Starting a Medical Billing Business > Starting Your Own Medical Billing Business

What constitutes a "claim"

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williamportor:
Hello Folks- This may be a silly question, but I've had several doctors ask me how much my company charges. I offer a 2 tiered pricing, either a set amount per claim (for claim submission only), or a percentage of the return to the doctor. May I ask...what is a "claim?" Is it one date of service, or one HICFA form (possibly 6 dates). I was leaning to one date of service, but I'm not sure now. Any thoughts?

DMK:
For MOST doctors, a claim will be one date of service.  For chiros and P.T. there may be multiple dates of service on one claim since the patients are usually seen a few times per week.  Then there's the hospital "global" claims which would encompass a "stay" for a procedure.

Merry:
Never a silly question.  That's why we are here.. To share.  I think a claim could be for multiple service dates as long as they are given to you at one time.  I also never put 2 months or years on a claim.  Of course you really can but for clients I would tell them,  if you give me up to 6 procedures at one time for the same month,  that is a claim.  No holding a claim for more days of service for the same month.  Looking forward to hear what others say.

Merry

williamportor:
DMK, Merry. Thank You! This was a Chiropractor asking. I told him 1 claim= 1 HCFA form (Max 6 lines).  This will work for me. This was really helpful. ;D

DMK:
Merry brings up the point I was going to make next.  How OFTEN will you be sending claims out?  In my office I determined that the most cost effective way for me to bill and to keep a reasonable cash flow was to bill every 10 days.  That way I have multiple visits on each claim (and I pay 44 cents per claim to my clearing house).  Each office will have different expectations depending on volume, practice practices, and overhead costs.  Some offices may only send the info to you once a week, others every day.

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