Author Topic: charging a %  (Read 5648 times)

best biller

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charging a %
« on: February 06, 2013, 04:54:58 PM »
Today in a meeting with a doctor i told him that its  not legall for a provider to enter into fee splitting arrangement in NY, he answered me that it have nothing with NY state, its a national issue and in fact even the biggest billing companies like Athena health are charging a %, so its not a law to follow.

PMRNC

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Re: charging a %
« Reply #1 on: February 06, 2013, 05:10:23 PM »
Print this out for him. Indeed this is a STATE statute.  If you are a  PMRNC member you can dowload case precedences and other articles as well.  My attorney also gave me a letter which I carry in my portfolio which has this exactly for NY Physician.    Keep in mind, it's not illegal for YOU, if HE disregards the law and your contract is ever challenged, it's basically worthless (Null Void)    I do have to ask, do you have other pricing means for NY Physicians ready? If so does he have a reason for challenging it? If a provider questions me about this (I don't offer % based contracts anymore) I simply tell them I don't price that way, hand them the letter from my attorney and then I tell them the way I price comes out better for both of us.   I don't haggle over things like this, if they are just set on this I don't want a provider who's willing to disregard state laws like this. I have never had to argue, once I explain they are fine with it.   Even if it wasn't a state regulation, I would never go back to charging on a %. I like getting paid for my work.

Section 6530.19 - 19. Permitting any person to share in the fees for professional services, other than: a partner, employee, associate in a professional firm or corporation, professional subcontractor or consultant authorized to practice medicine, or a legally authorized trainee practicing under the supervision of a licensee. This prohibition shall include any arrangement or agreement whereby the amount received in payment for furnishing space, facilities, equipment or personnel services used by a licensee constitutes a percentage of, or is otherwise dependent upon,
the income or receipts of the licensee from such practice, except as otherwise provided by law with respect to a facility licensed
pursuant to article twenty-eight of the public health law or article thirteen of the mental hygiene law;
Linda Walker
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best biller

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Re: charging a %
« Reply #2 on: February 06, 2013, 07:44:18 PM »
He didn't said there is not such a law.

He said that its a national law and because even such big companies like atena health are not following it its not an issue

Thanks

PMRNC

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Re: charging a %
« Reply #3 on: February 07, 2013, 10:47:41 AM »
Quote
He didn't said there is not such a law.

He said that its a national law and because even such big companies like atena health are not following it its not an issue

So basically he is saying because everyone else does it it's ok. hmm  Is he giving you hard time about it?
Linda Walker
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RichardP

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Re: charging a %
« Reply #4 on: February 07, 2013, 02:18:05 PM »
Can I gently remind all of the point made starting in Paragraph 3 of this link?

http://www.medicalbillinglive.com/members/index.php?topic=7097.0

There is a distinction between a law on the books and a law that is enforced.  My experience in California is that you can find lawyers who will tell you to obey the regulation, even tho it is not being enforced by the state, and lawyers who will tell you that it is OK to ignore the regulation, because it is not being enforced.  Legally, deciding whether to obey a regulaton is a bit more complicated than just it's OK to do it because everybody else is doing it.

Having said that, I would be curious to see what national law the doctor is referring to that governs fee-splitting.  I'm not aware of anything on the national level other than the rules against self dealing that apply to doctors who accept Medicare and Medicaid patients  (Stark Law, etc.).  There may be some words about fee-splitting in these regulations, but they don't (yet) pertain to restricting how doctors can pay their billers.

best biller

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Re: charging a %
« Reply #5 on: February 07, 2013, 07:38:46 PM »
Quote
He didn't said there is not such a law.

He said that its a national law and because even such big companies like atena health are not following it its not an issue

So basically he is saying because everyone else does it it's ok. hmm  Is he giving you hard time about it?

He will not take me anyway! he say that he is satisfied with his current company, only if I could offer better service he will switch, but i am honest and i cant beet his billing company in the stage i am now that i dont have any client yet.

but from our conversation i see that its not an issue for provider's to pay % even if its illegally.

Thanks


PMRNC

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Re: charging a %
« Reply #6 on: February 08, 2013, 09:57:49 AM »
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lawyers who will tell you that it is OK to ignore the regulation, because it is not being enforced.  Legally, deciding whether to obey a regulaton is a bit more complicated than just it's OK to do it because everybody else is doing it.

Well, to each their own but if my attorney told me to ignore a reg because it's not enforced, (which BTW is not true in this instance, ) I'd find another lawyer. My own attorney would tell me right there that would be extremely unethical. But again, to each their own.

their are small numbers of cases but that is NOT same as not being enforced.  A billing company I know in NYC just got their contract thrown out and lost a case, the provider is up on additional charges of something else, but the billing company's contract was thrown out because it's null/void. The state will choose to enter that as a charge or not. Many times these contracts just don't get "CAUGHT".   

