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

How to invoice based on % for some of a practice's claims

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DrHayser:
Hello fine forum folk,

I am trying to wrap my head around how to invoice my clients. I am doing billing for a few practices, but I am only processing some of their claims. Basically as a specialist for their large and/or complicated ones. I am locked into billing as a percentage of what is paid. My question is how do I know what is paid? I have a clearinghouse, but the payment notification option would show all payments for my clients, regardless of who processed the claims. This makes it near impossible to invoice off of if I have to manually check payments and try and cross reference them for hundreds of claims to see if I processed them or if they did. How do most of you know what amounts are paid and thus know what to bill your clients?

Thanks

Michele:
So are you saying that you are only supposed to be collecting the percentage of what was paid on the complicated claims that you worked on?  What does your contract state?  Are you using the provider's PM system? 

DrHayser:
Correct. We only bill a percentage of the amount paid on the claims we submit. I imagine a typical billing service would do all the claims but we only do some of them. We do not use their software. They upload the claim info to us via an electronic method for processing as they deem necessary.

RichardP:

--- Quote from: DrHayser on September 27, 2016, 10:50:47 PM ---  We only bill a percentage of the amount paid on the claims we submit.
--- End quote ---

I'm confused.  If you don't know what was paid, how do you bill a percent of an unknown?

I assume that you either have some feedback mechanism that you haven't stated here, or you have not yet submitted any invoices for the work you've done, or you are simply contemplating this and haven't actually started yet.

There is no cost-effective way to get paid a percentage of an unknown figure, when there is no reasonable way to determine what that unknown figure should be.  No business can survive that.  So, either you are pulling our leg, or you need to rephrase your question.

DrHayser:

--- Quote from: RichardP on September 28, 2016, 06:01:43 AM ---
--- Quote from: DrHayser on September 27, 2016, 10:50:47 PM ---  We only bill a percentage of the amount paid on the claims we submit.
--- End quote ---

I'm confused.  If you don't know what was paid, how do you bill a percent of an unknown?


--- End quote ---

This is exactly the question posted. How can I know what was paid on a per claim basis. I have some practices now that use a flat fee, but I have some new clients that require a percentage based on what is paid. This is the model I hope to shift to for all clients except those in states that don't allow "fee splitting", but I am at this very large roadblock. I know there are people out there billing percentages of only what is paid, so I am hoping this finds their attention.

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