BILLING FOR YOUR NEW SERVICES

YOU WANT TO BE PAID, DON’T YOU?

Who will you bill? How will you bill? How do you decide how much to bill? What else?

WHO WILL YOU BILL?

Can you bill insurance? What are possible codes? 97533: Sensory integrative techniques to enhance

sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by the provider, each 15 minutes.

Medicare reimbursement $24.22 for each 15 minutes. 97124: Therapeutic procedure, one or more areas, each

15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)

Medicare reimbursement $20.68. 97113: Therapeutic procedure, one or more areas, each

15 minutes; aquatic therapy with therapeutic exercises. Medicare reimbursement $31.03.

WHO WILL YOU BILL?

Can you bill insurance? Yes, but they probably won’t pay for these

services Can you bill the patient directly?

Yes

HOW DO I BILL THE PATIENT DIRECTLY? Certain services are not reimbursed by the

patient’s insurance but are still valuable to provide

An example of these might be e-visits, or online consultations Many providers bill the patient for these directly

without submitting to insurance For example, Mayo clinic charges $35 for an e-

visit, but most insurances don’t pay, so the patient gives their credit card number for payment

HOW DO I BILL THE PATIENT DIRECTLY? Another example of billing the patient

directly are procedures that are considered “luxury” procedures, like Lasik vision correction surgery The patient’s insurance does not pay for

this procedure, but the patient values the service, and sees that it will benefit them, and so pays for it directly

HOW MUCH DO I CHARGE?

Consider costs Start-up costs, e.g. dimmer light, eye

pillow, etc. Advertising costs Cost of your time to provide the service Cost of any additional personnel’s time Cost of the overhead for your practice Cost of any equipment

HOW MUCH DO I CHARGE?

Consider what others may be charging in your area

Consider what patients say they would pay

Consider what the “market” will allow

SHOULD I BUNDLE SERVICES?

If learning a technique will take a few sessions, consider having the patient pay for all sessions up front, but at a slightly discounted rate

If one or more techniques naturally fit together, consider offering training for both at a slightly discounted rate

CAN I DISCOUNT SERVICES

Define the “break point” The point at which you cross over from

simply making less profit, to having the service actually cost you money

Discount to above the break point

QUESTIONS AND DISCUSSION