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The age old question of how to set fees for your Billing Service

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No one really purchases software, not even stand-alone PC based. It's Licensed, so you pay a license fee. You really don't own the software. It's a big racket and always has been. I don't pay anything as it's a cost my clients assume and they like it because they maintain control. I like it because it keeps my overhead low which allows me to be more competitive or flexible with my fees. It also takes ALL of the headaches away of ending a contractual relationship, it keeps startup costs and time down since there is no need for me to waste valuable time setting up or doing a conversion which is another costly expense of time and money.

Thanks for your feedback.


--- Quote from: HeidiK on May 29, 2014, 03:07:28 PM ---Hi Everybody!

As a medical billing service, I was asked recently what my charge would be "per claim" and I hadn't heard this term in a verrrrry long time!  I reached out to Linda Walker and Merry Schiff who both gave me some insight but I wondered how others in the field might respond to a request like that.

It's a different concept that was used back in the day when an office might only want someone to enter their claims and submit claim electronically.  I believe it was popular when most offices didn't use computers but wanted the quick turn-around for their reimbursement.  Crazy to believe, but that was only in the last 20 years or so! 

Now that pretty much everyone has a system in place, a "per claim" fee is hard to determine because you have to consider what is involved.  I came up with the following levels and wondered if anyone would like to offer their opinion on what you would charge for each level, and if you think other items should be listed or taken out.

TIER 1: CLAIMS PROCESSING   _____ per claim
   Submission of primary, secondary or tertiary commercial claims with required attachments when needed. (Each claim is charged individually)
   Submission of Workers Compensation claims and No Fault claims
   Posting patient and insurance payments for all claims filed
Analyze explanation of benefits statements from insurance companies and verify accuracy of payments. 
   Notification to the office when claim(s) are determined to be rejected, denied or paid inaccurately.
   Claim status review for all claims 35 days past submission date.  (Refiled claims are handled as a new claim submission)
Monthly Patient Statements printed and mailed, office handles patient phone calls

TIER 2: PRACTICE MANAGEMENT    _______ per claim
   All services as listed in TIER 1
   Toll-Free number and secure, encrypted email for patients use regarding any and all questions pertaining to billing.
   Monthly report of claims submitted, payments and adjustments applied.
   Quarterly review and report of Revenue Cycle Management Process
   Review and correction of billing errors when claims are rejected, denied or paid inaccurately and/or query to doctor for additional assistance when needed.

   All services as listed in both TIER 1 and TIER 2
   Certified Coder review of records to verify documentation supports claim, query to physician when addendum is warranted.
   Customized design of coding and billing forms and reports.
   Yearly Fee Schedule Review with Coding Updates
   Monthly Eyecare Professional Newsletter with billing, coding and marketing tips
   Discounted rate for subscription to
   2015 ICD-10-CM Update to System and applicable forms (Training available separately)

   Service available separately or in addition to any of the Tiers listed above. Current demographic and insurance information must be provided.
   Active coverage is verified online, and then a live call is made to the carrier to obtain details of patient coverage including patient and/or family deductible, out-of-pocket expenses, material allowances and eligibility.
   Completed EB Form will be sent back to the office prior to the patients scheduled appointment.  Copy should be given to patient when they check-in so they are aware of the full expected payment at check-out.
   Office will be notified immediately for patients who are found to be ineligible for have terminated coverage so other arrangements can be made or appointment cancelled.

I'm looking forward to seeing what everyone thinks, but please include how long you have been "in the business" with your post.  I think it makes a difference and hope to keep this topic informative and helpful.  :)  Thank so much and have an amazing day!

--- End quote ---

Hello - I get asked this quite a bit too, and you might be able to simplify your message to the client by telling them you base your fee on what "package" of services they want. i.e. Claim submission only $250.00. Claim submission + posting of payments $425.00 Claim submission + posting of payments + insurance verification $675.00 etc. This way you can give them a more condensed presentation and save the tier details for your service agreement, that they can read through.  :) 

Hey Guys am new to this forum. How do we post a question?   :-\

You just did.   :)

Just select the category you want to post your question in, then click "new topic" at the top. 


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