Author Topic: What To Charge Client For Research, Verifying Benefits and Submitting Claims?  (Read 7818 times)

jyoung65

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This client has patients that has not met their deductible, but the claim still need to be submitted to the insurance companies. I have to verify benefits, research and submit claims. They will not pay out because patient has not met deductibles. What should I charge per claim for this type of service it is time consuming? Thanks for your suggestions!

PMRNC

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This client has patients that has not met their deductible, but the claim still need to be submitted to the insurance companies. I have to verify benefits, research and submit claims. They will not pay out because patient has not met deductibles. What should I charge per claim for this type of service it is time consuming? Thanks for your suggestions!

What does your contract state? Your contract should specify what constitutes a "claim" and should clearly define services. If it's Full practice management than the fee is all inclusive to what you are charging.

This is one of reasons I charge monthly flat fees based on my time so that I get paid for all services fairly.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

jyoung65

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This is a client that I work on her aged and denied claims. I do not do full practice management for her.  Thanks :)

PMRNC

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This is a client that I work on her aged and denied claims. I do not do full practice management for her.  Thanks :)

It would still depend on what is in your contract. If your not contracted to work on current claims or provide FPM, but aging only you would still want a contract to protect you and define the services. This way when you have situations like this come up there are no questions.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

DMK

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This is really an important issue folks!  More and more patients will have high deductibles so there won't be claim payment from the insurance company, but there will still be the same amount of work!

PMRNC

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This is really an important issue folks!  More and more patients will have high deductibles so there won't be claim payment from the insurance company, but there will still be the same amount of work!

ABSOLUTELY. and if your contract is NOT specific, you will lose big. Contract has to be very specific when dealing with billing/charges. I've seen billers only state in their contract that biller is to receive X% and not specify if it's Insurance only, full collections, etc.   BE specific and make it idiot proof.  If you don't have a contract, you don't have any assurance of getting paid anything.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

JenniferPT

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Where might someone find some good examples of sample contracts? 

I do full practice management for one client and have another potential client that wants me to do her billing/claims only when she goes private practice in the near future.   

My agreement with client 1 is she pays me a certain amount every two weeks.   I do everything for her, part time in her office because she has 5 therapists and wants/needs individual attention and we have no contract.   I've worked for her for a few years and it's, truthfully, bad practice on both our parts but we trust each other.   We have discussed that we need to write up a contract just for both of our sakes. 

Honestly, have no clue where to start as far as contracts.     Any suggestions? 

Michele

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We stick by the "You should never use a sample contract" rule.  I know it sounds harsh but it is just not a good idea.  I always use the analogy "Would you use someone else's will?  It may work as long as you don't die."  It's important that your contract protects YOUR business and it can't if it's not written for your business.  Many people struggle with the contract, including us!  We have a template, but each contract we do for each provider ends up being different.  Our template was created for our business by us.  We do offer a book that helps you with your contract.  You can read more about it at:

www.medicalbillinglive.com/medical-billing-service-contract.shtml

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