Billing Service Fees and Scope - Who Receives Payments

by P. Philbin
(Annapolis MD)

I am wondering what the standard in the business is....When an insurance processing company says they charge 7% of claims made income, does that include all the income from any patient that would have insurance processed?


Does this include the deductible and out of pocket? And, would the processing company also then be responsible for collecting the money from the patient as well as the insurance co.?

Response:

By processing company I assume you are referring to the billing services company.

The rate (or fee) charged varies based on the negotiated services provided and the expenses required by the billing service company to serve the client.

As far as what all is included that varies also. Our approach as a billing service is this would include everything we bill for. This would include claims filed and paid by the insurance company and patient payments for deductible and co-insurance that we send statements for.

We don't bill for co-pays but some billing serviced include this in their contract.

Typically all payments would go to the providers office. This includes both insurance and patient payments. We (the billing service) post payments based on the remittance advice provided with the insurance payment that is either sent to us by the providers office or we can access online. We post patient payments based on regular reports provided by the providers office.

Some billing services make arrangements for the payments to be sent to their office - but we prefer not to.

Again this varies with each situation. I invite other billing services to comment using the link below.

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Dec 08, 2017
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Would this include self pay patients?
by: Anonymous

Would a percentage fee apply to self pay patients? If a 6% fee is charged but patient self pays $100 did you charge $6.00? Self pay payments must be put into patient billing ledger and tracked and be available for printed receipts or to send bills of unpaid. Thank you for the so much information.

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