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

Billing in NY

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PMRNC:
What type of client is this?
Also I wouldn't include credentialing in your billing fees. JMO, that is more a consulting service and should be separate.
What types of insurance are they submitting, what approximate reimbursement is there by insurance plan? Do they have WC, PI, etc. Those are some of the additional things I would need to know before submitting a proposal.

Michele:
I agree with Linda (feel the love, all this agreeing going on :) ).  Credentialing should be considered separate.  I've learned that the hard way.  Also, if they need credentialing does that mean they are not already established with insurance carriers?  That could affect your receivables in the first few months. 

Michele

midwifebiller:
Are there any other states that prohibit fee splitting?  Would you share your NY attorney opinions and cases with us, please?

Thank you!
~Kelli

PMRNC:
There is NY, Florida, and Illinois which are pretty cut and dry, there are a few cases from Illinois and Florida.
The statutes can be found by searching "fee-splitting". There are also a few states  in which there is some 'Grey" area.
The key is to remember this is not an illegal billing procedure for billing companies it's a matter of it being illegal for the provider to "enter into" a fee splitting arrangement and the three states I mentioned all have different verbiage in the rulings. When other billers say "well everyone else is doing it" it's usually because they research and look at this as though they are doing something that could be illegal..from their own angle and not from the provider angle. The provider when they enter into these types of contracts are the ones that are not acting within the law.. Where you come in is if you ever have to go to court over your contract or the provider ever gets into a situation where your contract is challenged and then it really becomes "null and void" for you in a court of law in those three states because it was entered into illegally (again, by the provider).   When I get a potential client in NY I usually don't go into this subject unless it comes up, and a provider asks me why I don't charge on a percentage, and then I explain to them. Only once has a doctor asked to see the statute and that was because he was paying his old company on a percentage, he spoke with his attorney who told him I was correct and he thanked me because he was unaware.  Doctors usually don't have a problem with it, in fact if they are looking at other companies that bill on a % and I bring this up, usually it lands me the client.

midwifebiller:
Very good information to know--thank you.

~Kelli

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