Author Topic: Questions after reading Pricing your MB Scv.  (Read 263 times)

Jmojica

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Questions after reading Pricing your MB Scv.
« on: October 03, 2017, 07:27:24 PM »
Hi everyone! I'm so excited to belong to a group of billers and more.  Below are some questions that came to mind:
-I too use practice mate/office ally.  Do you combine your providers into one account/one log in? This would prevent the ability to allow the provider access to view their account since multiple providers would be reported right?
-If my business is registered in NY can I provide services to clients in other states?  If yes, how would the fee splitting rules apply if the other  states allow that method?
 
- I offer credentialing as part of my services but sure can use some advise as it's not my main love.

This last thing is more of a statement,  I have been charging my providers via a % since I started my business 1yr ago. Knowing that is illegal here in NY is an eye opener and I will immediately revamp my contacts and send notices. ....even if it means I'll lose some providers. I'm prepared to start over if needed. I want to have an honest business.

Jessica

Michele

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Re: Questions after reading Pricing your MB Scv.
« Reply #1 on: October 04, 2017, 09:01:49 AM »
Hi everyone! I'm so excited to belong to a group of billers and more.  Below are some questions that came to mind:
-I too use practice mate/office ally.  Do you combine your providers into one account/one log in? This would prevent the ability to allow the provider access to view their account since multiple providers would be reported right?
NO!  You should never mix providers into one account.  No matter what software you use make sure you keep your practices separate.  We refer to them as "houses".  Each practice gets it's own "house".  Our software allows us to set up as many "houses" as we need.


-If my business is registered in NY can I provide services to clients in other states?  If yes, how would the fee splitting rules apply if the other  states allow that method?

Yes, we bill for providers in several other states.  We use the flat fee method no matter which state they are in.  Some states do allow % billing like California.  It just works better for us to do the flat fee no matter what state.
 

- I offer credentialing as part of my services but sure can use some advise as it's not my main love.

Not really much I can say.  Just contact each company and ask what needs to be done.  Each company is different, except Medicare which has standard forms nationwide.  Most use CAQH which is an online universal credentialing form.  I would stay away from fee/contract negotiation and just stick to basic credentialing.

This last thing is more of a statement,  I have been charging my providers via a % since I started my business 1yr ago. Knowing that is illegal here in NY is an eye opener and I will immediately revamp my contacts and send notices. ....even if it means I'll lose some providers. I'm prepared to start over if needed. I want to have an honest business.

Jessica

You definitely need to change.  I would just approach your clients and explain that you weren't aware when you originally gave them the contract that % billing is illegal in NY and you need to change to a flat fee.  Present your flat fee.  They most likely will understand and be happy to change.  Many providers and billing services in NY are being hit by the Atty General for charging %!
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PMRNC

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Re: Questions after reading Pricing your MB Scv.
« Reply #2 on: October 05, 2017, 12:32:04 PM »
NEVER EVER combine your clients in one database. Also EACH USER should be held accountable for access in order to protect the Audit trail along with HIPAA compliance. Even as a billing company owner, if you have others access a client's database they must have their OWN login (secure). The audit trail MUST be protected.

If you are in NY but you bill for a provider in another state that does not prohibit providers from entering into a contract that is considered fee-splitting you would be ok. Remember it's not the billing company that is libel it's the provider. However I still maintain that billing a percentage is still an enticement to fraud and abuse and the billing company NEVER receives fair compensation for their hard work. I just don't believe in % based billing at all anymore.

As for credentialing. I never include that in my billing contract. It's a separate contract (consulting) and I also go much further than just plain credentialing. There are two tiers to credentialing and depending on how far you go with it I would go based on an hourly fee if your doing ALL of the work (Fee schedule analysis, adjustment analysis, contract review, negotiations, etc) or a flat fee if your only service is to just get them in network.

As for NY and fee-splitting.... You won't lose providers if you explain it properly. Explain that it's you that is protecting THEM. They are the ones that would end up in trouble, not you. It is NOT illegal for YOU to charge a %. It is illegal for them (providers) to enter into a contract that fee-splits. If you explain it like that, your golden. If you are a PMRNC member we have some great resources on fee-splitting in our members only area. I think it would be impossible to lose a client for trying to protect them. It's also been a great marketing tool for me since there are so many billing company's in NY that ignore this law. Again, remember it's NOT the billing company that's acting illegally, it's the provider signing the contract.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

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Re: Questions after reading Pricing your MB Scv.
« Reply #3 on: October 05, 2017, 01:41:38 PM »
Actually we have always preached that it's the provider who is breaking the law but we personally know of two local billing services that have been hit by the Atty General for % billing.  One settled, the other is still negotiating.  So my advice is, whether it falls on you or not - stay away!
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PMRNC

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Re: Questions after reading Pricing your MB Scv.
« Reply #4 on: October 05, 2017, 02:42:59 PM »
Quote
Actually we have always preached that it's the provider who is breaking the law but we personally know of two local billing services that have been hit by the Atty General for % billing.  One settled, the other is still negotiating.  So my advice is, whether it falls on you or not - stay away!

Yes.. For NY providers.

There is a law pending in NY right now that might change that... we are watching it closely. 
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

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Re: Questions after reading Pricing your MB Scv.
« Reply #5 on: October 06, 2017, 06:41:01 AM »
Is it moving again!  Last I checked it seemed stalled.
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PMRNC

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Re: Questions after reading Pricing your MB Scv.
« Reply #6 on: October 06, 2017, 07:23:03 AM »
Senate Bill S4736  ... passed senate June 2016... last stop is Governor.. not sure I would call that stalled...as bills waiting longer pass and go to the Gov.. could be they are waiting for party change though as i don't see Cuomo signing it.
Linda Walker
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www.billerswebsite.com