Consulting

[mnuhfer04]

I recently left a practice after 9 years, 5 as their medical biller/coder. The physician has reached out asking if I would be willing to assist with some issues they are experiencing.

From what I understand, their clearinghouse rejections (Waystar) have not been worked for approximately 4 months, and there may be a mix of insurance-related and coding-related issues.
I am considering offering short-term consulting services to review the rejections, identify root causes, and provide guidance on next steps. I am not looking to return as an employee.

For those of you who do independent billing/coding consulting, what would you consider a fair hourly rate for this type of revenue cycle troubleshooting in the Western NY area? Would you structure this as an hourly engagement or a flat assessment fee?

I appreciate any insight!

 

[antoniamay]

I recently left a practice after 9 years, 5 as their medical biller/coder. The physician has reached out asking if I would be willing to assist with some issues they are experiencing.

From what I understand, their clearinghouse rejections (Waystar) have not been worked for approximately 4 months, and there may be a mix of insurance-related and coding-related issues.
I am considering offering short-term consulting services to review the rejections, identify root causes, and provide guidance on next steps. I am not looking to return as an employee.

For those of you who do independent billing/coding consulting, what would you consider a fair hourly rate for this type of revenue cycle troubleshooting in the Western NY area? Would you structure this as an hourly engagement or a flat assessment fee?

I appreciate any insight!

I am probably very late to this but Congrats on going out on your own, even if it's just for this project. A few thoughts from the consulting side: Don't price yourself like an employee. Personally I'd charge $200 an hour for this kind of work, and here's why. As a contractor you'll want to set aside roughly a third of what you earn for taxes (self-employment tax plus federal and state). On top of that you're covering your own insurance, you have no benefits or paid time off, and there's a lot of unbillable time: drafting and negotiating a Business Associate Agreement, a contractor agreement and scope of work, getting system access set up, invoicing, and following up on payment. Once you account for all of that, a rate that sounds high is a lot less than it looks. Your nine years with this practice also counts. You already know their payers, providers, and workflows, so you'll find the problems faster than an outside consultant would. I'd structure it as a flat-fee assessment first (pull the Waystar rejection reports, categorize by payer and rejection type, deliver written findings), then hourly with a not-to-exceed cap for any cleanup. A flat fee is easy for the physician to approve and lets you build your setup time into one number. Before you start, get a written scope of work, a Business Associate Agreement since you'll be handling PHI as an outside party, and your own Waystar login rather than your old employee account. Consider E&O insurance too. For the BAA and your files, I recommend the Microsoft 365 suite with SharePoint. You can handle signing and keep your agreements and client documents in one secure place, and Microsoft's business plans include their own BAA, so your storage is covered for HIPAA too.

Good luck!