Author Topic: Who charges the provider per claim?  (Read 2649 times)

Christy

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Who charges the provider per claim?
« on: July 10, 2014, 11:54:59 AM »
This is not a debate about the best way to charge providers for billing, etc.  I am just curious as to what people charge per claim if using that model?

When I say "per claim", I mean "per date of service." Not one claim for 6 dates.

I currently charge $25-$30 per hour (depending on specialty.) I am seeing some grumbling about this from one provider.  Based on numbers, I have proven to her that she is actually spending $2 per claim or about 5% of total earnings. That is pretty darn cheap.

I am pretty sure that the going rate is $3-$4 per claim and in that case I would make more money and the providers would feel like they knew ahead of time what it will cost.

I work for very small providers whose patient volume fluctuates widely, so flat fee would not work for me.

Christy

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Re: Who charges the provider per claim?
« Reply #1 on: July 10, 2014, 01:12:10 PM »
just found an old fee schedule for a local mental health billing company and see that they are charging $7 per encounter up to 50 encounters per month and $5 per encounter for over 50 claims per month.

since my business is primarily mental health billing, I think that I am quite the bargain at this point at $25 per hour.... :-\

PMRNC

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Re: Who charges the provider per claim?
« Reply #2 on: July 10, 2014, 03:56:50 PM »
Quote
I currently charge $25-$30 per hour (depending on specialty.) I am seeing some grumbling about this from one provider.  Based on numbers, I have proven to her that she is actually spending $2 per claim or about 5% of total earnings. That is pretty darn cheap.

Christy, you don't have to change anything, they do NOT need to know the hourly rate, instead use your hourly rate to come up with a flat fee and sliding scale. So let's say your expenses total $500 a month. Your hourly fee for that particular specialty/client is $30 an hour. You base your flat fee on fact that it will take you approximately 12 hours a week.  That's 12 X 30=$360 add in the $500 expenses and your flat fee is $860.  To get your sliding scale you want to know approximately how many claims you can process in an hour, let's say that number of claims is 10. For every 10 new patients, your fee goes up $30.00 :)

That's how I do mine. I can even bundle a different hourly rate to accommodate things like A/R Cleanup, consulting, credentialing, training, etc..without the client knowing THE hourly rate.
Linda Walker
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Christy

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Re: Who charges the provider per claim?
« Reply #3 on: July 11, 2014, 09:29:59 AM »
thanks for the response, Linda!

Was also hoping to hear what people charge per claim....anyone?

Michele

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Re: Who charges the provider per claim?
« Reply #4 on: July 14, 2014, 10:19:19 AM »
We have VERY few situations where we agree to charge per claim but if/when we do it's $5 per claim (allowing up to 6 visits) with NO payment tracking/aging.

We also do flat monthly fees based on the number of claims.  For example 100-124 claims for $750 flat monthly fee, 125-149 for $875, etc.  This includes followup.  Our fee also depends on the type of provider.  This is purely an example.  (Pulled the numbers out of my head!)
« Last Edit: July 14, 2014, 10:21:06 AM by Michele »
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Christy

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Re: Who charges the provider per claim?
« Reply #5 on: July 16, 2014, 08:50:49 AM »
thank you, Michele.  ;D

mindy167

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Re: Who charges the provider per claim?
« Reply #6 on: September 06, 2014, 12:33:47 PM »
Linda, this formula makes sense. We've looked at offering small volume providers a flat rate with a % based on collections, whichever is higher. If the flat rate is higher than the net collections, the flat rate would prevail because it meets what we have to recover in terms of costs. However, this usually means we have a high % rate because it equates to what we have to bring in the door to cover expenses. It seems like a win/win pricing model but what flaws do you see with this strategy?

We're also looking at how to best set the rate for other services like what you mentioned in your response. We've gone both ways--- value added and add on, although we have received push back from some docs on X includes it and we're at the same price point. We stay away as much as we can from those who only look at price vs. perceived value. Sometimes it is a real challenge. 

PMRNC

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Re: Who charges the provider per claim?
« Reply #7 on: September 06, 2014, 12:56:12 PM »
I really have not seen any flaws.. I get paid what I'm worth because, again it's based off of the hourly rate I want and I don't have to disclose that. I would say it can be challenging to go this model if you are new because your really unsure of how fast you can be and account for the inexperience you don't want to base your flat fee on $50 an hour starting out.. I can see that being a drawback.   I also don't have the overhead most billing companies have. I don't pay for software, support, or clearinghouse fees.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com