Bill Sample / December 9, 2018 / Ellen Tillman
You want to imagine a symbiotic relationship with your providers and then list the reasons this relationship works and put those actions in your contract as responsibilities of yourself or the provider. You need a list of everything that you have ever heard of going wrong in a medical billing business between the provider and the biller. You need to decide how you would avoid those situations if possible and cover how it would best be handled in your contract if unavoidable. What you are charging your provider and how you will get paid is a fairly important part of your contract. Are you charging a percentage a flat rate or a per claim fee? Is it clearly defined how you are charging? Is the percentage on what is billed out or what is received? Are patient payments included? If charging per claim what constitutes a claim? Is it a line on a claim form or is it per page? You also need to take into account what will happen when the relationship ends.
If you dont include the responsibilities of each party in the contract how does it protect either of you when the relationship starts to fall apart? And if neither party knows their responsibilities how can you expect that the relationship will work? Here is an example. You specify in the contract that it is the obligation of the providers office representative to supply you with all the payment remittances but you are not getting them which is causing you to do a lot of extra work in contacting the insurance carriers to check status on claims that were already paid. It is upsetting to spend three or four hours calling insurance companies to find that the claims were paid but the doctors office missed sending you the eobs.
Contracts are kind of like insurance you dont need them until theres a problem. But when there is a problem its a relief to have one. There are really a lot of areas that you need to make sure you are covered in and a contract is really the only way to do that. When starting a medical billing business there are many things to think about and writing a contract is just one of them. There are many expenses in getting started and most of us just starting out dont want to spend our limited investment money on an attorney. So what do many of us do? We "google" sample medical billing contract and use what we think sounds good and make up a contract for our business. That can be a big mistake. Thats what we did sixteen years ago when we started our business except there was no "Google" then.