Home Forums Discussions General Discussion Need to do something about billing

I need a recommendation because I have not had good results with billing. I outsource it now to a local company; the first company I was with was not reliable with actually filing. I switched to another local company: at first I thought they were good because insurance payments were coming in. After six months suddenly I started receiving alot of patients' payments and some (very reliable) patients were telling me they only just received a statement at about that time. I call the billing place and she says they send out a statement every month, but it's pretty clear that is B.S.

Because I prefer to do a lot of disability examinations, I have a relatively small volume of private patients. That probably has something to do with getting poor results from these companies.

Could someone tell me what is involved in doing your own billing? Hiring my own person/people is out of the question. Either I will handle the small volume on my own or take a recommendation for an online billing company.

I won't pay $1000 setup fee so AC billing is out. and MTBC (sp?) at first was going to take me on, but then the rep reversed himself and told me my practice was too small and was not a good business decision to do billing for me and would only give me the EMR software with $5000 charge (this was before I discovered AC).

Is it difficult to do it on your own without experience? Any good company recommended?

thanks!

I have had good success with our billing company. We ftp PDF format billing sheets out of AC to their server as they are 5 hours away in Detroit. Medical Practice Made Perfect The owner's name in Vonda. Although it/we are in Michigan, they may serve Indiana as well. 5.5% of whatever they collect + a postage fee to send out the patient invoices.

I have no relation to their company or services other than being a customer.

We are billing through Office Ally. So far I have not had any glitches whatsoever. You need to have a basic knowledge of coding and billing though. Office Ally people are quite helpful answering questions but again you need to know what to ask, so to speak. I have a principal objection to outsourcing the billing.

What do I need to know? I know my coding is 99% 99212/02 through 99214/03, so that should simplify things. What kind of questions would one need to ask? I know what I know, but don't know what it is I don't know that I should know. If I know enough, I'd do the Ally thing.

I do not know what you know or you think you know. I do know that whatever you need to know you will know if you really want to know.
Anyway, I am talking about things like if you see Pt for DM and ST you should put code for BS 82947 before 250.00 and code for strep 87880 before lets say 463. You do it wrong and they will pay for the visit but will deny few bucks for BS and $12-15 for strep.

hm.... I don't do much extra like that, but I can see how that could happen. If this is something I can "learn by doing", with a few minor stumbles along the way, I'll do it.

The problem with outsourcing for me is, for example: I told this biller when I first contacted her that I have a very small volume and she insisted that many of her clients are small practices. Then you fork everything over and they do whatever. I don't know how to know I can trust a biller. They will give you references of people that never have a complaint so what's the use? Or maybe they are big enough practices that they don't notice a few hundreds of dollars in lost collections.

At least I know how much loss is due to myself if I handle it. What do I need to do to switch the insurers from the old billing company to my office? In the past, the new biller had things changed, but obviously I'll have to do that. Do I have to contact every insurer separately and give the new address/phone number?

What? Is there a translation guide somewhere so others can follow?

Do it yourself. It's NOT HARD at all. I had the fear of god in me that it would be horribly difficult and I would starve if I did it myself. I was wrong and I have a lot more coding than you'll have to do.

I'm not sure how much per year or per month you are spending on your biller but there are easier options.

Use an online program like TotalMD that's only $99/month. Straightforward, easy to use.

The thing you will have to do that is the more time consuming part is chase down denials. Hopefully there won't be many and with 99% of your codes being simple E&M codes, it shouldn't be tough. I rarely, if ever, have a denial for an E&M code. Mine are always big operations where the insurance company is trying to avoid paying me.

Of course, a lot of people have good results with Office Ally as well. I just don't know how that works.

In the end, you can do it. It will save you a ton of money. You KNOW it is being done correctly and every claim is being pursued appropriately.

My wife does it for me and she easily spends less than 10 hours per week doing it.

You do not need to transfer anything from your current biller. Just contact Office Ally and they will tell you what to do. I found them to be very helpful. They also have manuals and web training. I am using their billing module and practice management module called practice mate. Mr. Scalpel is right: the most important thing is chasing denials and it is much less cost effective for us as family doctors than for surgeons.
On the other note it is quite frustrating that we have to deal with all those issues outside AC. It does not have to be this way. Unfortunately, I see some users actually urging the owner not to attract the capital (not to get "sold to big companies", etc) Here we have a great EMR - Amazing Charts, produced amazingly well by family doctor. And I say great product not necessarily because of the price, I had a chance to evaluate closely eCW, soapnotes and a few others. I liked AC best. But AC needs a further development, rapidly and simultaneously on many fronts. That can not be accomplished without investment and big muscles behind the whole project. There are certain rules in play when it comes to business and it does not matter in principal if it is EMR company or publishing company or computer or car production. I do not think there will be any more advantageous environment to sell EMRs than now. Stimulus money (even if it is a complete BS it still generates a lot of interest), the fact that the health industry is one of very few which is not "under" yet, general feeling among doctors that EMRs are inevitable - all these factors contribute to urgency to come up with COMPLETE product for small or medium size medical office. Why did eCW sign up with Sam's club? Why AC is not sold at Costco? Because management at eCW works accordingly to old russian saying - it does not matter if we are trying to sell a "rotten" product as long as our buyer is blind. So they put a lot of resources "to blind" the buyer so to speak. AC is superior product by itself but needs resources for development. The Owner does not have to surrender his vision and direction. It can be accomplished in a way Steve Jobs directs his company. ( I am not a fan of Apple but I do respect their business culture).

