Author Topic: Confused!! I have 2 ?'s, please help  (Read 1486 times)

AllAboutU

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Confused!! I have 2 ?'s, please help
« on: March 16, 2014, 11:56:39 PM »
I have a potential client...yaay!! The thing is he wants to pay as a commission based client. I am still trying to work out the fee portion of my business, I had thought of doing more of a "straight pay" type fee schedule as I am extremely iffy on the % billing. I would like to structure my fees as such...

Submission of Claims Only: $XX.XX per Claim (between $2-$5)

Submission Of Claims With Follow-Up: $XX.XX per Claim (between $4-$8)

So here is my confusion on pricing: If I am doing submission with F/U am I considered full service?? Or should I structure a third tier of pricing to add in A/R reporting, payment posting ect??? like between 0-3000 claims is $XX.XX per claim?  I really want to work with Medicaid providers only, but I know to extend my svs to a larger group of providers, I would have to take all provider billing types. As a billing svs can I opt out of patient billing?

I currently work for a company that bills 1700- 1950 claims in 2 days with 4 people. I've been timing myself the past week and keeping track of my A/R F/U to give me a guide on how much I can handle once I am on my own. And want to base my fees off of that since it will just be me doing the billing. I already use the software that I will be using for my company so I know how long setting up an account will take and how long it takes me to enter a claim. I just don't think providers will want to pay per claim.

That all being said, percentage billing.... If I go with % billing is it JUST on AR collected money for the month? If I bill out $1000 and only collect on $500 and my fee is 6% is that is $30 really all I'm making??? It doesn't seem very feasible doing % billing. Am I missing something???

As far as Commission based, that would be practically the same as % based billing correct?

My second bit of confusion is fee splitting: I have tried to find links or web pages for Texas about fee splitting ... Is this physician trying to get around fee splitting by calling a horse by another name? And how or where can I find what's legal in Texas so I can cover my bases. I have called 3 attorneys in my county to ask about the legalities of running a home based businesses and they were all confused basically said as long as im registered it "shouldn't" be a problem so I'm hesitant on asking about fee splitting.


I guess in a nut shell since it's almost midnight and I'm half asleep...lol,

What is the difference of % billing and Commission based billing, is any better than the other, (fee, commission, straight pay)

If I structure fee based SHOULD I change my billing base to accommodate the physician (in other words two fee structures just in case)

where can I research more about fee splitting and what's legal in texas?


Thanks Everone!!!

Merry

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Re: Confused!! I have 2 ?'s, please help
« Reply #1 on: March 17, 2014, 12:10:52 PM »
I don't understand commission based billing.
What does the physician want you to do. You can certainly offer various services to your providers. I personally do not see why you would offer claims only as the biggest part of medical billing is the followup. Remembering that this is not a data entry business which is what just doing claims really is.
There is quite a bit about fee splitting in Texas and other states on the Internet.

I just do not see a provider hiring a biller to only do claims and not do full practice management which means posting, tracking and followup etc.

PMRNC

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Re: Confused!! I have 2 ?'s, please help
« Reply #2 on: March 17, 2014, 06:48:46 PM »
We have an extensive area on fee-splitting including legal verbiage and case precedences for the states that prohibit physicians from entering into a fee-splitting arrangement and also methods of pricing.   www.billerswebsite.com  It's only a matter of time before it's prohibited across the board. The OIG already frowns upon it, medical associations also educate and warn providers against it as well.

Commission is basically a "cut" to sum it up easily.  I agree there are no more physicians willing to pay for claims only. Today's medical billing company needs to be a practice management company and they need to do MUCH more than billing. Even with the ACA they need to be well versed to review physician contracts.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

AllAboutU

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Re: Confused!! I have 2 ?'s, please help
« Reply #3 on: March 17, 2014, 08:06:44 PM »
Thank you both Linda and Merry. I appreciate both inputs.

I want to do full practice management, but am confused on the fee structuring, which is why I was trying out different options. So just submitting claims is off the table, what about fee setups? Is there one that is better than the other? I'm really still iffy on % billing but that seems to be the "norm".

Merry, the physician didn't mention exactly what he wanted to pay as far as commission, I was in for an appointment for my kids and mentioned that I have a billing business and worked for a company as a biller as well, he wanted me to quit both and work full time in office for a commission based paycheck. He really didn't say much after I told him I had not coded nor billed his specialty before but was willing to learn. All he said was he would be in touch. He hasn't been yet. I plan on calling on Friday to follow up.

I actually have one provider that WILL NOT allow for full service billing. I was an IC with her last year. Her staff walked out on her and I worked at night to make sure everything ran until she hired new people. Guess what, she called me again 3 months ago, her staff WALKED OUT AGAIN!! I offered to help her again, but she said she only wants 1 person on claims, 1 on f/u, 1 on coding AGAIN. I she thinks 1 person doing everything is giving them too much power. I kinda want to help her because it's a learning experience for me.

Linda, thank you for the website. I will be looking at it tonight. I googled fee splitting and it's all mumbo jumbo to me at this point lol.

Thanks again ladies, I really do appreciate the help




shanbull

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Re: Confused!! I have 2 ?'s, please help
« Reply #4 on: March 18, 2014, 09:44:41 AM »
Quote
I want to do full practice management, but am confused on the fee structuring, which is why I was trying out different options. So just submitting claims is off the table, what about fee setups? Is there one that is better than the other? I'm really still iffy on % billing but that seems to be the "norm".

The general consensus here is that percentage is less preferable than a flat fee, although some have had success with percentage billing and are happy to continue to do so. I personally was hired by the clinic I bill for, I work full time and have an office here. I cannot imagine percentage billing in my case would be advantageous at all, first because there was a backlog of old claims to go through when I started (and many ended up with no payment despite me working on them for various reasons, many for timely filing), and also because we just bought another practice and the providers there are all new, and I've had to write off thousands of dollars because the providers did things like see patients without a referral or treated patients under a specialty that they had no benefits for without checking with the insurance company first (and they are primarily seeing destitute immigrants, there's no way we can bill the patients). Flat fee protects me from having my bottom line affected by the mistakes of other people. I get paid the same hourly wage regardless. If I were to start my own billing business, I would definitely go for flat fee only.


Quote
I actually have one provider that WILL NOT allow for full service billing. I was an IC with her last year. Her staff walked out on her and I worked at night to make sure everything ran until she hired new people. Guess what, she called me again 3 months ago, her staff WALKED OUT AGAIN!! I offered to help her again, but she said she only wants 1 person on claims, 1 on f/u, 1 on coding AGAIN. I she thinks 1 person doing everything is giving them too much power. I kinda want to help her because it's a learning experience for me.

Well, there's one common denominator here, isn't there? Since you were able to help her out before without issues, go for it. Just don't let her take advantage of you. I don't really understand her thinking here at all, and it sounds like she is oddly concerned about staying "in charge" to the point of having to pay more for different people to do what one person could do more cheaply, but whatever. It's her practice. Our practice is so big that we have to have 3 different people on those jobs but we're expected to be able to fill in for each other if necessary.