For every business model, pricing is a crucial factor when it drops down to making profitable revenue. And in the healthcare industry, for every medical billing company, the primary question that pops from their customer is, “what is your pricing model?”
Every medical billing company is judged on a broad range of evaluation factors. The factors include customer satisfaction metrics, ease of communication, accuracy rates, and last but not least, revenue cycle management.
Since all these metrics also depend on pricing models, we can fairly say that a higher quality has higher pricing models. It means that practices and healthcare organizations need to consider the cost evaluation to get profitable returns.
Following are the models which many medical billing companies follow for their clients.
Co-managed revenue cycle model
These are part of end-to-end revenue cycle management services that is common practice among medical billing companies. So the process is where you submit claims to insurance companies, where the company takes complete charge of the revenue cycle. From eligibility verification to AR analytics all is covered in this end-to-end process.
Most of the companies charge somewhere around 8% to 12% for co-managed revenue cycle services. Using high-quality electronic health records (EHR) systems, you will be charged around 3%-6%.
An FTE model is based on a full-time equivalent model – that gives out services to organizations at total capacity. For example, the medical billing services offer a team or a group to the said practice full time to cover their requirements. It helps when there are specific gaps within the organization or training, but they don’t want to outsource their needs. Instead, they’re in a group to complete or boost up their process to get quick returns.
Percentage basis model
Under this model, the medical billing company collects a certain percentage of the money they collect on a month-to-month basis. That is only valid when healthcare providers or practices get paid through billing customers. The practices that have a high denial or unpaid claims ratio can opt to percentage basis models. They typically charge around 4% to 15%, depending on the range of cases, receivables, and patient volume.
Full cycle RCM model
This model is based on healthcare organizations and practices outsourcing their entire revenue management to a medical billing company. It works for most organizations because it removes the complex medical billing or coding and revenue management activities from the system as experts from medical billing services handle the end-to-end process.
At Info Hub Consultancy Services (ICS), we provide comprehensive and fully integrated medical billing solutions to help your practice achieve profitable revenues efficiently.
Fixed-Rate per claim model
Many medical billing companies charge clients a fixed rate per claim. Meaning, the rates are charged based on claims processed and not on the amount collected. This model you can adopt when you don’t feel the need to opt for end-to-end solutions and where claims are cleaner.
Hourly rate model
Some companies charge the practices or providers for their medical billing services at hourly rates. This model is ideal for large-scale operations or hospitals that usually have standardized claims and handle claims hourly. Medical billing companies hire dedicated staff for such operations. The charge depends on operations, clients, and negotiations done for the future of a healthcare organization.
This model is based on a system where hospital chains hire medical billing services with mixed or hybrid pricing for its range of requirements. The benefits are provided to different groups within the healthcare organization, which have various operations and needs. Medical billing companies often charge a fixed rate on claims and a percentage of the organization’s amount.
There are multiple models for your practice to choose the ideal one suitable for profitable operations. But it is always essential to understand what metrics you choose to drive your business’s success and then compare the suitable pricing model.
Info Hub Consultancy Services allot experts to your practice to understand your business metrics and drive your revenue to the best. To know about our pricing model, book a free consultation today!