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BILLING FEES

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msskenny:
I am an outpatient biller and charge per claim. I have just begun billing inpatient professional services for a doctor and I would like to know the best way to charge. Could I still charge per claim or service? Is it per patient? Or per length of stay?

Thanks,

msskenny

PMRNC:
That's up to you and your contract, I always think it best to do a complete analysis before quoting the provider any fees. There are pro's and con's to each method. In some states it's illegal for providers to enter into percentage based (fee-splitting) contracts. I personally like the monthly fee so that I can get paid for my time either way.

msskenny:
The contract states "per claim" however the dispute between biller and physician is the definition of "claim". I look at it as "per day". Each day a service was provided in the hospital is a seperate charge. She thinks one claim is the entire length of stay in the hospital. If they are in the hospital for 10 days, then that is one claim charge not 10 claims.

Again, this is for inpatient professional service billing for Mental Health.

How would you define "per claim"?

Thank you,

msskenny

Michele:
I define per claim as one CMS form.  So if I put multiple visits on one form, that is one claim.  Even if I am submitting electronically, I allow up to 6 charges per 'form' or claim.

PMRNC:

--- Quote ---The contract states "per claim" however the dispute between biller and physician is the definition of "claim". I look at it as "per day". Each day a service was provided in the hospital is a separate charge. She thinks one claim is the entire length of stay in the hospital. If they are in the hospital for 10 days, then that is one claim charge not 10 claims.
--- End quote ---

Well the contract SHOULD be more specific in defining what a "claim" is, there is going to be a problem if it's not defined.
Personally if I were going to bill on a per claim basis my contracts might define "per claim" differently depending on the type of provider. For example, for some types I might define per claim as PER date of service and another it might be further defined by submission (per date, per dayslips submitted) for example you might have a small provider (therapist for example) that sees patients once a week and submits their billing to you once a month or once every two weeks.

For your scenerio, I'm not clear on the exact services but I wouldn't want to be billed PER date for an inpatient stay, it really should be per hospital stay, per claim FORM.  JMO

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