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

Who charges the provider per claim?

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Christy:
This is not a debate about the best way to charge providers for billing, etc.  I am just curious as to what people charge per claim if using that model?

When I say "per claim", I mean "per date of service." Not one claim for 6 dates.

I currently charge $25-$30 per hour (depending on specialty.) I am seeing some grumbling about this from one provider.  Based on numbers, I have proven to her that she is actually spending $2 per claim or about 5% of total earnings. That is pretty darn cheap.

I am pretty sure that the going rate is $3-$4 per claim and in that case I would make more money and the providers would feel like they knew ahead of time what it will cost.

I work for very small providers whose patient volume fluctuates widely, so flat fee would not work for me.

Christy:
just found an old fee schedule for a local mental health billing company and see that they are charging $7 per encounter up to 50 encounters per month and $5 per encounter for over 50 claims per month.

since my business is primarily mental health billing, I think that I am quite the bargain at this point at $25 per hour.... :-\

PMRNC:

--- Quote ---I currently charge $25-$30 per hour (depending on specialty.) I am seeing some grumbling about this from one provider.  Based on numbers, I have proven to her that she is actually spending $2 per claim or about 5% of total earnings. That is pretty darn cheap.
--- End quote ---

Christy, you don't have to change anything, they do NOT need to know the hourly rate, instead use your hourly rate to come up with a flat fee and sliding scale. So let's say your expenses total $500 a month. Your hourly fee for that particular specialty/client is $30 an hour. You base your flat fee on fact that it will take you approximately 12 hours a week.  That's 12 X 30=$360 add in the $500 expenses and your flat fee is $860.  To get your sliding scale you want to know approximately how many claims you can process in an hour, let's say that number of claims is 10. For every 10 new patients, your fee goes up $30.00 :)

That's how I do mine. I can even bundle a different hourly rate to accommodate things like A/R Cleanup, consulting, credentialing, training, etc..without the client knowing THE hourly rate.

Christy:
thanks for the response, Linda!

Was also hoping to hear what people charge per claim....anyone?

Michele:
We have VERY few situations where we agree to charge per claim but if/when we do it's $5 per claim (allowing up to 6 visits) with NO payment tracking/aging.

We also do flat monthly fees based on the number of claims.  For example 100-124 claims for $750 flat monthly fee, 125-149 for $875, etc.  This includes followup.  Our fee also depends on the type of provider.  This is purely an example.  (Pulled the numbers out of my head!)

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