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Fee

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Pay_My_Claims:

--- Quote from: Michele on January 29, 2009, 10:41:24 PM ---If we are doing a full service (insurance billing and patient billing) we just charge a % on all collected whether from insurance or patient.  No separate charge for pt statements.

I've never done just patient billing or charged separately for patient statements.

Michele


--- End quote ---

how do you charge for balances after the claim has paid (ded/coins/)? Would you charge a % on claim you processed, and also what you bill the client and may or may not receive?  This is what I am looking at, and please you can give me some feedback its very welcomed.

-Claims submissions-% or per fee on claims submitted or paid (i'm leaning towards the fee)
-resubmitted claims same fee if its attributable to the provider (incorrect insurance information, etc) If I have to refile because I didn't use the correct mod, or transposed a number
-patient statements, a flat fee per each claim sent (soft collections) invoices sent monthly, utilizing a collection code, as per his policy when they get to a collection code (pre set) accounts are sent to a collection agency of his choice.
-training employees how to do upfront collections, insurance benefits, medicare/medicaid rules, difference in plans, ref, approvals etc Seminar fee
-Full Patient Management all inclusive (monthly flat fee)
* Monthly AR reports are included in all aspects of the billing service*

Michele:
If we are not doing patient billing, then we don't collect on the balance after insurance pays.  We have a special provision in our contract to allow us to collect on amounts applied to the deductible if we don't do the patient billing.  If a claim is applied to a deductible, we did the work, but if we don't bill the patient or if there is no secondary, then we don't get credit.  Therefore we specifically mention that in our contract. 

We bill some clients per claim but most %.  If we are billing % and have to refile there is no separate charge, we get paid when the claim gets paid.  Patient statements are included in the %.  When we do patient billing, we collect on all patient payments, including ones made at time of service, since we have to track it all.  That makes it worth the money to send the patient statements.

Hope that helps
Michele

Pay_My_Claims:
I def understand, so who does the patient billing for your providers?
I guess I'm more set on a per claim charge except for DME i'm doing % on those providers.
Also if it the claim applied to the clients deductible and the physician "technically" hasn't gotten paid for that do you still get a % on what he didn't actually receive.

Thanks.

Michele:
Some of our providers chose to keep the patient billing inhouse.  That is fine with me, but I don't concern myself at all with if the patient pays.  We post the insurance payment and adjust off the balance (we actually have a method that shows what the patient should have paid in case the provider needs to ask us to explain).  If we don't do the patient billing, and a charge gets applied to the deductible then we do charge a % on the deductible.  I know there is a chance the provider won't get paid, but most do and if we didn't we'd go broke every January.  They couldn't get paid by the patient if we didn't bill the claim and get the statement showing deductible.  It's not ideal but it has worked for us for over 15 years. :)

Michele

Pay_My_Claims:
Thanks for the insight.

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