Starting a Medical Billing Business > Starting Your Own Medical Billing Business
Pricing your billing service
Rclausing:
Hopefully we can start airing our differences with a bit fewer pejorative statements...
First, these are state laws, all of which differ in many ways except one: They were written to help eliminate the occurrences where physicians were referring services to facilities which they either had an ownership interest in, or were paid by the facilities for referring patients. Many times, especially in cases where a state attorney is trying to decide whether or not a law has been violated, the intent of the law is closely examined. In this case, no state that I am aware of had any intent whatsoever to limit physician/billing entity relationships with a fee splitting legislation. However, the point here is that THEY CAN BE INTERPRETED in that way, and many may choose the safer path of not seeking percentage contracts.
The fact is, a percentage contract between biller and physician does not provide the same self referring benefits that lab and diagnostic testing self referrals do. Sure, a practitioner could upcode, or bill for services not provided, but the billing service relationship does not provide any extra ability to do so. In fact, most relationships between providers and billing services retard such occurrences. Again, the intent of the law will likely play a key role in the decision making of any prosecuting party.
I for one refuse to chastise anyone for trying to be on the safe side of any law.
One last thought. I spent a good number of hours over the last few days of last week pouring over court records to find any cases (in the state that I am providing billing services for) of fee splitting that involved a billing service. I could not find a single one. Not to say I couldn't have missed any, but it seems somewhat unlikely.
PMRNC:
--- Quote --- In this case, no state that I am aware of had any intent whatsoever to limit physician/billing entity relationships with a fee splitting legislation. However, the point here is that THEY CAN BE INTERPRETED in that way, and many may choose the safer path of not seeking percentage contracts.
--- End quote ---
Not true at all. Let's look at the language of NY
Section 6530.19 - 19. Permitting any person to share in the fees for professional services, other than: a partner, employee, associate in a professional firm or corporation, professional subcontractor or consultant authorized to practice medicine, or a legally authorized trainee practicing under the supervision of a licensee. This prohibition shall include any arrangement or agreement whereby the amount received in payment for furnishing space, facilities, equipment or personnel services used by a licensee constitutes a percentage of, or is otherwise dependent upon,
the income or receipts of the licensee from such practice, except as otherwise provided by law with respect to a facility licensed pursuant to article twenty-eight of the public health law or article thirteen of the mental hygiene law;
Referral of patients has nothing to do with many of these laws anymore, there is just as much incentive for fraud with a billing company to share in revenue based on billed fees than there is referral/kickbacks.
--- Quote ---One last thought. I spent a good number of hours over the last few days of last week pouring over court records to find any cases (in the state that I am providing billing services for) of fee splitting that involved a billing service. I could not find a single one. Not to say I couldn't have missed any, but it seems somewhat unlikely.
--- End quote ---
There are case precedence's and I've found a few for Florida,NY, Illinois (prior to them revising their law), and North Carolina. One of the biggest law firms in the country has a lot of great information and can weigh in on other cases (Liles & Parker). It's important to note that WHERE these fee-splitting laws are found VARY from state to state. For example NY is under Public health law or article thirteen of the mental hygiene law. Arizona is professional conduct, and public health and safety, some states list it under education, etc. Some of the state laws are completely CLEAR and others are vague. Tennessee is another one that is pretty CLEAR, Florida has the most case precedence's, with NY following. In fact many of the cases have actual set precedences making this not just about referrals, but about "incentives" between non licensed medical personnel. I've been doing the research on this for about 15 years starting with the OIG's reccomendation back in 1997. It's also important to know that in cases presented in Illinois, NY and Florida, there were instances where billing companies contracts were null/void due to not being legal (physician). So while many who have billing companies in those states will not violate the law, if they EVER need to go to court, their contracts will be challenged.
Michele:
I can see this is a heated topic. I just wanted to chime in with one small comment.
--- Quote from: tallmanusa on May 16, 2015, 06:49:16 PM ---There are Public and private companies that sell medical billing services and charge a percentage fee. They also do business in New York.
--- End quote ---
We actually recently signed a Neurologist from NYC who specifically hired us because we were the first billing service to NOT charge her a %. She had been advised by her medical society that it was fee splitting and she refused to sign with any billing service charging a %. This is not the norm, but it is accurate. I do believe that more and more providers will become aware of this in the future.
--- Quote from: tallmanusa on May 16, 2015, 06:49:16 PM ---Percentage billing is the norm in the industry.
--- End quote ---
I actually agree with you on this statement, it is the norm.
PMRNC:
--- Quote ---I actually agree with you on this statement, it is the norm.
--- End quote ---
I too agree it probably is the norm too, but I think with more and more states adding these fee-splitting restrictions, it won't be the norm in the near future. Again, the OIG and HCCS, along with many other large medical associations frown upon it as an added incentive for fraud.
MY side note.. why on earth wouldn't you want to get paid for ALL of the work you do?
Rclausing:
--- Quote from: PMRNC on May 18, 2015, 01:06:10 PM ---
--- Quote --- In this case, no state that I am aware of had any intent whatsoever to limit physician/billing entity relationships with a fee splitting legislation. However, the point here is that THEY CAN BE INTERPRETED in that way, and many may choose the safer path of not seeking percentage contracts.
--- End quote ---
Not true at all. Let's look at the language of NY
Section 6530.19 - 19. Permitting any person to share in the fees for professional services, other than: a partner, employee, associate in a professional firm or corporation, professional subcontractor or consultant authorized to practice medicine, or a legally authorized trainee practicing under the supervision of a licensee. This prohibition shall include any arrangement or agreement whereby the amount received in payment for furnishing space, facilities, equipment or personnel services used by a licensee constitutes a percentage of, or is otherwise dependent upon,
the income or receipts of the licensee from such practice, except as otherwise provided by law with respect to a facility licensed pursuant to article twenty-eight of the public health law or article thirteen of the mental hygiene law;
And herein lies the issue. It's ALL about interpretation. As the above states, an "employee" or "associate in a professional firm or corporation" are exempt. So what constitutes either of those exemptions? I just filed articles of incorporation (LLC) so that (in my opinion only) should fit the definition. Also, even though I am on a % I am on the payroll. Again, the very definition of employee.
The bottom line is that the outcome of any court incident will depend greatly on the attorneys arguing the case. We, as practice management consultants should be far less worried about what kind of contract WE need, and focus more on physician education and let THEM make the decision as to what kind of contract they want. Many physicians - especially the older school ones - may prefer the % contract and the incentives it provides for quality work on our part.
Our job is to help a practice run smooth, and turn physician services into cash. If we focus on that, the rest usually takes care of itself.
JMO.
--- End quote ---
Navigation
[0] Message Index
[#] Next page
[*] Previous page
Go to full version