Author Topic: Home Health  (Read 2826 times)

mbloom

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Home Health
« on: June 01, 2012, 12:35:35 PM »
What is an ideal percentage to charge a home health agency that bills Medicare primarily?

Michele

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Re: Home Health
« Reply #1 on: June 04, 2012, 06:57:46 AM »
There really is no way to answer that question.  First, even though % billing seems to be the most common method, it really isn't the most ideal method for charging.  Some states % billing is illegal.  I don't know if you are in one of those states. 

Having said that, your fee will depend on what services you are providing.  Are you insurance billing only?  Patient billing?  Filing secondaries? 

The national averages for % billing are from 5% (low in my opinion) to 13% (high in my opinion).

Hope that is helpful.
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Sriram_Sub

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Re: Home Health
« Reply #2 on: June 04, 2012, 07:34:47 AM »
Hi Michele,

I would like to gain some idea about the list of States where % billing is illegal. Please share if you have one. Thanks.
Sriram

Michele

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Re: Home Health
« Reply #3 on: June 05, 2012, 05:59:28 AM »
I am only 100% sure about NY & FL.  I know there are others, but not sure which ones.

Michele
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Sriram_Sub

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Re: Home Health
« Reply #4 on: June 05, 2012, 07:17:39 AM »
Thanks Michele!
Sriram

mbloom

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Re: Home Health
« Reply #5 on: June 05, 2012, 09:17:06 AM »
Hey MIchele! Well actually I found out it is hospice billing. I will be doing the billing and follow up work (like paperwork and stuff that comes from hospitals). I agree with you regarding the hourly vs. percentage billing. She looks to make about 40k-50k weekly and I do not feel like my responsibilities warrant 75 to 10% of that. But this is my first rodeo, so I don't want to undervalue myself either.

Please tell me what you think???

Michele

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Re: Home Health
« Reply #6 on: June 06, 2012, 06:42:09 AM »
Do you have any idea how many hours a week you will be spending on the account?  It's hard for me to comment without knowing more information.  I would ask things like "how many patients do you see in a week" and "how many claims do you file a month".  Those numbers will help you calculate your time.  Then when figuring a flat fee, make sure your hourly rate covers things like your overhead, software costs, etc.
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PMRNC

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Re: Home Health
« Reply #7 on: June 07, 2012, 01:21:33 PM »
I've been researching the legal structure of % based billing for years and have now found 23 states do have SOME sort of fee-splitting law on record. The states I have verified I've had legal opinions given along with the actual statutes. I am also looking to continue researching. I've found and verified so far 8 states with the laws and some with case precedences. Those 8 states so far verified: Tennessee, Kansas, California, North Carolina, New York, Florida, Colorado and Arizona. Again remember that some of those states are not so cut/dry.  The research is extensive and ongoing.
Linda Walker
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dblakelarde

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Re: Home Health & Fee Splitting
« Reply #8 on: July 21, 2012, 11:25:28 PM »
Hi Lisa,

I am a new member and have spent hours reading over the forum. I came across this posting as I have a potential client located in NY.  I've read over the laws regarding fee splitting and the definitions are a little confusing to me. Many MB companies in NY build their fees off % agreements. Yet when I do my research it states that it's illegal on the provider side and not the billing company side. Based on the "legal opinions given along with the actual statutes" and "case precedences" are the laws as cut dry or NY is definitely one that will provide professional disciplinary action towards the physician? So, to be safe I would want to use flat fee pricing?

Thank you for your advice in an advance.

Dawn

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Re: Home Health
« Reply #9 on: July 22, 2012, 01:03:00 PM »
Quote
MB companies in NY build their fees off % agreements. Yet when I do my research it states that it's illegal on the provider side and not the billing company side.

That's correct, it's considered illegal fee-splitting to which doctors in those states can not enter into any arrangement that can be construed as "fee splitting"

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Based on the "legal opinions given along with the actual statutes" and "case precedences" are the laws as cut dry or NY is definitely one that will provide professional disciplinary action towards the physician?

I get asked this a lot and I have to answer that ? with another question. What does it matter? why would a billing company or physician want to do anything that would be challenged in court anyway.. The billing companies contract at that point is NULL and void so what happens if the doctor takes billing company to court or even, let's say the billing company doesn't get paid and wants to take doctor to court? Sure that provider stands big fines and sanctions for entering into the contract, but guess what? It's null and void since he entered into it! So your contract isn't worth the ink it's printed with.   But with all of that.. yes physicians have been sanctioned and faced discipline and yes billing companies lost out as well in having their contracts voided.

Quote
So, to be safe I would want to use flat fee pricing?

Well, I can only answer that for myself, my mom always said "Better safe than sorry". We live in a world where ANYONE can sue anyone and whether your right or not, you can end up in a court room defending yourself and bankrupting your business. It's just not worth it to me for a marketing angle. Do you see accountants charging doctors a %? Why should billing companies? Why not get paid for the work you do period. The old saying "We don't get paid till you get paid" is no longer an advantage point for the billing company.    since you asked about NY, I'm in NY and while you think many are doing it, my attorney said it's still a VERY common legality here and physicians ARE aware of it and so are Billing companies. It's pretty cut/dry.  I've taken calls from providers here and they say "Well such and such a company quoted me 4%" and I'm going to reply.. "Well such and such a company doesn't seem to have your best interest in mind". 
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com