Hello , My state doesn't allow for Fee Splitting . I was thinking of pricing flat rate monthly for the amount of claims that come in . Do you think this would be a good idea ? ( 0-1500 - $1000 monthly ,1500-2000- $1500 monthly) That is just a example . How do you price your billing service in the states that doesn't allow fee splitting ? Thanks in advance
Not a bad idea you have there. I prefer to bill my clients a flat rat, but based on a percentage of their average monthly volume. i.e. $10,000 average monthly billing volume x .07 = $700.00/mo. This can be adjusted when the contract is up for renewal.
QuoteNot a bad idea you have there. I prefer to bill my clients a flat rat, but based on a percentage of their average monthly volume. i.e. $10,000 average monthly billing volume x .07 = $700.00/mo. This can be adjusted when the contract is up for renewal.This would not work in NY since the verbiage includes language to say the fee cannot even be BASED on %. I bill my flat fee based on an hourly rate + expenses. Easy and straight forward. I get paid for all work I do. There is a sliding scale to accommodate practice growth.
Dang, that would be nice to be able to be on a time clock. On the down side, your clients pay extra for appealed and/or claims delayed for info requests etc.
I understand the desire to eliminate the capacity for fraud when getting paid a % based on claims (billing agency upcodes, or bills for services not performed in order to increase their income), but it also eliminates some desire on the billing entity to be efficient. Quite a trade off. I really don't like the idea of getting a % based on what's billed as opposed to what is paid - lacks incentive to squeeze (collect) every dollar billed out for the client. In order to avoid even the slighted hint of any improprieties, I require my client to code their own superbills. It's just one doc and a PA, so not a big deal.
There are Public and private companies that sell medical billing services and charge a percentage fee. They also do business in New York.This includes Athena Health (Symbol ATHN), General Electric (GE), Cerner (CERN).Also private companies, like Kareo, Nuesoft, Advanced MD. There are thousands of other companies who do the same.All of the above companies charge a percentage fee for medical billing services. A visit to their websites or call to their rep would confirm that.These companies have CEO who are paid in the tens of millions of dollars; and have full time General Counsels who are paid millions. I am sure they have looked at the law very well.All of this is public information.Percentage billing is the norm in the industry.
So there is one set of laws for those who make millions (or billions) in this business and another set for those who at the bottom of the totem pole filing claims for a few bucks an hour. And they are advised that they should charge other than percentage so that they remain at the bottom and can never compete.
Ours is a society in which rich get richer and poor become poorer; lack of proper information is but one of he causes that makes the poor poorer.
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.
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.
There are Public and private companies that sell medical billing services and charge a percentage fee. They also do business in New York.
Percentage billing is the norm in the industry.
I actually agree with you on this statement, it is the norm.
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. 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.