Author Topic: Charging a Fee - Need assistance asap!  (Read 3386 times)

RCC

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Charging a Fee - Need assistance asap!
« on: January 21, 2014, 11:48:22 AM »
I am a new biller and I am working on a price to charge a office that bills 3000 claims a month, but that said 65% of the claims are capitation, I will be charging per claim because I am in NYC and we cannot charge % they charge between $225 & $325 per visit. Do I just calculate by the number of claims per month? thanks for your help

PMRNC

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Re: Charging a Fee - Need assistance asap!
« Reply #1 on: January 21, 2014, 01:47:39 PM »
65% capitation?? really?

Why don't you do a full analysis of their current billing and entertain a flat fee rate based on a competitive hourly rate to start? If you have other clients this is pretty easy to do as you know how long it takes you per account, provider, etc. I'm in NY too and I do it that way and would never go back to % billing even if we could in NY.
Linda Walker
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RCC

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Re: Charging a Fee - Need assistance asap!
« Reply #2 on: January 21, 2014, 05:14:58 PM »
Thanks Linda, thats what they said, thats a lot right.

PMRNC

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Re: Charging a Fee - Need assistance asap!
« Reply #3 on: January 21, 2014, 05:26:44 PM »
I'm not sure I'd buy 65% capitation .. even in NYC.. BUT in all fairness most office managers on the fly really don't have a good accounting of what's going on. I'd be shocked if it was even 35% capitation.. they are disheartening from the market and have been for years.  I've also learned that some offices do refer to capitation as participating/managed care.. so they could just be confusing it.
Linda Walker
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www.billerswebsite.com

Merry

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Re: Charging a Fee - Need assistance asap!
« Reply #4 on: January 21, 2014, 10:04:27 PM »
Is this a primary care practice? You do want to be sure that you are tracking the monthly checks and withholds if the practice  is contracted with  capitated plans.

PMRNC

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Re: Charging a Fee - Need assistance asap!
« Reply #5 on: January 22, 2014, 09:43:26 AM »

Quote
Is this a primary care practice? You do want to be sure that you are tracking the monthly checks and withholds if the practice  is contracted with  capitated plans.

I'm doubting that number on capitation out here on East coast, let alone NYC.. Capitation has been dwindling over the years big time out here.
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

RCC

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Re: Charging a Fee - Need assistance asap!
« Reply #6 on: January 25, 2014, 04:26:25 PM »
I was doing a practice analysis and that was one of the figures they gave me? Thanks

PMRNC

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Re: Charging a Fee - Need assistance asap!
« Reply #7 on: January 25, 2014, 04:35:08 PM »
What was the % of withholds.. you also have to remember that GOOD data in is good data out. I can't tell you how many times I've done a practice analysis only to have the practice put crap data in and expect a miracle with reports coming out.    LOOK at "WITHOLDS" when dealing with capitation.. HOPEFULLY the practice was diligent in their data.

Remember that NO software in the world can work with crappy data.. sorry to be blunt but I've seen medical billing companies and doctors expect a miracle with data and reports but never TRACKED their data properly. I NEVER take an account I can't get into their system to run my own numbers.. I don't trust someone Else's means of data.
« Last Edit: January 27, 2014, 10:58:16 AM by Michele »
Linda Walker
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RCC

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Re: Charging a Fee - Need assistance asap!
« Reply #8 on: January 25, 2014, 05:02:15 PM »
Thanks. Right I only can go on what they told me and they already have a biller, I just reached out to them and they allowed me to do the practice analysis and asked for their reports, they said the biller never gives them any. So I asked for them to get one so that I can see for myself. But I am not sure what I am looking for, I wanted to see the aged reports to see and show them where they were losing money.

PMRNC

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Re: Charging a Fee - Need assistance asap!
« Reply #9 on: January 25, 2014, 05:23:33 PM »
Quote
Thanks. Right I only can go on what they told me and they already have a biller, I just reached out to them and they allowed me to do the practice analysis and asked for their reports, they said the biller never gives them any. So I asked for them to get one so that I can see for myself. But I am not sure what I am looking for, I wanted to see the aged reports to see and show them where they were losing money.

What kind of experience do you have.. when I'm asked to analyze a practice I ask for following reports:

Full A/R   by patient and by carrier
Full report of all managed care adjustments
Medicare/Medicaid/WC/PI  for last year
carrier contracts  - might seem like overkill but I know what to look for in problem contracts
Staff/office report - those involved in billing process, hours worked on average, etc. This helps me find problems within the office
over 90 day claims analysis

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

RCC

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Re: Charging a Fee - Need assistance asap!
« Reply #10 on: January 25, 2014, 06:20:53 PM »
Wow, I see I have no experience. I was a medical secretary for 30 years I only did the billing on the superbills I know the terminology and codes, but I see on this end I know nothing. I took a medical billing course but I see it didn't teach much, I need to do some hands on training.

PMRNC

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Re: Charging a Fee - Need assistance asap!
« Reply #11 on: January 25, 2014, 06:33:38 PM »
Quote
Wow, I see I have no experience. I was a medical secretary for 30 years I only did the billing on the superbills I know the terminology and codes, but I see on this end I know nothing. I took a medical billing course but I see it didn't teach much, I need to do some hands on training.

All is not lost.. I just don't like to mislead anyone. 30 years as a medical secretary is nothing to sneeze at.. it's not hopeless.. can you get the practice to give you the reports I suggested and we can help you more? 
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

RCC

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Re: Charging a Fee - Need assistance asap!
« Reply #12 on: January 25, 2014, 06:45:09 PM »
Ok I am suppose to meet with her ?Monday, what reports do I ask to see and what am I looking for?

PMRNC

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Re: Charging a Fee - Need assistance asap!
« Reply #13 on: January 25, 2014, 07:20:42 PM »
Go in there and don't try to answer her questions all at once.. YOU will gain MORE credibility if you offer to research. With that in mind..these are reports I would ask for:


Full A/R   by patient and by carrier
Full report of all managed care adjustments
Medicare/Medicaid/WC/PI  for last year
carrier contracts  - might seem like overkill but I know what to look for in problem contracts
Staff/office report - those involved in billing process, hours worked on average, etc. This helps me find problems within the office
over 90 day claims analysis

Before getting those reports write down everything she says.. try to find out any common denominators there are with the current billing procedures. Find out how many on staff, who is responsible for what, what their policies and procedures are. The more you ask for..the more KNOWLEDGEABLE you look.. it may seem like that's not true, but it's not. the more QUESTIONS you ask..the better you look.  IF you do not know the answer to something on the spot, you write it down and tell them honestly you will find the answer. Make them seem like they are getting a deal.. an hour of your time.. a free consult. Ask questions and above all LISTEN .. I bring my cell phone and put it on record when I meet with a client for the first time so that I can review the conversation later for anything I missed.

Do not lose confidence. Be confident and be honest. It's OK not to know something ..it's even better to tell then you will FIND OUT for them. :)
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

RCC

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Re: Charging a Fee - Need assistance asap!
« Reply #14 on: January 25, 2014, 07:42:13 PM »
Ok thank you so much