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

What constitutes a "claim"

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Merry:
From a billing service perspective I would never hold a claim.  Give it to me at one time.  Fine.  Let the office keep track.. Not you.  Ok ok.  Yup did it once. 
Never again.  There is enough to do
without having to keep a file of these
claims. 

PMRNC:
I don't like the per claim model because it does not allow for time management/tracking.. for example a claim can either take 10 min or it can take a week depending on the type of claim. In order to make a profit you would need MOST claims to be simple and charge upwards of 8-$10 per claim.  To me this model of invoicing just doesn't allow much in the way of getting paid for your time, especially if you are dealing with chiro's or mental health practitioners who have patients coming in once a week or more sometimes.

supertaz93:
Instead of the word "claim", you might try changing your wording to "encounter" if you are wanting to charge for each date of service.  I define it as "per patient, per day".  If a patient is seen weekly, I get paid for each time the patient is seen whether the doctor sends me his billing daily, weekly, or monthly.  If a doctor sees a patient in the hospital day after day, I get paid for each day the patient is seen.  If a patient has an office visit and a procedure done in the same day or if the patient has a bunch of lab work done (even if it takes more than 1 claim form), as long as it is on the same day, it is one encounter.  If the doctor sees 20 patients in one day, I get paid for each patient.  This method has worked out great for me.  It is also very popular around my area.

The word "claim" or whatever word you use should be defined in your contract. 

Michele:
Also, it is important that you spell out what a claim is in your contract once you determine what you will be using.

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