Fee-for-service concept

Many insurance-billing services base their fees on collections….8-12% of collections is common. Our fees are based on work we actually perform…new intakes processed…sessions entered…and so on. This arrangement benefits you in two important ways:

1. If you make the collection (private-pay clients), we charge you only for recording the collection…just 45 or 90 cents.
2. As we are compensated for actual services, we never lose interest in
   collecting your accounts. Note that a billing service on a percentage arrangement only receives about $2.00 to collect $25.00. So, small balances often get neglected.

Ultimately, the goal is to have a fee arrangement that will be fair to both parties, under all kinds of scenarios, and one that will promote aggressive collections. Although our fee structure is more complex, it accomplishes those goals...while % arrangements do not.

Clinicians using our services enjoy higher-level services at fees less than or comparable to other billing services. We will be happy to help you estimate the fees for our services.

Processing fees

Intake-entry services - $6.75 per intake

Capture and maintain intake data, needed for insurance processing and family collections. Set up the financial file.

Session-entry services - $.90 per charge or credit

Capture procedure charges, needed for insurance processing. Note that "free" sessions and no-show charges are subject to the fee.

Co-payment services - $.45 per payment

Capture family payments made at the session, needed for family collections.

Mailed payment services - $.90 per payment

Capture payments mailed in by the family, needed for family collections.

Family collection services - $0.90 per statement

Prepare, review and mail statements. Answer billing questions from responsible parties. This fee includes the cost of postage and supplies, for mailing statements.

Insurance setup services - $6.75 per policy

Specify the insurance billing instructions. This is more for collecting the policy information, than it is for data-entry. It only takes a couple minutes to enter the data...but, collecting the right billing information is often difficult and time-consuming.

Insurance collection services - $2.75 per successfully processed session

Do the insurance claim processing: Send out claims, re-submit, challenge underpayments, and post amounts received. This fee includes the cost of postage and supplies, for mailing claims and sending out miscellaneous correspondence.

Notes

1. The $2.75 is assessed on each session successfully processed. So, if a client had primary and secondary insurance, the fee would be applied twice. Note that dealing with secondary insurance is complex and time-consuming.
2. A "successfully billed" session is one where the charge was processed and paid in accordance with the policy. Note that a claim that would have been paid, had it not been for a deductible, is a successful claim.
   

Appeals - $25.00 per hour

Appeals are beyond the scope of the standard service agreement. The problem is that you can make a case for appealing almost any denied claim...and each appeal is very time-consuming. Another problem is that most appeals involve clinical issues...and we're not clinicians. For these reasons, appeals are always an added-fee service.

If the counseling center feels that an appeal has merit, we will assist in every way possible...at the given rate per hour.

Family collection calls - $25.00 per hour

Our standard "Family collection services" does not include telephone collection efforts. We'll send out regular statements...we'll send out warning letters...but we do not call. Our policy is to stay clear of any confidentiality issues...unless there is special program in place that assures confidentiality. We will be happy to design a program for you...under an hourly rate arrangement.

Accounting coordination - $40.00 per hour

Summit-Edge has personnel trained in accounting...and we are in a position to provide limited accounting assistance. These services are intended to coordinate relations between you and your accountant. As your billing service, we have a close working relationships with counseling centers. Many times, it is easier and cheaper to use us for your day-to-day accounting needs and questions.

Data "feedback"

This is a free service. Every week, we send you a CD...loaded with your data. After you insert this CD into your computer, you can view your client statements, and run all kinds of helpful reports.

Copyright 2003, Summit-Edge, Inc.