Acupuncture Billing Service

Thank you, Matthew, for bringing all this information to us. It has been helpful thus far.

I am considering using this service which provides out of network billing. The pros are; more money, more patients and I won’t have to do much of the annoying paperwork. 

My question is about fees. The biller suggested I raise my rates for a couple of reasons; first, I am below the FAIR health (a non-profit that uses claim info to develop stats on medical billing) rates for my area at 80 percentile and second, I will incur costs in processing claims for patients including billing charges and noncollectable charges.

My current rates are: initial treatment – 90 min=$120, follow up – 90 min=$80, 60 min=$65

Biller suggests: initial –  $190 w discount for payment at time of service (cash) of $30, follow up – $140 w discount for payment at time of service of $20

Is this a wise move? It seems more lucrative than in network and less headache. I do live in a small city with a saturation of acupuncturists including several community practices, so I’m hesitant to proceed.

Thank you for your time.

CJ

Hi CJ. Thank you for posting here. You raised a very good question. Like many good questions, there is no simple answer but I will try to give you some advice and hope others may offer theirs also. While I am by no means against using billing services, I am against Acupuncturists believing that insurance billing paperwork is so awful that they should pay someone else to do the billing for them to save them from the trouble before actually learning how to do the billing themselves.   I am not sure if you have much experience billing insurance but if not, I always advise you first learn how to do insurance billing before paying someone and maybe never learning how to do it well. If you know how to bill insurance and then decide it is too much trouble – that is one thing. But, how would you know it is too much trouble if you never took the time to learn how to do it efficiently?

As far as your fees go, that is an issue with so many different considerations to it. It would be much easier if you could know how many of your patients would end-up being cash vs. insurance. It seems like you are leaving money on the table to charge less than what you could get from some insurance plans but then again, charging at those rates might price you out of the range for cash patients. If you live in an area that has a large employer that has insurance that pays at those top rates and you expect many patients you would see to have that insurance, setting your fees at those higher rates could make sense. In many markets, those with the higher paying plans are few and far between and practitioners would be better off charging at rates the cash market could afford and take the hit on those insurance plans.

I do think those who are getting the high insurance fees are by far in the minority and their days are numbered. Acupuncture can be done well taking a modest amount of time and for modest fees. It is only a matter of time before most insurance plans realize that those high fees are not really customary in much of the country and start to slash fees. The few getting those high fees will complain and rail at the insurance industry, of course, but having such big discrepancies in fee structures always ends in the higher fees coming down.

I would suggest you do your homework and try to find out what other Acupuncturists charge and just what type mix of cash and insurance patients (at what rates) those in your area typically see. I hope this helps and please post again with more on your progress in making these types of tough decisions.      

Matthew Bauer