Author Topic: How to invoice based on % for some of a practice's claims  (Read 1496 times)

DrHayser

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How to invoice based on % for some of a practice's claims
« on: September 27, 2016, 06:13:31 PM »
Hello fine forum folk,

I am trying to wrap my head around how to invoice my clients. I am doing billing for a few practices, but I am only processing some of their claims. Basically as a specialist for their large and/or complicated ones. I am locked into billing as a percentage of what is paid. My question is how do I know what is paid? I have a clearinghouse, but the payment notification option would show all payments for my clients, regardless of who processed the claims. This makes it near impossible to invoice off of if I have to manually check payments and try and cross reference them for hundreds of claims to see if I processed them or if they did. How do most of you know what amounts are paid and thus know what to bill your clients?

Thanks

Michele

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Re: How to invoice based on % for some of a practice's claims
« Reply #1 on: September 27, 2016, 07:31:00 PM »
So are you saying that you are only supposed to be collecting the percentage of what was paid on the complicated claims that you worked on?  What does your contract state?  Are you using the provider's PM system? 
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DrHayser

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Re: How to invoice based on % for some of a practice's claims
« Reply #2 on: September 27, 2016, 07:50:47 PM »
Correct. We only bill a percentage of the amount paid on the claims we submit. I imagine a typical billing service would do all the claims but we only do some of them. We do not use their software. They upload the claim info to us via an electronic method for processing as they deem necessary.

RichardP

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Re: How to invoice based on % for some of a practice's claims
« Reply #3 on: September 28, 2016, 03:01:43 AM »
  We only bill a percentage of the amount paid on the claims we submit.

I'm confused.  If you don't know what was paid, how do you bill a percent of an unknown?

I assume that you either have some feedback mechanism that you haven't stated here, or you have not yet submitted any invoices for the work you've done, or you are simply contemplating this and haven't actually started yet.

There is no cost-effective way to get paid a percentage of an unknown figure, when there is no reasonable way to determine what that unknown figure should be.  No business can survive that.  So, either you are pulling our leg, or you need to rephrase your question.

DrHayser

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Re: How to invoice based on % for some of a practice's claims
« Reply #4 on: September 28, 2016, 06:29:24 AM »
  We only bill a percentage of the amount paid on the claims we submit.

I'm confused.  If you don't know what was paid, how do you bill a percent of an unknown?


This is exactly the question posted. How can I know what was paid on a per claim basis. I have some practices now that use a flat fee, but I have some new clients that require a percentage based on what is paid. This is the model I hope to shift to for all clients except those in states that don't allow "fee splitting", but I am at this very large roadblock. I know there are people out there billing percentages of only what is paid, so I am hoping this finds their attention.

Sriram_Sub

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Re: How to invoice based on % for some of a practice's claims
« Reply #5 on: September 28, 2016, 08:02:20 AM »
Hello DrHayser,

If I have understood your question right, I think you only submit the complicated claims and the rest of the charges are submitted by someone else using the practice's billing software. Also, I think you don't post any payments even to the charges that you submitted.

If I got it right, here are my questions.
1. You have access to clearinghouse portals where you can review the remittances. But how about the EOBs that were mailed to the practice?
2. What if the practice does not share information about the paper remittances with you? You will end up sending an invoice for a lesser amount.

When you don't do all of the billing and don't have access to payments, it is not advisable to go with a "% of what was paid" Model. Your invoice will always be wrong. In fact, for you to arrive at an invoice amount, it involves a cross verification process which again is an added work. So, MHO is to revisit your contract with your customer so that you can bill for a flat fee per every complicated charge that you handle. This should be calculated based on the time taken for each complicated charge vs. the hourly rate one can charge in your locality. Hope this helps. Please let us know if I have not got your question right.

Regards
Sriram
Sriram

Michele

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Re: How to invoice based on % for some of a practice's claims
« Reply #6 on: September 28, 2016, 08:05:06 AM »
The problem is that you are billing only on selected claims.  Most services bill on a total.  We do have some clients that we only submit a certain portion of their work but we enter it into a PM system which allows us to track it, etc.  If they are uploading to you "via an electronic method" then how are you submitting the claim?  If you are not using some sort of system that allows you to track it then the only option I can see is manual which is certainly not ideal. 

