Starting a Medical Billing Business > Starting Your Own Medical Billing Business

Few Questions....

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gderilus:
so basically, I would have to charge my clients a flat fee for for all the services i provide to them. I would be loosing money if that's the case unless I charge them a high flat fee.

Pay_My_Claims:

--- Quote from: PMRNC on June 20, 2009, 01:37:15 PM ---Florida is one of the states where it's actually nearly cut & dry that it's considered illegal fee-splitting. You want to make sure when pricing your services you do not base them on a percentage or even a perceived notion of percentage. The states where there are actual cases on the books and the law is clear is Florida, NY, & Illinois. A few other states have similar laws but with some "grey" area.
 
Here is the verbiage from the Florida Law:

The basis for the final order appears in F.S. 458.331(1), which sets forth a list of acts or
 omissions for which the board may take disciplinary action against a physician's license.
The list includes 458.331(1)(i), which prohibits "paying or receiving any commission,
bonus, kickback, or rebate, or engaging in any split-fee arrangement in any form
whatsoever with a physician, organization, agency, or person, either directly or
indirectly, for patients referred to providers of health care goods and services . . ."

--- End quote ---

Ok, this is such a good topic because I have looked at a lot of information regarding fee-splitting and I just don't see where the services that a medical billing service provides is considered fee-splitting. When i looked on the OIG website it clearly states that fee-splitting is forbidden, but by definition fee-splitting is a kickback not a fee for service. The MD can't give a cardiologist a free physical so he can refer his patients to the MD. Thats a kick-back. The billing company can't do something like this. I bill for a OBGYN, and a pediatrician. I send information to my pediatrician about clients that have or are having babies. I make a financial profit off of that.  I found this on the FS website. Let me know your opinion.

http://www.doh.state.fl.us/mqa/medical/Petitions/DOH-99-0977.pdf

Pay_My_Claims:
Here is another good article on Fee Splitting. As it stands, 2 states I don't touch Florida & Illinois!!

http://virtualmentor.ama-assn.org/2009/05/hlaw1-0905.html

PMRNC:
Here is where MOST people get confused.  It is not illegal to charge a provider based on a percentage of collections, however it is illegal for a provider in a state where fee-splitting is illegal to enter into ANY fee-splitting type arrangement.  A percentage of Anything (billed or collected) is fee-splitting.  Using again Florida as an example:

"paying or receiving any commission,
bonus, kickback, or rebate, or engaging in any split-fee arrangement in any form
whatsoever with a physician, organization, agency, or person, either directly or
indirectly, for patients referred to providers of health care goods and services

So many billers try to argue this the wrong way, but not only have I researched this for years but have talked to several attorney's in all three of those states as well as others where there is some grey area on the rule.
The argument is not whether it's Illegal to do.. it's actually on the provider..they are prohibited from entering into such a contract. As for the biller, this could be harmful to their business to have this type of arrangement because if you ever have to go to court over a contract dispute (breach of contract, dr doesn't pay, etc) your contract in those states are NULL AND VOID so winning your case would be moot as you wouldn't see a dime.

In our subscriber area I have some actual case rulings/precedents.

Also you don't have to do just a flat fee, you can do hourly, per claim, per service, etc. As long as you don't COME up with the pricing based on a "percentage"   In NY they actually are more specific with this in wording it so that you shouldn't even CALCULATE fees based on a percentage.  BTW, NY's Law is as follows:

"Section 6530.19 - 19. Permitting any person to share in the fees for professional
 services, other than: a partner, employee, associate in a professional firm or corporation,
professional subcontractor or consultant authorized to practice medicine, or a legally
 authorized trainee practicing under the supervision of a licensee. This prohibition
shall include any arrangement or agreement whereby the amount received in
 payment for furnishing space, facilities, equipment or personnel services used
by a licensee constitutes a percentage of, or is otherwise dependent upon,
the income or receipts of the licensee from such practice, except as otherwise
provided by law with respect to a facility licensed pursuant to article twenty-eight
of the public health law or article thirteen of the mental hygiene law"

Pay_My_Claims:
I understand totally what fee splitting is, but looking at the case that I showed you, I just wanted your opinion on it. This is what can be confusing for a lot of us. It does not say "billing services can't charge a provider a % of fee's collected in the state of florida". In this case it stated that because the service wasn't responsible for expanding the growth of the medical practice, they don't consider this fee-splitting. Even your post says "paying or receiving any commission, bonus, kickback, or rebate, or engaging in any split-fee arrangement in any form whatsoever with a physician, organization, agency, or person, either directly or
indirectly, for patients referred to providers of health care goods and services

This case states that the billing service isn't receiving any money that would be deemed fee splitting since it is not receiving money from patients that are referred to the provider. This is where it gets confusing, because although it can be deemed "fee-splitting" to charge the % the fee-splitting doesn't come from referrals.

Just for me, before I would take any clients from these particular states, I would be quick to get an attorney to advise me. I feel personally the statute is poorly written, and very hard for "laymen" to comprehend. I did read what you were speaking on in regards to if you enter into the agreement it becoming null and void. With such the billing service wouldn't get monies owed by the physician, nor the physician would be able to get anything back thats being held by the billing service.

such a very interesting topic.....

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