to make and deserve to make! Remember that the economy is bad on everyone and every business is adapting!

If you need help with any of this, feel free to contact me. Going flat can be very easy and painless!
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

DMK

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Re: Deductibles
« Reply #8 on: February 10, 2011, 12:23:33 PM »
All brilliant advice.  I would like to add another reason to do flat fee.  More and more patients are getting high deductible plans.  The insurance may NEVER pay a claim because the patient never meets their deductible (I met mine once). 

You still have to enter the patient date, file the claims, enter the EOB, and keep the books.  If you don't get something per claim, you will ultimately get nothing for all your work.  I even question the co-pay portion.  I applaud the patients who pay their co-pay at time of service, but what if the visit goes to the deductible?  You are STILL entering the paperwork, the fees, the payment, and keeping the books.

Go flat fee....it makes SO much more sense!

Pay_My_Claims

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Re: Deductibles
« Reply #9 on: February 10, 2011, 12:25:53 PM »
*grin* yes it is DMK  so glad to have been doing it for 2 years now :-)

PMRNC

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Re: Deductibles
« Reply #10 on: February 10, 2011, 12:59:54 PM »
Quote
All brilliant advice.  I would like to add another reason to do flat fee.  More and more patients are getting high deductible plans.  The insurance may NEVER pay a claim because the patient never meets their deductible (I met mine once).

You still have to enter the patient date, file the claims, enter the EOB, and keep the books.  If you don't get something per claim, you will ultimately get nothing for all your work.  I even question the co-pay portion.  I applaud the patients who pay their co-pay at time of service, but what if the visit goes to the deductible?  You are STILL entering the paperwork, the fees, the payment, and keeping the books.

Go flat fee....it makes SO much more sense!

I agree it's easier, but when I did percentage I got a percentage of TOTAL practice revenue's so I didn't lose money, even if the account went to collections I got paid my portion and collection agency got their's Sure there are some accounts than never see the light of day..but your right flat fee solves that problem completely! 
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Cherylwilli

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Re: Deductibles
« Reply #11 on: February 10, 2011, 02:02:54 PM »
This is another good example of why this forum is so good :)  It's tough when you're solo trying to sort through this stuff. 

I agree with the reasoning for going to a flat fee.  When I realized what I do and what I'm not collecting, that prompted me to ask. 

I appreciate the candid advice--I need it.  I keep reminding myself to think like a business woman.  For all my life (until I started this business), I was always on the other end. 

Thanks everyone for the great advice.

Cheryl