Starting a Medical Billing Business > Starting Your Own Medical Billing Business
New Business - Pricing Questions...
PMRNC:
--- Quote ---01-13 encounters per week or 4-52 encounters/per month. All inclusive flat fee of $200/per month.
14-27 encounters per week or 53-108 encounters/per month. All inclusive flat fee of $400/per month.
28-40 encounters per week or 109-140 encounters/per month. All inclusive flat fee of $800/per month.
--- End quote ---
I think I'm getting hung up on your definition of an "encounter" vs. a "claim". I'm very anal with details and this could matter if I were to give you advice. I look at the big wide range of 4-52 and I am just not understanding. Can you describe to me what constitutes a claim for that provider vs. encounter as a "visit"? Like I said, some mh providers will want you to bill a patient's full month of services (4 visits if seen once a week) on one claim form if a biller is charging per claim. When you say "Per encounter" it's not really sinking into me what time you will spend doing what. For example, will you just enter the encounter, wait for 6 service lines or a month to file "A" claim? or will you enter and bill each encounter as a claim? Also what is your average time spent submitting claims (Clean claims) I hope I'm explaining this right. I read your examples as an encounter being "one" visit, but I'm not really getting a clear picture of how you will be submitting charges, recouping time for new patients demographics to be entered, etc. Because my figures are based on my time and then I minus out costs, I don't really HAVE a set pricing schedule. I go into the practice and I do a full analysis and then also run costs so that my flat fee is fully inclusive of my time and costs involved PER client. where I gave the example of 18-20 hours.. that's after I have looked at the practice, specialty, etc..
--- Quote ---What do you think of this fee schedule? It really doesn't seem worth it to charge any less than $200/per month...if you're checking eligibility & benefits, getting prior authorizations, and sometimes chasing down information from the provider! Right now I seem to spend a lot of time "chasing down" my Provider/Friend for information, but it has been a great opportunity to learn in so many ways...so I let him slide to an extent.
--- End quote ---
No, and I agree, less than $200 wouldn't be worth it for many of us.. however one of my oldest and dearest clients I still bill for is only in his office (he's a teacher) once a month, and he only sees a small load of patient's every month. Also.. Just something to think about.. if you are billing for therapists, psychologists, your actually doing more than you would the average psychiatrist would.. Psychiatry is straight forward, your just changing the CPT (even numbers I go by <g>) and using the med management codes of 90862 and M0064 in addition. The better money is with the psychiatrists of course because of their degree vs. therapist, LCSW, and even PHD. Also many psychiatrists visit hospital's and nursing homes as well which is also pretty standard and straight forward. I guess what I'm trying to say is , don't LIMIT yourself.. not even starting out, your ready for it as it's not much at all different from what your doing.
KathyG:
Linda,
I'm really making myself dizzy at this point...and I'm sure you're feeling the same at about this point! ;D Thanks for bearing with me...and maybe this will help someone else who is struggling with this issue. Okay, this is my latest beakdown...and I hope it's my last! After I sent the last email to you, I thought there was too much of a gap as well between the previous 3-tiered pricing structure I gave you. Under this new version, once the provider's monthly encounters/visits billed increases by 20/month, they will move into a higher pricing category, which will be an increase of $100/month. Hold onto your hat, cause here we go again!:
>01 and <10 encounters/visits per week = $200/month
>01 and <41 encounters/visits per month
>10 and <15 encounters/visits per week = $300/month
>40 and <61 encounters/visits per month
>15 and <20 encounters/visits per week = $400/month
>60 and <81 encounters/visits per month
>20 and <25 encounters/visits per week = $500/month
>80 and <101 encounters/visits per month
>25 and <30 encounters/visits per week = $600/month
>100 and <121 encounters/visits per month
>30 and <35 encounters/visits per week = $700/month
>120 and <141 encounters/visits per month
>35 and <40 encounters/visits per week = $800/month
>140 and <161 encounters/visits per month
Essentially an encounter is a visit, as well as a claim. Normally, clients are seen once per week by the providers I'm currently targeting (LCSWs) so I'm considering each visit as a claim. I'm billing weekly to "keep the money flowing" for the provider. I also don't like to bill infrequently and will not take on clients who want to stockpile their claim billings until the end of the month. I think it's especially important when your keeping track of the RFT's for a provider. If there's an type of error, you've already lost a month. Once I move on to the psychologists/psychiatrists, I'll need to come up with another formula, I guess.
I believe my costs should be covered enough and it basically breaks down to $5/claim using the highest number of encounters/visits in each separate level, which will include prior authorizations, client statements, etc.
So what do you think??? Is your head whirling???
Thanks...
KathyG :D
PMRNC:
No head whirling, I just needed to see how you were billing (per claim/per encounter) :) Now knowing that and without the large gap.. those are more in line.. The thing that concerns me (AND THIS IS JUST based on my experience and a tip only, not meant to do anything but advise :)) is that it's still somewhat a "menu" of services/prices. Will this be something you propose to a particular client or do you plan to offer this pricing schedule to all potential clients? I started my business in NJ back in 1996, I still have a few clients I do consulting with there as well. It was just my experience that presenting a "menu" or "ala carte" of pricing services intimidated many providers. When you tend to break it down and it's $5 a claim, that just may be undercutting yourself for some clients because they are all not the same. Again, I started out in NJ and also with mental health and NO two practices were alike in any way. I had small providers with big problems and large provider's with little or no problems, etc. But this is JUST based on my own experience, if this does work for you than you should continue. I don't know what area you are in ..but as a rule of thumb..the further North you go in NJ (closer to city) the higher the rates.. so $5 a claim might be "ok" for south jersey but really low ball figure moving into even central jersey and North Jersey.
KathyG:
Yes! I'm almost there :D
These figures are more for my own use to set my fixed fee...and help me with these first accounts. My first two perspective clients approached me, thanks to my Provider/Friend, so I'm now under pressure to "get my act together" and finally set sail! I'm not going to show any perspective client these figures. If I go in a little low on the first two, I can live with that as they will "spread the word" about my services. Your input has really helped me feel more secure about the figures I'll be presenting. The first client does happen to be located in S.Jersey, so that helps too. I may "bump" each one up $25-$50. Thanks to you, I feel confident now that I'm setting rates that are neither too high or two low. As you said, each practice will be different and each will be a learning experience, especially in the beginning.
When I write my contract, how would I handle growth issues? For example, this first client does not take insurance now. He's doing mostly group work with court ordered participants and cash payments. Once he is credentialed, the practice will be changing. He intends to expand his practice beyond the current focus on substance abuse and the number of clients and insurance claims will increase over time. Is there some type of clause I could insert into the contract that will address growth issues?
Thanks, Linda...
Kathy G.
PMRNC:
Perfect.. yes you are on your way :) :)
As for the contract, you will be spelling out each contract with how you charge, your sliding scale should be addressed there. In regards to any practice growing, you can include an option to "re-evaluate" in 6 months or even offer the first 3 month trial period under contract with clause to adjust/re-evaluate in 3 months. IF your sliding scale incorporates fees to accommodate the growth, you wouldn't really need a separate clause. Just be sure to have an attorney review your contract, but it sounds great so far. Your thinking of everything and that's always a good thing.
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