Starting a Medical Billing Business > Starting Your Own Medical Billing Business
How to invoice based on % for some of a practice's claims
Sriram_Sub:
Hello DrHayser,
If I have understood your question right, I think you only submit the complicated claims and the rest of the charges are submitted by someone else using the practice's billing software. Also, I think you don't post any payments even to the charges that you submitted.
If I got it right, here are my questions.
1. You have access to clearinghouse portals where you can review the remittances. But how about the EOBs that were mailed to the practice?
2. What if the practice does not share information about the paper remittances with you? You will end up sending an invoice for a lesser amount.
When you don't do all of the billing and don't have access to payments, it is not advisable to go with a "% of what was paid" Model. Your invoice will always be wrong. In fact, for you to arrive at an invoice amount, it involves a cross verification process which again is an added work. So, MHO is to revisit your contract with your customer so that you can bill for a flat fee per every complicated charge that you handle. This should be calculated based on the time taken for each complicated charge vs. the hourly rate one can charge in your locality. Hope this helps. Please let us know if I have not got your question right.
Regards
Sriram
Michele:
The problem is that you are billing only on selected claims. Most services bill on a total. We do have some clients that we only submit a certain portion of their work but we enter it into a PM system which allows us to track it, etc. If they are uploading to you "via an electronic method" then how are you submitting the claim? If you are not using some sort of system that allows you to track it then the only option I can see is manual which is certainly not ideal.
I have been billing for over 25 years and I have not seen this type of a situation so that is why we are asking so many questions. It is a bit odd to have someone say they are charging a percentage but they don't know how much is being paid. :) I think I understand what you are doing but unless you are using some sort of system that allows tracking I am afraid that manual is the only way.
Michele:
--- Quote from: Sriram_Sub on September 28, 2016, 11:02:20 AM ---Hello DrHayser,
If I have understood your question right, I think you only submit the complicated claims and the rest of the charges are submitted by someone else using the practice's billing software. Also, I think you don't post any payments even to the charges that you submitted.
If I got it right, here are my questions.
1. You have access to clearinghouse portals where you can review the remittances. But how about the EOBs that were mailed to the practice?
2. What if the practice does not share information about the paper remittances with you? You will end up sending an invoice for a lesser amount.
When you don't do all of the billing and don't have access to payments, it is not advisable to go with a "% of what was paid" Model. Your invoice will always be wrong. In fact, for you to arrive at an invoice amount, it involves a cross verification process which again is an added work. So, MHO is to revisit your contract with your customer so that you can bill for a flat fee per every complicated charge that you handle. This should be calculated based on the time taken for each complicated charge vs. the hourly rate one can charge in your locality. Hope this helps. Please let us know if I have not got your question right.
Regards
Sriram
--- End quote ---
This was posted while I was typing mine. That is a good suggestion also. Do you ever run across a situation where the complicated claim is not paid? Then are you out? A flat fee would eliminate that.
Sriram_Sub:
This was posted while I was typing mine. That is a good suggestion also. Do you ever run across a situation where the complicated claim is not paid? Then are you out? A flat fee would eliminate that.
[/quote]
Thanks Michele, What I meant was a flat fee for every complicated charge irrespective of whether or not it is paid. When DrHayser does not have any control over the payments portion, I think he should not charge by what was paid. Instead, by how many he submits will make more sense to me. What do you say?
Regards
Sriram
Michele:
--- Quote from: Sriram_Sub on September 28, 2016, 11:21:31 AM ---
Thanks Michele, What I meant was a flat fee for every complicated charge irrespective of whether or not it is paid. When DrHayser does not have any control over the payments portion, I think he should not charge by what was paid. Instead, by how many he submits will make more sense to me. What do you say?
Regards
Sriram
--- End quote ---
That's why I said it was a good idea! Make sure he is paid for all his work. Good suggestion! :)
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