Billing > Billing

Deductibles

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Cherylwilli:
I'm a biller to a few providers for whom I don't post copays or bill their patients.  My question is: Can I bill the providers for patient deductibles?  It seems logical since I've done all the work.   Or, if the provider gets paid at some point for the deductible, are they obligated to inform the me?  I bill %, not flat fee, so not billing on deductibles really adds up.

Thanks for your help!

PMRNC:
What does your contract state?  If your contract says you will collect X% of all practice revenue's then yes. If it says you will collect 7% of insurance payments than no, likewise, no if it also states: you will collect X% of all practice collections (because then you are not entitled to anything you don't bill for)  Your contract has to be specific.
My take on this is that if you are seeing the claim all the way through, then yes you should get a cut. It takes you time to post payments and also those payments are included in the reports given to the provider. Some billing companies will only charge for insurance payments and not post anything else or run statements but to that I ask? Are their two sets of books then? That would be a big problem!

When I billed on a % of collections, my contract stated "HRS, will collect __% of ALL practice revenue's"  Covered me for everything. My time=Money

Pay_My_Claims:
@ Cheylwilli, this is why since day one with everyone talking about % billing, I have NEVER done anything other than flat rate billing. If you google flat rate billing, you will come up with nothing even close to what I have been doing since I started my business. When I started over 2 years ago, and joined a couple of the forums, percentage was all that was spoken, except for those that did the per claim because of the "fee splitting states" More providers are becoming keen to billing services (home based). They know how competitive it is and seeking the lowest estimate. As far as the deductibles are concerned everyone's opinion is different. If you file the claim, and it goes to the deductible and you subsequently "collect" via statements phone calls etc then you should get your %. Copays are the exact same thing. Why should a biller collect money off of a copay that was collected BEFORE a claim was filed?? What about an established patient who forgot and they stated bring it in next week, should the biller get a % off of that? I saw the flaw in % years ago because of that specific scenario. I still have people debate the % because they focus on the penny they may miss because the provider made 100 bucks more this month than last. The provider I interviewed with on Tuesday, her biller only charges 3% and the other company 4%. Since they are not doing her billing consistently, because she has a facility she bills for as well making big $$ off of them, she considers my flat fee high because of what she is currently paying. However, because of the services I offer, they are considering paying my fee. Even if you put it in your contract be cautious and fair as well. I bill for Opthalmology, and they sell glasses in the office. This is a cash business, and according to the wording "% of all practice revenue" I would be entitled to that as well. Change over to flat-fee billing!!

PMRNC:
Yeah I would say flat fee kind of got a better appeal a few years ago but I think it's mostly because there was worry of the states that prohibited physicians to fee split. The good thing about flat fee is that it's very simple, there are a few formula's very straight forward and it's not as hard of a sell as many think. I have only had ONE provider question the flat fee and when I simply explained the concept of someone getting paid for all their hard work, he actually said "yes, that does make more sense!"  It's also a great marketing tool if you don't mind playing a little dirty pool. I have gotten a few clients right here in NY where they were either paying a billing company a percentage OR looking at other companies that do. When I show them and explain the fee-splitting information they are usually stunned and a little miffed that other billing companies in NY have never mentioned it.

I do have to say that switching right from a percentage to flat fee isn't easy you have to be a little careful on how you do it and when you do it. Make sure your contract allows for changes like that.

Sorry.. I know you didn't ask for our input on going from flat fee to percentage.  :o

Cherylwilli:
Unfortunately, my contract states I will charge % of all payments received. If I track and post copays, deductibles the % also applies.  So I guess I answered my own question :(

Based on your responses, I can understand how it makes sense to do flat fee billing.  But how do I change over?  As we all know people don't like change.  I've had my business for 2 years and some my providers I've had from the beginning.  Of course the first thing that comes to mind about changing is that I'll lose providers. 

Thanks for your responses.  I'll research flat fee billing to get a better understanding.

Cheryl

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