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but from our conversation i see that its not an issue for provider's to pay % even if its illegally.

Then why do people even ask? LOL  Of course it's not an issue if you don't care about following laws. I've never had a provider fight this, in fact they are QUITE grateful for the heads up, which is a positive move for me.   So all the ones that want to ignore it whether it's enforced or not. .be my guess but if you already have it in your head to do it anyway, why waste the time asking about it?   

Now Richard .. YOU are indeed picking on me.  THIS time I GAVE a legal source/citing so your on to the next level which is saying it's not same as being enforced <sigh>  I myself have 14 case precedences that say it is enforced (when caught) for just NY.  I have even more for the state of Florida.   
Linda Walker
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RichardP

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Re: charging a %
« Reply #7 on: February 08, 2013, 10:50:30 AM »
I will try to be more careful in the future.  I was not intentionally picking on you.  I was giving best biller a different perspective why some doctors say it is OK to ignore a law - other than just because everyone else is doing it (their lawyers tell them to ignore it because it is not being enforced - which is the case with some of my clients).  I was trying to add to what you said, not replace what you said.

And I am impressed with how you have stepped up your game.  Good job.  That might sound patronizing.  Please don't take it that way.

PMRNC

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Re: charging a %
« Reply #8 on: February 08, 2013, 12:59:39 PM »
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And I am impressed with how you have stepped up your game.  Good job.  That might sound patronizing.  Please don't take it that way.

LOL. I have thick skin..   I've been researching fee-splitting laws for years. I have talked with several lawyers from several states. I have a folder full of information. When I was in NJ I billed on a percentage, I later moved to PA and even though it wasn't illegal for providers there, I moved out of %. I'd NEVER go back. I like getting paid for ALL my time.
Linda Walker
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Re: charging a %
« Reply #9 on: February 10, 2013, 02:51:14 PM »
Quote
Then why do people even ask? LOL  Of course it's not an issue if you don't care about following laws. I've never had a provider fight this, in fact they are QUITE grateful for the heads up, which is a positive move for me.   So all the ones that want to ignore it whether it's enforced or not. .be my guess but if you already have it in your head to do it anyway, why waste the time asking about it?   

I asked about that because i tried to convince him to change his billing company so i mentioned that its not legal for him the way he is currently paying for his billing company!

Billergirlnyc

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Re: charging a %
« Reply #10 on: February 10, 2013, 03:36:59 PM »
I can't say I've never had a provider fight my pricing structure. Most I encounter are thankful for the information, but understand that what's on a state's statue and what's industry standard are 2 different things (in their minds). Those of us who don't use a percentage-based pricing system are often fighting an uphill battle. I mean ethics aside, set-fee's (at this time) isn't industry standard, and that's what I believe this particular doctor you were meeting with was referring too. I can't sit here and say I've never had a percentage-based contract, I have. I've moved away from them.  I too like getting paid for all my services and my set-fee based pricing structure works perfectly for me and my clients, but in the past it was definitely a point of contention with certain clients. You will more than likely encounter more than just this doctor who pushes back and believes that industry standards supersede any state or federal statue. This is why I have stated and Linda have stated having an attorney is your best bet especially when structuring your contracts and the rules on the books for your state.
« Last Edit: February 10, 2013, 05:43:27 PM by Billergirlnyc »
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RichardP

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Re: charging a %
« Reply #11 on: February 10, 2013, 05:23:02 PM »
He's pushing for the language to be clearer ...

Edit:  That quote was in Billergirlnyc's last paragraph before she edited it.  It is not there now, but I'll leave this here anyway.  /Edit

I like the language in the California Code.  It makes things quite clear.

b) The payment or receipt of consideration - for services other than the referral of patients - which is based on a percentage of gross revenue or similar type of contractual arrangement shall not be unlawful if the consideration is commensurate with the value of the services furnished or with the fair rental value of any premises or equipment leased or provided by the recipient to the payer.

From here:

http://www.medicalbillinglive.com/members/index.php?topic=7131.msg21583#msg21583

You will more than likely encounter ... [those who believe] ... that industry standards supersede any state or federal statue.

