Home Forums Discussions Problems Advice on billing solution for new user

HI all,

Have finally made the decision to try AC for real when I join my wife's solo practice this July. She's a genl internist; I'm a family doc coming back to the real world out of an academic practice. I have read comments here both plus and minus regarding AC's exporting function and use of billing software such as EZClaim and others. I haven't seen any true first-hand testimonials of AC's internal billing service - just second-hand comments like "most people don't like it".

My wife Patty has been using Medware (a product from Sage software that is still supported but no longer sold, I don't believe) for scheduling and billing. Our plan is to have me start in AC for scheduling and charting from the first day and gradually convert her over to AC from her paper charts and Medware, ultimately sharing some billing solution together.

My question for you folks: what is your suggestion for a billing solution for this practice? We obviously don't want to use 2 programs forever. I don't think AC has a workable export into Medware.

I guess I'm leaning toward trying AC's own internal 6% plan first and, if I don't love it, then once Patty and I are both using AC 100% (in 6-9 months or so I would guess) sign on with an external billing program and use a clearinghouse as we do now. That way, I can focus on getting Patty's patients' demographics transferred over into AC, and continue to use Medware for her remaining AR as I use the other solution. I can also test-drive AC billing without a lot of risk and maybe stay with it if it seems like a good deal.

Any other suggestions? Anyone willing or able to comment on AC's advertised billing service?

Thanks! Jim, in New Orleans

I have no experience with AC billing. I have been using MTBC for 4% of collections. I figured out it is not profitable for me to do in-house billing unless I collect at least $750,000 a year, because billing person salary ($25,000) plus billing software/support/update/postage expences would cost me more, than 4% of my collections I am paying to the billing company now.

Dr. Apricot,

Thanks for the reply - so you export your claims data electronically, or scan and send MTBC superbills you print out from AC? I looked at the website; seems reasonable so long as we won't have to enter demographic/claims data into 2 separate programs in parallel. How do they get your claims data?

I share your pain regrding the $$ a dedicated in house biller costs; for my wife's small practice, it just isn't worth it (but we've done it) paying an employee to handle billing/collecting AND paying for patient statements to be mailed AND paying monthly support fees for the software we use AND the per statement fee we pay the clearinghouse. Whew! It do add up.

Jim

The key, guys, is having employees who can multi-task. Billers who can make appointments or bring patients back and receptionists who can put in charges and post payments and file insurance. Personally, out-sourcing billing is the last thing I would consider. No one cares about my bottom line as much as I do and being able to see who pays, who doesn't, where my charges are too high or too low, looking at which insurance companies are sending us down the river....those are the advantages of having my billing program in-house. I have recently contracted with a mobile ECHO outfit. Within 10 days after the first run, I knew what insurance companies made it worth while and which patients needed to go elsewhere for their tests. If an insurance company ticks me off too badly I can quickly run a report on them and be able to tell them sayonara if it has been a recurring problem. I agree that the cost of a PM program seems huge and I am hopeful that Jon will someday either develop a good, functional PM module, or collaborate with a low-cost one already available, but for now, this is too important an issue for me to send it out to people who really don't care about my money.

Leslie

I forgot to mention also that I do not use a clearing house. The majority of my claims are Medicare and Anthem which go through their own free hyperlink. Most of the other larger insurance companies also now have or will have web sites which one can use to send claims electronically for free. And those that don't....I can put 4-5 claims in one envelope for the price of one stamp...a lot cheaper than clearing house prices.

I agree completely w/ Leslie.
I do not outsource billing because our collections tend to be better than a billing service. Many local services will claim 5-6% in Maine, but with hidden monthly fees it can easily top 9-10%. Some have even told me that they can get 90-95% collections. They try to make it sound like they can get 90-95% of WHAT I CHARGE, however this is a lie...no one can possibly achieve that. Maybe they can get 90-95% of what my insurers discounted fees are.

But what about patient balances?
We do well w/ my biller, because she is kind yet firm. She represents my office and therefore she represents me. Patients will pay their balances because they respect me. They are less likely to pay their account balances to some faceless billing service. For those few patients who are chronically late in paying or have never paid a bill, then I will discharge them from the practice. Perhaps harsh, but even some of the most indigent patients can afford $5/month. Considering we discount private pay by approx 50% if they pay on the spot, I don't think it's too much to ask for a return in good will from the patient.

Plus you never really know how ruthless your billing service is. But I occasionally overhear my biller on the phone and she does a good job, kind but persistent and firm.

We also use Medware by Sage. I don't have any problem in using two systems (AC and Medware). Since Medware is a much better billing program, I would prefer to ensure good collections than to rely completely on an all-in-one EMR/practice management solution.

EzeeJim,
I export my office AC claims electronically. We scan patient info/insurance cards when patient first comes, then upload this to MTBC via FTP. All office claims are uploated electronically. There is an AC option: Billing -> Pull/Export Bills by date -> Pull Bills -> Export
The daily bills will be securely uploaded to a billing company of your choice.
As for hospital bills, I scan paper superbills and upload them via FTP to MTBC. It is possible to create hospital superbills in AC and upload them the same way as office superbills, but it is more time consuming.
All money and EOBs are coming to me. We scan EOBs and upload them to MTBC. I usually go through all EOBs before uploading to see if any claim was denied. Sometime I let MTBC deal with denial (i.e.missing modifier), sometimes I tell my receptionist to investigate (i.e.insurance cancelled).

