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Billing in NY

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jcbilling:
I have a prospective client in Plattsburgh, NY. Can someone tell me what the rules are for charging a percentage for billing services in NY. I have never done billing for this state and not sure how it differs from others? But it seems like I have read something about fee-splitting arrangements and I don't know how to draw a proposal if that's the case.

Thanks,
Charity

PMRNC:
Plattsburgh is right in my backyard.

Yes in NY it is illegal for a provider to enter into any percentage based fee splitting arrangement. NY is one of the states in which I have over 5 attorney opinions and there are also a few cases on the books.

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

jcbilling:
So then what are my other options for charging for my services?

Per claim or flat rate? How do you handle this?

This practice is looking for full service with a lockbox service.

Any suggestions?

PMRNC:
There are a few different ways you can charge. You will of course want to do a full practice analysis so that you can come up with a figure/estimate that is fair to you and advantageous to the provider. I usually go back and analyze a full year of A/R.   I have clients in NY right now I'm charging a flat fee with a sliding scale that can be adjusted up or down according to the work. For another I am charging a per claim fee and that per claim fee takes into account all services included. You really have to look at the practice in whole because a per claim fee for some practices would not be beneficial. There is also an option of hourly rate as well, I have a proposal in to a provider here in NY that wants to pay on an hourly basis, for them and me this will be beneficial.

jcbilling:
Since I have only charged a percentage of collections, I am having trouble figuring what is fair to the client, yet profitable for our company.
 
Forgive my detailed explanation, but I'm trying to give an accurate proposal without running off a client, but still coming out on top  ???

Here are the services the prospective client is requesting:

Credentialing
Verification of Benefits
Entering Demos & Charges
Claim Submission
Posting & Follow-Up
Denials & Appeals
Patient Statements & soft collections
Monthly Reports
Remote access given to provider to all billing info (using web based software)
Appointment Scheduler
Lockbox Service


Basically - the whole 9 yards!!!

On a monthly basis, the practice sees approx 1100 patients and submits approx 2800 procedures @ $40 per procedure.

We would be responsible for all the expenses associated with the account - which I figure will be close to $1000, without figuring labor cost for all the data entry and time spent working the account.

I originally thought of 8.5 % - which would net $9520, if every claim was paid - so approx $8700 to be safe.

So, do I propse a flat rate or $8500 or $9000, or is $8 a claim more reasonable? Should I offer both options and let them choose which method is better for them. 

Any suggestions?

Thanks so much,
Charity

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