I have been billing for over 25 years and I have not seen this type of a situation so that is why we are asking so many questions.  It is a bit odd to have someone say they are charging a percentage but they don't know how much is being paid.  :)  I think I understand what you are doing but unless you are using some sort of system that allows tracking I am afraid that manual is the only way.
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Michele

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Re: How to invoice based on % for some of a practice's claims
« Reply #7 on: September 28, 2016, 08:12:42 AM »
Hello DrHayser,

If I have understood your question right, I think you only submit the complicated claims and the rest of the charges are submitted by someone else using the practice's billing software. Also, I think you don't post any payments even to the charges that you submitted.

If I got it right, here are my questions.
1. You have access to clearinghouse portals where you can review the remittances. But how about the EOBs that were mailed to the practice?
2. What if the practice does not share information about the paper remittances with you? You will end up sending an invoice for a lesser amount.

When you don't do all of the billing and don't have access to payments, it is not advisable to go with a "% of what was paid" Model. Your invoice will always be wrong. In fact, for you to arrive at an invoice amount, it involves a cross verification process which again is an added work. So, MHO is to revisit your contract with your customer so that you can bill for a flat fee per every complicated charge that you handle. This should be calculated based on the time taken for each complicated charge vs. the hourly rate one can charge in your locality. Hope this helps. Please let us know if I have not got your question right.

Regards
Sriram

This was posted while I was typing mine.  That is a good suggestion also.   Do you ever run across a situation where the complicated claim is not paid?  Then are you out?  A flat fee would eliminate that.
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Sriram_Sub

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Re: How to invoice based on % for some of a practice's claims
« Reply #8 on: September 28, 2016, 08:21:31 AM »
This was posted while I was typing mine.  That is a good suggestion also.   Do you ever run across a situation where the complicated claim is not paid?  Then are you out?  A flat fee would eliminate that.
[/quote]

Thanks Michele, What I meant was a flat fee for every complicated charge irrespective of whether or not it is paid. When DrHayser does not have any control over the payments portion, I think he should not charge by what was paid. Instead, by how many he submits will make more sense to me. What do you say?

Regards
Sriram
Sriram

Michele

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Re: How to invoice based on % for some of a practice's claims
« Reply #9 on: September 28, 2016, 08:26:39 AM »


Thanks Michele, What I meant was a flat fee for every complicated charge irrespective of whether or not it is paid. When DrHayser does not have any control over the payments portion, I think he should not charge by what was paid. Instead, by how many he submits will make more sense to me. What do you say?

Regards
Sriram

That's why I said it was a good idea!  Make sure he is paid for all his work.  Good suggestion!  :)
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Sriram_Sub

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Re: How to invoice based on % for some of a practice's claims
« Reply #10 on: September 28, 2016, 09:31:06 AM »
Thank you, Michele!
Sriram

RichardP

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Re: How to invoice based on % for some of a practice's claims
« Reply #11 on: September 28, 2016, 06:01:06 PM »
I know there are people out there billing percentages of only what is paid, so I am hoping this finds their attention.

I'm not trying to be difficult here, but your original post made it sound like you were already submitting invoices in situations where you had to charge a percentage of what was paid, and you had no way of verifying what was paid.

Everyone here is saying the same thing, although maybe in different ways.  There is no way to bill a percentage if you have no reliable information on what was paid.  Plus, how do you contest a denial, or provide additonal information requested on a denial, if you have no idea what happens to your claim once you submit it?

The effort involved in tracking payment on the claims you submit is time you are spending on that client's business.  Your time is worth a certain dollar amount - and it can quickly cost you more to do this type of billing than you are being paid (assuming you guess at an amount to charge a percentage of).

I know the cliche about doctors being lousy business people (and I've had experience with that), but I can't imagine any client expecting you to charge a percentage of an amount that you have no knowledge of.

PMRNC

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Re: How to invoice based on % for some of a practice's claims
« Reply #12 on: September 29, 2016, 07:36:53 AM »
Does your contract state responsibility in regards to providing you with practice reports? If not you need to modify your contract to be exact in how you are charging clients and how you will rectify monthly collections. I echo what everyone else here has said, without proper access to the proper reports and which also depends on how payments are posted, your operating blind here.

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