Starting a Medical Billing Business > Starting Your Own Medical Billing Business
What Services Should I Provide (Mental Health Billing)
GenerationalResources:
I worked for an insurance company for 23 years processing claims, and I was approached recently by a mental health provider to do his medical billing. I have degrees in psychology and mental health counseling, so I thought I would do it, but I'm not sure what steps to take. I have registered my business name, I have an EIN, I have purchased medical billing software, and have presented the client with a contract for 8% of billed charges. The provider stated that he has seen others bill for 4%. So my first question is what is reasonable?
Also the provider has many questions for me such as credentialing issues, and what charges they can bill. My question is as a biller, exactly what the parameters of my services should be? I have other questions but I don't want to overload the board right now. I look forward to hearing response.
BASICALLY, WHERE DO I GO FROM HERE????
Thanks!
Michele:
--- Quote from: GenerationalResources on April 01, 2015, 11:55:13 AM ---I worked for an insurance company for 23 years processing claims, and I was approached recently by a mental health provider to do his medical billing. I have degrees in psychology and mental health counseling, so I thought I would do it, but I'm not sure what steps to take. I have registered my business name, I have an EIN, I have purchased medical billing software, and have presented the client with a contract for 8% of billed charges. The provider stated that he has seen others bill for 4%. So my first question is what is reasonable?
Also the provider has many questions for me such as credentialing issues, and what charges they can bill. My question is as a biller, exactly what the parameters of my services should be? I have other questions but I don't want to overload the board right now. I look forward to hearing response.
BASICALLY, WHERE DO I GO FROM HERE????
Thanks!
--- End quote ---
Wow. Not sure where to start. I guess with Congratulations! Getting your first client is the hardest. :)
OK, so what is reasonable. Well there are a lot of variables that affect that. Your location, your experience, the specialties, etc. We have found that billing services charge anywhere from 4% (possibly lower for off shore but that's a whole different topic) - 13% (personally I don't know how anyone could get paid that). But before I go further I must mention that many feel that percentage billing is not a good way to charge. It is the most common way, but is actually considered fee splitting in several states. With that being said I'm going to answer your question. When we started 20 yrs ago we started at 4-5%. It was too low. We couldn't do a good job and still make enough money to pay ourselves. We went up to 6 and then eventually 7. Whenever a provider says "that's high, other services only charge 5%" I say "You get what you pay for." I do a good job, I'm very thorough and I make sure that the provider collects all he is supposed to. The services that charge 4-5% in my opinion have to cut corners somewhere. The ones I know personally do not do aging reports, do not send regular patient statements, and do not handle denials. I'm worth every penny that I bill my provider for. I am fair, but I am good.
Regarding credentialing, we do help our providers when needed. We do charge separate fees but we charge less for providers we bill for than we do for other providers.
Your parameters are going to be what you set them. Most billing services do not like to get involved in credentialing. If you are not going to be involved then you should establish a relationship with someone who will do it for them so that you can at least refer them to someone. As for helping them with what they can charge, you want to stay away from actual coding (unless you are a certified coder). It is ok to guide them, give them some tips, or resources, but don't let them think that you will do it all for them. We tell providers "if we see something that we don't think is right, or something that you should possibly be doing differently, we will tell you so that you can decide."
Keep us posted with how it is going!
PMRNC:
--- Quote --- I worked for an insurance company for 23 years processing claims I was approached recently by a mental health provider to do his medical billing
--- End quote ---
Wow that sounds like how I started.. I was a claims examiner as well.
If you intend to start your business and you quote 8%, you will always have the doctor tell you they know someone else to do it for 4%. Of course when I hear less than 6% I immediately think "offshore" ::) :o If I'm told someone can do something cheaper, I usually give them my card and walk away, they will be back. With your years on the other side, that's INVALUABLE..trust me. That was my smoking gun when I started marketing.. so you have a gold mine, don't undercut yourself at all! I live in NY which doesn't allow physicians to enter contracts for a % of revenue as Michele mentioned, there are a few states that don't allow it. I started out with a % when I lived and worked in NJ, but the best decision I ever made was moving away from % billing. I invoice based on a flat fee which is actually based on an hourly rate + expenses, with sliding scale to accommodate growing practices. Works great. I get paid for ALL work. I think in general, billing companies are moving away from %.. makes for messy exit, pain in rear when you have refunds, etc. And then there is the common sense theory.. you should get paid for YOUR time. Professionals get paid for their time and experience, it's that simple. I do think the new biller needs to charge a %, only because they are inexperienced and really don't know what their time is worth or what they can do per hour or how long it will take.. BUT, you have extensive experience from the other side. Billing is just reversing the side of the fence you were on..that's it. You've also worked on the complicated and extensive systems insurance companies have to process claims.. so practice management software will be like learning the ABC's for you.
Welcome to the forum by the way :)
RichardP:
--- Quote from: GenerationalResources on April 01, 2015, 11:55:13 AM ---... I have purchased medical billing software ...
--- End quote ---
Can you tell us what billing software you purchased?
GenerationalResources:
Thanks Guys! This is something I've wanted to do since 2006 but things just never worked out. This is the first time I've gotten this far in the process. I am so glad to have found this site. So I will be asking a lot of questions. I'm supposed to meet with the provider next week to finalize the contract. The software I purchased is HealthFusion's Meditouch. I hope this was not a bad decision. What concerns me is that this provider has never billed before and I want to make sure that I set the right expectations. and also that I meet those expectations. I know this is just the opposite of what I have done for years, but when I read the other posts on the forum, I feel that there is a big piece that I'm missing. But it may just be that I am not familiar with some of the lingo that is used for terms that I know as something else. Another question that I had was do I actually need a business license in addition to registering my LLC with the state, to run this business from my home in Georgia?
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