Medical billing contract - things to consider - reponsiblity and duty

Medical Billing Contracts

If you are going to try and create your own medical billing company, you should have a medical billing contract.  You can either have a basic contract, or have an attorney draft up a contract. 

In the contract there are some things to consider

Name of the billing company and the name of client.

Effective date of contract and expiration date if any.

Where will the insurance payments go to?  I recommend having the payments go to the physician's office to avoid any legal matters.  There should be a contract stating the provider will send copies of EOB's of all payments.

Providing monthly reports or meeting once a month or quarterly.

How will payments be made?  You can either charge by percentage.  Some of the average ranges are 8 to 15% or an average of $4 to $10 per claim.  Things to consider are the patient volume, average income and if the client is established or not.

Who will do the coding?  You will want to interview the company that you will be outsourcing with to make sure they are not doing anything illegal first.  You do not want to do billing for a company that is in violation.
Once you have interviewed with them, you can either agree to have coding stay with them or choose to outsource coding as well for an additional fee.

Things that the client is responsible for:
      provide true and accurate data(the client will be responsible for any submission of false date that can be prosecuted by law)
      verify insurance
      client will be responsible for his/her own credentialing
      client will not offer kickbacks or professional courtesy to client(this means the client can not wave copay or give free services to preferred patients, THIS IS AGAINST THE LAW)
     
Note that claims and patient information belongs to the property of the client and the billing company is only using it while contracted with the client.

Billing company is responsible for
      following up on unpaid claims
      patient billing
      paper and electronic submission of claims

If you are going to try and create your own medical billing company, you should have a medical billing contract. You can either have a basic contract, or have an attorney draft up a contract.

In the contract there are some things to consider

Name of the billing company and the name of client.

Effective date of contract and expiration date if any.

Where will the insurance payments go to? I recommend having the payments go to the physician's office to avoid any legal matters. There should be a contract stating the provider will send copies of EOB's of all payments.

Providing monthly reports or meeting once a month or quarterly.

How will payments be made? You can either charge by percentage. Some of the average ranges are 8 to 15% or an average of $4 to $10 per claim. Things to consider are the patient volume, average income and if the client is established or not.

Who will do the coding? You will want to interview the company that you will be outsourcing with to make sure they are not doing anything illegal first. You do not want to do billing for a company that is in violation.
Once you have interviewed with them, you can either agree to have coding stay with them or choose to outsource coding as well for an additional fee.

Things that the client is responsible for:
provide true and accurate data(the client will be responsible for any submission of false date that can be prosecuted by law)
verify insurance
client will be responsible for his/her own credentialing
client will not offer kickbacks or professional courtesy to client(this means the client can not wave copay or give free services to preferred patients, THIS IS AGAINST THE LAW)

Note that claims and patient information belongs to the property of the client and the billing company is only using it while contracted with the client.

Billing company is responsible for
following up on unpaid claims
patient billing
paper and electronic submission of claims

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