As for collections, MTBC will bill the patients. Patients send money to me. If patients don't pay over a certain period of time, MTBC fowards them to me. My receptionist calls them, and if they still don't pay, we sumbit them to collection agency through MTBC website. MTBC has all patient accounts avalable online, so it is very easy to monitor collections.

Apricot-
Your method is very similar to our practice. We export our bills on a regular basis and FTP them to the billing company. We are putting the hospital patients in the system for now for tracking purposes. We also use a lockbox to accept the payments so they are automatically deposited in our checking account. All check copies, EOB's and correspondence are copied by the bank into their system and then forwarded to us via regular mail. We scan and FTP to billing company.

One question: How do you handle encounters signed after your billing submission date but were seen prior to the date? We have a few of these when my doc gets behind and I have to go back, export the previous month, and manually separate the unsubmitted encounters in MSExcel. This is really the only time consuming part of the process.

EricB,
I simply print out CMS-1500 on the encounters signed after billing submission, scan them, and FTP them to my billing company.

Thanks for the good discussion everyone. I agree that in-house is ideal for the reasons Leslie and Adam mention, assuming you have the people with the skills. Our labor pool here in New Orleans is so thin, if we lost our main biller-person, I'm really not sure what we'd do.

Adam, have you found a way to get demographics, claims and insurance information shared between Medware and AC? I'd love to keep Medware, since all of my wife's patient information is already on there. Or does your biller person simply take each day's superbills in AC and enter the information manually into Medware? Seems like a lot of duplicated clerical effort to have 2 parallel databases like that.

Thanks again, all - this is very helpful to me to think through the various options.

We just started with MTBC, but after about a month we want to discontinue with their services. The workers that are handling our account don't seem to know what they are doing. After reading Leslie's post, we are thinking of doing the billing in house. Does anyone know if we will lose any pending payments that we alread uploaded to MTBC?

Hi. Welcome to AC. This is probably not helpful, because I know NOTHING about billing, but I can't imagine they would not owe you for what you have submitted already. I don't know all of the billers/coders/OMs on here, but you could ask Paul or Donna. They would know for sure.

Bert, thanks (btw AC is amazing!!).
The other thing I wanted to know if MTBC applied the commission to the co-pays of other MTBC users? They verbally told my wife (she is the doctor) it won't be applied, but we got our first bill today, and they applied it. She tried talking to them, but to no avial.

MTBC....goodness, get away from them! That was the WORST mistake I made when we opened. I talked with several offices and providers before we signed up with them...and my experience was nothing like they described.

They did the same thing with us regarding their "comission". They even wanted payment on money I collected that was cash and those that I billed myself.

You should not loose any pending payments because the payments do come to you, however, be aware, they will send they lawyers after you for "breach of contract" and all sorts of things.

I hate to be so negative about any company or person, but they stink! I found myself, 3 months after I started having to learn to bill on the weekend, because I did not trust anyone. I found it was not so hard and was delighted when money starting coming in from my efforts just a week later.

Getting rid of them was worth it.

I won't say I'll never outsource again...but then again with companies like MTBC, I doubt it.

I have been using MTBC for several years, so far not too many complaints. Of course, they do some minor mistakes sometimes, like missing modifiers which I find and correct by looking at EOBs, or calling the insurance (my receptionist does it). I don't think I should expect 100% collection and outstanding work from somebody who only charges me 4%. I realize, that an experienced in-house billing person would collect more money than MTBC or any other billing company. How much more would they collect? How much more would I have to spend for the billing person salary and billing expences? That's a question.
My billing is very straightforward. I submit CPT/ICD codes to MTBC, and I make sure medical necessity is met before I submit them. So far it works.
I used to work for a big group and we paid 10% for billing/collections. My collections were worse then, than now.

Barbara/apricot

Thanks for the input. I feel like our situation is like Barbara's. The good thing (if you can call it that) is my wife's high school friend is a lawyer, and he said he'll take care of that.

When I was looking into different billing companies, a common thing I saw was that they wanted to bill the client on a percentage of the practice gross revenue. I find that completely absurd.

They should not get a % of your copays because YOU do that work, not them. Unless they bill a patient for an uncollected copay. They can have a % of that.

How about other cash services? Dr. C does quite a bit of pre-travel health consults and travel vaccinations. Alot of this is paid at the time of service. Why in the frell would they get a % of that? I already have to pay a % to the credit card processors. But at least they DO something.

Our biller charges PER CLAIM. And that's how it should be.

Our billing service charges per-claim...and for AC users, we can easily obtain the necessary information from providers for submitting claims. We also submit timely and accurately...by the next business day at the latest. Some providers may have spoken with us in San Diego at the AAFP Convention; we encourage all providers to view our website, www.mbpros.com, and contact the numerous references listed.