A good read that argues against this suggestion is the Mythical Man Month by Frederick Brooks. The book is one of my favorites.

His main points were 1) adding more resources makes a late project even later, 2) a design of a 2nd system or major version is very susceptible to over-engineering and 3) keeping conceptual integrity helps ensure a user-friendly system.

Software may deliberately provide fewer features than it is capable of to maintain that conceptual integrity (as AC pretty much has done so far). If a system is too complicated to use, then many of its features will go unused because no one has the time to learn how to use them.

There are many threads here dedicated to arguing Amazing Charts growth and features.

I need to do something about billing

You are right. I am sorry I hijacked this thread. My point was it is quite sad that we still have to discuss these very basic for successful EMR issues here.

I really appreciate the tips, Re: office ally. It is looking like I may give them a whirl.

I'm just trying AC right now. I don't know if it does this, but can it output HCFA files? If so, most EDI companies can take a test file and pull all the info off and send it out for you. We use GatewayEDI, send them a text file that our PM program produces, and they take care of the rest.

Collections are our headache, but the claims are sent out, and progress from most of the ins. cos are available online. They also sent out our secondary claims. $99/m.

Others are probably about the same cost.

Of course this is only good if AC can produce a claim file, which I stated at the beginning, I don't know yet.

yes, AC can output HCFA claims.

If it can make a text HCFA of all the day's claims, then you can send that to Gateway or the EDI of your choice. They can pull the needed info and send electronic claims out for you.

Most EDI companies also have tools to see what the claim status is. As I stated Gateway also sends out secondaries for us. This is on companies that provide electronic info on the status of the claim and when and how much was paid.

The others that do not receive electronic, they just send out on paper. You have to send the secondaries related to those yourself.

I think they will also do other things, but there's just so much I want to allow them to do.

Hope this helps.

Solomio,

Get copies of CMS 1500s for all your insurance companies that have successfully paid. This will give you examples of what you need to put on each form to have a "clean claim" that is acceptable. Once you finish your days notes go through signing your chart and putting your billing info into AC. Check this against your verfiable 1500. When you have these down and you are sure they are correct and after you sign up for office ally simply data enter them into office ally. You will only need to this once as the patient will then be in the data bank. You can then send the claim. The claim check will make sure all the fields are put into form correctly. If for some reason the claim is denied office ally will reload the claim and you will fix it and resend it. It is really not all that difficult. I will help you. Send me a personal email to my box and we can share phone numbers if necessary. I am up an running and only paying someone to do data entry. The insurance companies will tell you why claims fail and how to fix them for the most part. It is really simple data entry for the most part. g

awesome! I'll get around to that for sure.

Peter,

I have read your previous comments. I am a solo IM/Pulm. There are advantages and disadvantages to having your biller in house. Having your own biller will allow you to keep a closer eye on how much money is being billed out, how timely payments are and you can often process denials quicker. However, if you are small, and only have 1 biller, that person now truthfully holds the key to the cash flow in your office. Regardless of how many patient you see, or how many other evals you do, if those charges aren't processed and submitted, your cash flow is sitting stagnant on his/her desk.

I have been in solo practice for nearly 8 years. My first biller was very good, but eventually became quite power hungry and believed that she made the decisions about practice development and the like.... so I let her go. Living in a smaller area, my options for billers with experience were limited. I have had 2 other billers and each opted to go to a place with more money. One was irked that I would not pay for the link to let her work from home. It is hard to find a biller on such short notice, as when an employee leaves there may be 1-2 weeks or often no notice.

I use a billing company out of Pennsylvania called Medical billing professionals. We doe the charge entry.... ie E/M and procedure codes if any for both inpatient and outpatient work.
You prepurchase your claims in bulk.... do not pay a percentage.
They will bill primary, secondaries and the like.

My cash flow is not held hostage if my biller is out sick or on vacation. And I have no salary/benefits to pay for the employee.
Yes, I am paying for it in the data entry protion of things, but that far outweighs the cost to the business for an experienced biller. Additionally, I am not responsible for maintaining the training of the biller/billing service.

Just some thoughts.

Another option I am seriously considering is to go cash only.

Leaving aside the question of one's ability to attract patients to that, which depends upon the local market, anyone know how to go about extricating oneself from the "medical corporate industrial complex", (as hockeyref would call it)?

Do I just call up medicare, medicaid, etc and say, "I QUIT!", probably need it in writing. And how many months notice they need? I don't think I'm allowed to just stop accepting it without giving several months notice.

Start here: http://www.aafp.org/fpm/2003/1100/p15.html

Then here: http://www.aapsonline.org/medicare/optout.htm

thanks