And a biller may be from a state with a regulation on the book that is not being enforced, and the doctor's health care attorney has told him this.  That is one of the several reasons why it is good for medical billers to have access to their own health care lawyer for opinions.
« Last Edit: February 10, 2013, 05:30:43 PM by RichardP »

PMRNC

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Re: charging a %
« Reply #12 on: February 10, 2013, 07:05:07 PM »
Quote
Those of us who don't use a percentage-based pricing system are often fighting an uphill battle.
  No, actually not at all. I think the majority of the industry is just so stuck on the whole <yawn> marketing of "We don't get paid till you get paid" they have not sat down to look at it from an alternative payment method. I don't use fixed pricing. I have a monthly flat billing structure which takes into account time, expenses, hourly wage. NICE and simple. Just ask a doctor who else they split fees with, not their transcription, not their coder.. so why you?   MY stand is this. I don't ever get into a negotiation about HOW I charge. You wouldn't call your mortgage company, your utility companies or even your babysitter to price haggle, so why would I?  Generally I have only been ASKED "Why don't you charge a % of receipts?"  That's a fair question and usually my answer is sufficient to them, it's never gone beyond me just telling them, I prefer to get paid for all work I put in, my guarantee of timely and quality service is what they are getting in exchange. If it is a NY client I will just simply tell them also about the fee-splitting law (YES, sorry Richard it is indeed enforced here) and I've always been received great by that .. especially if other billing companies have quoted them a % or they used a service that billed on a %. To them it says I CARE about their license.

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He's pushing for the language to be clearer ...

Edit:  That quote was in Billergirlnyc's last paragraph before she edited it.  It is not there now, but I'll leave this here anyway.  /Edit

No fair.. if someone edits a post, there is a reason. so I don't feel addressing something that's not there in an edited post is called for. JMHO

Linda Walker
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Billergirlnyc

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Re: charging a %
« Reply #13 on: February 10, 2013, 08:05:29 PM »
Quote
Those of us who don't use a percentage-based pricing system are often fighting an uphill battle.
  No, actually not at all. I think the majority of the industry is just so stuck on the whole <yawn> marketing of "We don't get paid till you get paid" they have not sat down to look at it from an alternative payment method. I don't use fixed pricing. I have a monthly flat billing structure which takes into account time, expenses, hourly wage. NICE and simple. Just ask a doctor who else they split fees with, not their transcription, not their coder.. so why you?   MY stand is this. I don't ever get into a negotiation about HOW I charge. You wouldn't call your mortgage company, your utility companies or even your babysitter to price haggle, so why would I?  Generally I have only been ASKED "Why don't you charge a % of receipts?"  That's a fair question and usually my answer is sufficient to them, it's never gone beyond me just telling them, I prefer to get paid for all work I put in, my guarantee of timely and quality service is what they are getting in exchange. If it is a NY client I will just simply tell them also about the fee-splitting law (YES, sorry Richard it is indeed enforced here) and I've always been received great by that .. especially if other billing companies have quoted them a % or they used a service that billed on a %. To them it says I CARE about their license.

I agree about what the industry is stuck on, but it doesn't negate what I've experienced, which is how I was answering her question. Some doctors in NY just don't want to work with any other pricing structure. And my response to the original OP is so she doesn't think this is odd (the pushback I mean), because I don't think it is, well not based on my experience and what I hear from fellow billers in my area. Also acknowledging the issues I've run into helps her understand why she MAY have seen this doctor pushback on her knowledge and her terms. Of course you don't have to negotiate your pricing structure with anyone, but that's not what I'm discussing. I'm acknowledging that I've dealt with doctors like the one she has. It's clear this doctor knew about the rules but still refuses any other pricing terms than percentage. It's also clear that no matter how she framed her pricing structure or why this doctor wasn't interested, even if he was looking to change billing companies. I believe she was trying to figure-out why he was saying what he said, and I hope she has some insight into that now.

Quote
He's pushing for the language to be clearer ...

Edit:  That quote was in Billergirlnyc's last paragraph before she edited it.  It is not there now, but I'll leave this here anyway.  /Edit

Quote
No fair.. if someone edits a post, there is a reason. so I don't feel addressing something that's not there in an edited post is called for. JMHO

Thanks, as I feel the exact same way.
« Last Edit: February 10, 2013, 08:13:39 PM by Billergirlnyc »
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RichardP

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Re: charging a %
« Reply #14 on: February 10, 2013, 11:49:40 PM »
No fair.. if someone edits a post, there is a reason.

OK.  I get that.  In this instance, I quoted what was there, wrote my comment, and posted it.  Apparently, the edit was made after I copied the quote but before I posted my comment.  It was only by chance that I later reread the post I copied from to find the re-write.  Seems like this can happen any time folks are posting close in time to each other.  Or not.  Anyone can go delete from their post something that someone else has already quoted and commented on.  If that someone else doesn't ever go read the edited posting they quoted from, they won't ever know the quoted material was deleted.  I don't see a good way of preventing that potential problem. 

Let me know if I should delete the quote in question and my response to it.
« Last Edit: February 11, 2013, 12:15:00 AM by RichardP »