I'm pleased GoBruins/Gianni brought this up, and hope to learn from the responses.
Short answer:
PM - OfficeAlly PracticeMate
Cost - $0
Ease of use ? mild level of difficulty (only a guess, I have nothing to compare to)
Level of integration with AC ? none in my practice, but as below I've heard some limited ability, hoping to learn from other users.
Long answer (disclosure ? what follows delves into my imperfect separation or lack thereof between billing and practice management):
My challenge, prior to consider which practice management / billing system to use, it to identify what I need it to do, and then how the work flow will be implemented. Then I can turn my attention to the billing system's features and evaluate them. A bit of iteration is necessary, as for cost-efficiency I often have to adapt to what is available.
Having said that, I identify my billing needs as follow:
The billing codes I submit vary more by payer than by the events unfolding in the exam room.
1.) Traditional Private FFS ? enough ICD9s to support CPTs and discourage probability of an audit.
2.) Medicare (Traditional) ? also for first month of the year, PQRI CPT codes for the first several dozen patients, then no more for the rest of the year. These sometimes change each year, and every January I have to peruse the CMS website to refine the list of codes. I'm lazy, and try to identify the easiest minimalist implementation ? for my FP/general practice, usually the 9 HCM PQRI codes. Also, for Southern California, idiosyncratic additional HCFA form supplemental fields self-referring for any in office tests like EKG or UA (or no payment), and self ordering for homeINR borders.
3.) Medicare Advantage HMO ? it doesn't matter what the patient comes in for, by the time I bill for all the chronic HCC ICD9s, there is sometimes no room past the 8th ICD9 for the actual principle reason for the visit, for which there is no reimbursement anyway ? reimbursement in our local IPA micro-environment is ONLY for HCC codes that affect the capitation paid 12 months later the following year. This takes a considerable amount of physician massaging, as you don't want to waste one of your 8 HCFA ICD9 fields with a lower hierarchy ICD9 trumped by another entered higher ICD9 that gets you no additional capitation.
4.) Medicare Advantage non-HMO ? I have a quandry here. The payer forces us to take it or leave it accept a 10% reimbursement discount from Traditional Medicare, but does not share any of the HCC income they get from Medicare with us. So far taking the time to report HCC ICD9s has not been a high priority for these encounters for me.
5.) Commercial(nonMedicare) HMO ? Pay for Performance bonuses paid 2 years after date of service depend on judiciously playing a somewhat nonsense game here, like going out of your way to code anything close to a URI for which abx not dispensed as a URI, asking about and coding LBP every 6m if you are not ordering an XR, adding PQRI CPT codes for BP range for all diabetics, and more than 2 dozen other ICD9 and CPT codes that are idiosyncratic to my local IPA micro-environment yearly changing bonus reporting system and often have nothing to do with the appointment content. Also inserting prior auth numbers for supplies consumed (IZs, etc) and all non-capitated procedures (trigger finger injections).
6.) About half of my payers are now requiring NDC code submission for reimbursement of consumable injectable meds ? a manual edit of the claim using our current OfficeAlly PracticeMate PM.
There's a lot more, but these are those that come immediately to mind.
I would LOVE to turn this all over to a biller, either employed by me, or a third party regional service provider, and just write my note and go on to the next patient. However, I have been pessimistic that an employee at a reasonable wage would be able to understand much of this and execute even a small percentage consistently, and not optimistic that a regional service provider would be willing to learn our micro-environment of local IPA policy. Of course, I'm fantasizing that all I would have to do is write the note, and the biller would magically extract all this information from my note. Never having used a biller/service, my uneducated impression is this is not how it works ? they do not review your notes, the physician still has to code, and all they focus on is ?cleaning the claims? so the idiosyncracies of each payers HCFA field requirements are bounced back to you to supply additional information at the cost of an additional interruption. However, I hope to learn from forum participants that I am mistaken and that there is an easier way.
Left to my own perhaps misperceptions, I felt it would be just more work on my part to choose all the codes, and instead of just entering them myself immediately after seeing the patient into OfficeAlly PracticeMate, turn the data entry over to someone else subject to another layer of potential typos and data entry errors. So I do it myself. I'm not sure what a billing service adds thereafter, but would like to learn. We strive to anticipate to the penny what a patients share of cost will be and collect it up front, so we only send about a dozen bills per month out, which so far hasn't been enough work to fork over 3-7% of collections to a billing company. Perhaps they do the posting to the PM database for others? I suppose I could save part of a staff position if the cost was right for someone else to do this ? but my concern is that I trust my payment poster (who fortunately for me is also my wife) more not to accept suspicious payer write offs and go after payment than I imagine an outside provider would do ? again not having used a billing service perhaps I am mistaken. I need a discriminating eye to identify the 1-5% of unwarranted writeoffs separately from the majority that are just the difference from the contracted rate and my charges. About half of my business is HMO capitation, for which about a dozen commonly performed CPTs (spirometry, joint injections) are carved out as FFS, often happily not paid by the HMO until my poster goes after them, for which I am unsure how an outside billing service would recognize, given that this is ideosyncratic to my IPA micro-environment.
My imperfect solution to date has been using the free OfficeAlly PracticeMate practice management service. Unfortunately, I haven't learned how to integrate this with AC ? I hear rumors it is possible, but I am not optimisitic V6.3.3's limited #ICD9s would allow successful integration, as well as requiring a lot of effort on my part to rearrange Assessment/Plan paragraphs so the ICD9's appear in the correct autopopulated order. I do this all manually. For demographics, only the minimal required information is redundantly entered and updated in AC, and all of it goes into OA. Scheduling is only done in OA, not AC. After every patient is seen, I immediately (alright, 95% of the time) enter the ICD9 and CPTs into OA manually while my AC note is still open, freely rearranging the order of codes as needed for maximization of payment. In fact, as long as my note supports it, I don't even bother to enter any CPTs in AC (except for an E&M level or else no MU credit), just in OA. We signed up for electronic EOB / ERA and direct deposit with all payers using OA ERA, and 60% of remittances are documented here. This is a bit of work for my biller (wife) to view and then manually post in OA to the appropriate accounts as this is not done automatically, but no more work than the 40% of remittances that still are sent to us on paper EOBs. Then we use OA to generate the dozen or so bills we send out each month where we haven't anticipated the correct amount to collect from the patient upon arrival. My staff generally are pretty good at correctly identifying the level of service based on the reason patients call for appts with some standing orders / guidance from me.
That said, I'm always interested in learning a better way from other's experiences, as they might apply to my solo practice, particularly if it would reduce my costs and time. I would estimate that my wife's unpaid time working the billing amounts to about a 75% full time staffer. I look forward to seeing what portion of this workflow might be automated in the rumored future AC practice management module.
