When I have met with prospective clients, one of the biggest reasons they choose to hire a billing service vs. an employee is that they feel like they pay the employee whether or not the work is done correctly and promptly. Where as if a billing company is compensated for what they collect, they are more motivated to do a more accurate and efficient job.
Charlene - I understand what you're saying about upcoding and falsifiying claims. Although I consider my services very professional and work hard to stay compliant, I realize there are billing services that are just trying to "get rich quick" and therefore give the rest of us a bad name. I guess I have a mental block because I have read so many marketing materials engraving in my head why % billing is beneficial to the provider. Linda - You make a good point about not getting paid on the claims that are not the fault of our billing. I have a client who has 3 offices that we bill for. The one office refuses to verify insurance benefits because the receptionist "doesn't have the time" and since the provider is out-of-network, we have so many claims going to the deductible and they don't collect the payment upfront. So the provider is losing money and so am I. I have talked to the provider multiple times about this and he shows no effort to change. It makes me so frustrated, because we spend time sending the claims knowing they won't get paid. My next question is how do you determine what you charge a client on a flat rate plan? I know there are many factors, such as overhead costs, your time involved with the account, etc. Do you make a itemized fee schedule? Or do you just present a charge and negotiate...or do you not negotiate?
What I do is estimate the time I think necessary for each client on a monthly basis. I then determine my hourly rate (new billers will have this number lower, it should be based on experience, geographic location and education) then I deduct estimated costs and voila! my contract then has a clause that allows me to have a sliding scale so if the provider adds more work, that makes more work for me and I get paid more. It's quite simple but yes I hear you about the marketing stuff being drilled into your head. When I had my billing company setup a few years ago in PA I couldn't imagine charging anything BUT a %, but the more I researched, played the numbers..the more it worked. Then after you arrive at your monthly fee you get used to that way of thinking and you can justify it to the provider who questions it. For example here in NY it is illegal for a provider to enter into a fee-splitting arrangement, but there are a lot of billing companies who either don't know of it or just ignore it because "everyone else is doing it" When I have a potential client that is using one of these billing companies, I use it as a marketing tool I tell the provider that it's not illegal for me, but for them.. and that my best interest is their practice not just my wallet, that usually sells them or they research and see what I'm talking about, and then they have become educated. I don't negotiate.. I used to, but I've been doing this too long to do that anymore. For the first few clients I can totally understand having a bargaining chip or negotiation, but I just don't anymore.
I don't like sales,and % billing is a sales position. I work each claim regardless of how I am paid because I enjoy my job, and I like to succeed. My knowledge will get me the $$ I deserve.