Author Topic: Charging a Physician before they get the claim payment  (Read 1900 times)

Scott

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Charging a Physician before they get the claim payment
« on: May 23, 2016, 02:46:50 PM »
Hi.  My question is - other than a flat fee arrangement, has anyone ever charged a physician before the physician actually collected on a claim?  Here's the example we're looking at.  Let's assume we electronically adjudicate a claim and the system spits back 2 seconds later that the allowed amount is $100.  Also assume we normally charge 5% for our services.  In the normal world, when the physician sees the money hit his bank account, we then invoice him for $5.  Is it possible, though, to invoice the dr (or really debit his bank account) for the $5 once we see the allowed amount adjudicate for $100?  So, we'd charge the dr upon adjudication, not collection.  Understanding the issues with trueing up unpaid/short-paid claims, has anyone ever done it this way?  Are there legal issues doing it this way?  Thanks

kristin

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Re: Charging a Physician before they get the claim payment
« Reply #1 on: May 23, 2016, 07:44:16 PM »
I don't know if there are any legal issues with this, because I would imagine you would have this spelled out in your contract with the provider, and if they agree to it, then they agree to it. However, I have never heard of this type of fee arrangement being done before. I also imagine it could get kind of time consuming, in the end.

And what about claims that are adjudicated, but go towards deductible? Is that part of your unpaid claim scenario that you mention?

Scott

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Re: Charging a Physician before they get the claim payment
« Reply #2 on: May 23, 2016, 08:13:35 PM »
Thanks Kristin.  I've also never done this model before and was worried about any legalities.  I didn't think there was any, as long as my contract spells it out, but I wasn't sure.  Also, thanks for the heads-up on copay/deduct.  I believe we could counteract that by basing our up-front fee on the allowed amount net of copay/deductible.  It helps that these are pharmacy claims where we know both the allowed amount and patient responsibility within seconds (or less) of adjudication.  Our unpaid claim population would be fairly small since it's not common that a pharmacy network doesn't honor the adjudicated amount.

PMRNC

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Re: Charging a Physician before they get the claim payment
« Reply #3 on: May 24, 2016, 10:26:44 AM »
I think you are asking about invoicing the client your percentage based on what you are billing and not collecting? Or estimating the amount collected and invoicing that way?

I have heard of billing companies charging their % of billed charges, doctors usually won't go for this type of arrangement. If you are charging a percentage, the only benefit the provider has to that is that you don't get paid until they do, if you take that away the % based model has NO value to the provider and I can't see them signing a contract that includes billing for monies not yet collected. Have you thought about a flat fee? That's what I do, so I get paid for all my time, I don't have to wait for money to be collected to get paid for the time I put in. I'd never go back to % billing. I'm in NY where it's prohibited anyway.
Linda Walker
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kristin

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Re: Charging a Physician before they get the claim payment
« Reply #4 on: May 24, 2016, 07:31:37 PM »
I thought of something else, since these are pharmacy claims...what if the patient never picks up the prescription, or cancels it, after you have collected the monies ahead of time?

PMRNC

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Re: Charging a Physician before they get the claim payment
« Reply #5 on: May 25, 2016, 06:09:17 PM »
I'll be completely honest in my opinion.. no doctor or practice should or would want to pay for services NOT rendered. This is one of reasons I ditched % based billing. As a billing company you deserve to be paid by the work you put in.. JUST like any other service business, accountant, lawyer, etc.  When you bill a %, YOU are NOT getting paid for your time, you are telling the client..I'm not getting paid if your not getting paid. And while some thing that's a great marketing tool.. it's OLD, and it's INEFFECTIVE and it it's NO longer practical.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Scott

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Re: Charging a Physician before they get the claim payment
« Reply #6 on: May 27, 2016, 09:42:19 AM »
Hi Kristin.  The patients always pick up the prescriptions in this case because our providers dispense them directly to the patient.  So, if the patient doesn't take the med, it's not adjudicated.  Once it's adjudicated we know within 1-2 seconds the amount that will be paid by the payer and the patient responsibility amount.