State of Tennessee billing rates

[A One Billing]

Does anyone know the standard rate to charge for billing medical claims in Tennessee? We are starting out a new medical billing company and need some help in determining what you charge for this service. We have seen different answers regarding flat fee per claim or a percentage, but we are trying to determine the best way to charge in the area we live.

[PMRNC]

This really depends on a lot of variables. How you charge is a preference, some do %, flat fee, per claim, etc. If your looking for averages that varies depending on your area, I couldn't even begin to give you an average. i bill a flat fee based on my time. A % really only benefits the provider and not you. A per service fee is hard to sell as well as track because there are so many things a biller does to build a claim and you can outprice yourself with an 'ala carte' model.

You also want to research your state if you plan on a % as some states prohibit providers from entering into contractual relationships where there is fee-splitting. In addition to your state you would also need to research the state a provider is in if you plan to bill for out of state clients. That's why it's good idea to have a few pricing structures laid out. In most cases they will be different depending on the clients specialty, location, volume, type of carriers, and of course the work involved.

[A One Billing]

Thank you for your response. This is our first time on our own, I have billed for 18 years with other companies. How would you determine what flat fee to charge based on your time? Could you share some examples on how you determine this?

[PMRNC]

The client doesn't see my hourly rate. It's based on time I estimate to spend on the account. For example, I know how many claims and how much work a practice of three pediatricians will need. I then set my hourly rate and multiply it by the estimate of time. My contract is to be adjusted after six months to allow for time to create a more accurate price. To that, I add my expenses which isn't much because I don't incur PM software/systems cost, the client does, which allows me to keep the costs more competitive to other billing companies.  So for an example of a practice of three and an hourly rate I want of $50 an hour and estimate they will need 32 hours a month for total of $1600. I then add expenses (fax, claim forms, envelopes, stamps, phone, etc.) The sliding scale for practice patient growth would be to add one hour for every 5 new patients. That number would change depending on the specialty/number of doctors and types of insurance so that any extra work is calculated. Using this method I am always being reimbursed for all of my time.