General Category > General Questions

Credentialing

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PMRNC:
it depends on what you are charging, if you are billing the client a % of collections it's hard to justify the added fees since auth's are the first phase of reimbursement along with verification and eligibility.  If you are charging per claim, or per service or even hourly then it stands to reason you want to get paid..
250 Auth's is quite a bit..off the top of my head if there are 20 work days in a month that's 125 auth's per week 25 per day.  That could take 2 hours or 4 hours depending on the carrier and their guidelines. I had one client that wanted to pay per service as she needed them and I charged $2 per auth, but she didn't have nearly as many as 250 a month.
For all my other clients the fee was built into my percentage. Without that service the full fee was lost so it only made sense to be included in full %.

BillingMaster:
Again, thanks for the advise.  I am charging by percentage of revenue collected, so I think I will up the percentage by two percentage points.  I believe it will be alot of work not to mention the responsibilty.  I've never had a client ask me for this particular service.  Thanks again.

Phyllis

PMRNC:
I should have asked this..but these auth's.. I'm assuming they are initial authorizations? If you will be doing subsequent auth's, you might want to find out if they expect you to turn in the paperwork involved.. the initial authorizations are straight forward to get and you can usually get them when verifying benefits and eligibility, but subsequent ones will sometimes require clinical information.

BillingMaster:
I will be doing both.  I will have remote access to their software in hopes to obtain any clinical info needed.  This is a Florida provider, so lots of discounted plans with M'care/M'caid.  Apparently those types of plans require clinical info. for subsuquent auths and yes I will have to send the info to the ins company and complete any forms they need usually takes 5 days, so they say!!!

Phyllis ::)

PMRNC:
I never did any subsequent auth's where there had to be clinical information sent UNLESS the provider entered and filled out all clinical data.. that's too much liability IMO. When they contract with the managed care plans those are required to be done by them, it's in their contracts aside from the fact that it's "clinical" and best to keep that separate from the billing. What I used to do was provide the provider with a report weekly that showed which patients were in need of subsequent auth's, they would submit the required forms with clinical info and then send me the auth when received, reminding them was the key to having it go smoothly.

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