Author Topic: Billing Service Fee - UB04 in TX  (Read 1521 times)

jpositos

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Billing Service Fee - UB04 in TX
« on: April 12, 2016, 08:02:24 PM »
Hello,

Can anyone share what is the running billing service fee (percentage rate) to bill dialysis treatments to insurance using UB04 specifically in Texas? I own a Billing Company for 8 years and just want to make sure that I am not undercharging or overcharging my current and future clients.

Thank you.

Jocelyn

Michele

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Re: Billing Service Fee - UB04 in TX
« Reply #1 on: April 13, 2016, 09:13:23 AM »
I am not sure but TX appears to be a state that prohibits fee splitting which means you should not be charging a %.  But I am actually not sure I understand your question.  Is the "running billing service fee" mean what do you charge?  The rest of your question seems to be asking that but I have not heard it worded that way before so I wanted to be sure.  With that being said, why would you charge the dialysis treatment any different from other providers?  Wouldn't you charge the same?

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jpositos

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Re: Billing Service Fee - UB04 in TX
« Reply #2 on: April 13, 2016, 01:22:37 PM »
Hi Michelle,

Everyone I know charges % in TX for dialysis centers so I followed suit.  I meant, what is the usual billing service fee to charge in TX for facility billing .  I am in California and most of my clients bill professional so we mostly use 1500.  I am re-negotiating my fees with a client in TX and billing UB-04 is a lot more work than billing 1500 so I just want to make sure that I am not undercharging or overcharging this client of mine in TX.  They only have 3 to 5 patients but the out-of-network reimbursement averages at a minimum of $5,000 per treatment/patient and that's 3X a week.

Thanks!

Jocelyn

Michele

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Re: Billing Service Fee - UB04 in TX
« Reply #3 on: April 14, 2016, 08:20:52 AM »
Many billing services are still charging a %.  I felt I should mention that in case you weren't aware.  It is very difficult to change from the % mindset to another form of charging. 

I agree, the facility billing is more involved.   But the fees being higher make up for that.  When we do facility billing we charge are same fees that we do for non facility for the most part.  Sometimes we will negotiate depending on the type of facility.  For example, an inpatient D&A rehab that bills for the entire stay on one claim will get a different rate than an outpatient D&A billing for individual sessions. 

There have been previous posts about calculating flat fees.  I would try plugging your numbers into that formula and see what you get.  It may be helpful.

We have never billed for dialysis.

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Michele

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Re: Billing Service Fee - UB04 in TX
« Reply #4 on: April 14, 2016, 08:22:21 AM »
This is from a previous post by Linda:

"There have recently been a few threads on this.  How I do it is based on hourly rate, what I want to make per hour. My formula goes like this:

For this example I will use an hourly rate of $25 p/hour.

I determine the amount of time I will need per week per client (estimated). This is easy if you have been billing for the provider and it's always a good idea to calculate how much time you spend on each client no matter how you are charging. For this example we will say this provider will take or takes 12 hours per week.

I then add up my expenses PER client (this should NOT include any fees for the cost of doing business such as computer, attorney, books, education, etc) only costs such as clearinghouse, postage, phone, claim forms, software per client fees, envelopes, ink, paper, etc.. should be included in these costs.  For the sake of this example we will use an estimated cost of $500

I then take my hourly rate of $25 and multiply it by 12 hours per week=$300 per week X 4 weeks= $1200 per month
I then add my estimated costs for each month $1200 + $500 = $1700 monthly flat fee total.

To create the sliding scale I then break down (again estimating) how many patients/claims I can comfortably do per hour. For this example I will use 8 patients. That will equal $25 (hourly) per every 9 patients added.  That will allow you to continually get paid for your time and allow for growth of the practice. Remember to increase you "costs" and I do this once every 6 months as per my contract.

Nice and simple, and biggest factor is I get paid for all my work. :)"
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jpositos

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Re: Billing Service Fee - UB04 in TX
« Reply #5 on: April 14, 2016, 12:20:33 PM »
Thank you Michelle!

Jocelyn

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Re: Billing Service Fee - UB04 in TX
« Reply #6 on: April 15, 2016, 04:01:25 PM »
Quote
Everyone I know charges % in TX for dialysis centers so I followed suit

I mean no disrespect but this goes along with what our mom's used to say:  "Just because everyone else is jumping off of bridges, doesn't mean you do it too". LEGALLY the billing company does nothing wrong when they charge a % in a state that prohibits fee-splitting, the doctor however is in violation. What does this mean for the billing company? Any challenges that come your way make your contract "null and void". It can also be said that the billing companies that do due dilligence in this manner will sway a provider easily making it very easy for a billing company to come in and take the account away from you simply by making them aware of the legalities. 

Linda Walker
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aileenabela

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Re: Billing Service Fee - UB04 in TX
« Reply #7 on: July 13, 2016, 12:24:01 AM »
Training for self-dialysis: Part B covers training if you're a candidate for self-dialysis, as well as training conducted during the course of your regular treatments for you and the person helping you with your self-dialysis treatments.

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