Buried in the fine print of many PM contracts is the per-transaction fee when you exceed the limits included in your contract. If the limits aren’t reasonable, the additional fees could be exorbitant!
Example:
The Monthly Fee
A PM/Billing system contract is $350 per month and includes eligibility, electronic claims and electronic eligibility advice (ERAs) with a limit of 400 per provider per month. Additional eligibility checks, electronic claims, and/or ERAs are $0.85 each.
Patient Appointments
The average US provider sees an average of 20.3 patients per day. With 21 average working days per month, the average provider will have 426 patient appointments/visits per month.
Those additional patient appointments will likely cost $2.55 each ($0.85 each to check their eligibility, send the claim and receive back the ERA. For 26 additional patients, the additional monthly charge will be $66.
Denials
A study published by Physcians Practice (http://www.physicianspractice.com/billing-and-collections/5-specialties-highest-denial-rate-2016 ) found that for family practice 17% of claims are initially denied. This would add an additional 72 claims per month to our hypothetical provider. At $1.70 per claim (re-file and another ERA) this would cost $123.
Procedures
Do you have claims for lab visit, immunizations and other procedures performed outside of an office visit? A study published by ABFW (http://www.jabfm.org/content/27/2/268.long ) found that physicians report ordering labs for 31.4% of patient visits. For our example, we will assume that only ½ of those are drawn in the office. This would add another 62 claims per month. At $1.70 per claim ($.85 for the electronic claim and $.85 for the ERA) this would cost $109.
| Regular Monthly Fee: | $350 |
| Additional Appointments: | $66 |
| Denials Re-filed: | $123 |
| Lab/Procedure Visits | $109 |
| TOTAL | $648 |
Transaction fees have nearly doubled the monthly fee!
Obviously, the best way to avoid expensive unexpected transaction fees is to purchase a system with unlimited transactions. Short of this, you can carefully read the contract before you sign and compare the included amount of transactions to your experience – including ALL the reasons you file claims.