Home Forums Discussions General Discussion AC billing service

Hello group!
I was wondering if anyone had any experience with using the AC billing service. It seems like a nice deal in theory. I don't like the take a percentage of all that comes in but I would like to upload to a billing service who can take care of everything and make sure I get paid.
Trying to decide to keep my current option plagued with errors and problems (EZclaim) with a great clearinghouse vs AC billing service. HELP!!!!!!

This is no knock against AC or any other billing service in particular, but here is the rub.... We use a local billing service that knows most of our local carriers. We use an old fashioned paper system that is mailed, faxed and phone called. Others do use an "E" system, but reviewing, tracking and following those gets tedious as well. They are only as good as the interface and your ablility to read them and understand them. Without a way to make various custom tracking reports they are but snapshots that someone else wants you to see. But the devil is in the details and what is harder to watch and track...

BUT, most billing companies care about the "big picture" and not any one little particular claim. They care about volume of claims and bottom line dollars. So especially here in primary care our everyday, est'ed patient level 3's and 4's are sort of a batch kind of thing to them at best. Really harshly tracking and persuing any one claim becomes wishy washy at best. At some point they loss money pursuing small claims that are getting hung up, and so they tend to let those fall by the wayside, hoping that you won't notice them against the larger backdrop.

Personally, what I want to know is whether a system has an underpayment "flagging" system in place. I was looking at Altapoint and they seem to allow you to load your various fee shcedules from different carriers so then as you post a claim, the system will know right away whether is has been properly paid or not. I'd like to see a bundling "flagger" as well, so the system will notice that half your other codes from a particular visit were or were not paid. Right now, whn I read my weekly reports from our present billing company, if I don't catch these underpayments, my billing company and their poorly chosen, though pretty expensive program surely doesn't.

Now in the reverse, if you have a $2000 surgical claim, no less a bad pattern with the same, obviously those get their attention; get it? Those any billing company will pursue with vigor. And that is the ugly truth. In general what you need is a responsible person, who has to face you and answer to you regularly, like a small private contractor or a well respected employee who personally cares about you, your practice and your bottom line. That's what I think. Once we settle on a product and system that is exactly what we are going to do here. We are going to use this very experienced women who has only a few clients, that each and everyone of us matter to her. Even if she looses money on a few claims now and again, it's worth it for her because of customer service and satisfaction. Something most mid-sized and large billing companies just don't care about.

Lastly, I believe Rainy and a few others used AC billing for a while, so perhaps she and they will chime in here, or you can asked them, or go looking for some older posts on the subject and review what they covered. Hope this helps....

Paul

I have never used a billing service before. From my perspective, by the time one goes about inputting the demographics, the ICD-9 codes and CPT codes, 90% of the work is done!!! Why would I want to pay so much money (5-8% of billable) for someone else to do the 10% of work that is left over?
Posting and sending out bills is a pain in the [censored] but nobody does it better than my wife who runs the business!!

I think both Paul and Roy said it well. I have my own in house biller. She cares about each and every claim. As I am sure many of you know, the insurance companies play this game of "we never got it", "that claim was sent up to processing", "we need additional information before paying this claim". Any ploy to delay your payment or, better yet, fluster you so badly you just simply give up trying to get it. I am sure the amounts they never pay are staggering. My biller will not let them get away with even a penny. We run account receivable reports weekly as well as Unpaid Insurance Claim reports almost daily. She will then go through these with a fine-toothed comb and call the insurance companies. She will burn up the fax machine sending things they say they need or never got in the first place. She will stay on their butts until we fluster them and they pay the claim, as well as any finance charges (even if it is only a nickle) for a late payment on a proven clean claim. We almost never turn anything over to a collection agency as she is a ferocious collector. And, she can work the front office if needed. I have had billing services in the past and Paul is right...they have no real incentive to collect that $.30 balance. My billing program also gives me reports such as how many CPT codes I bill and what I get paid for each by each insurance plan I accept. I have dropped plans based on this data. When she posts, she can tell me immediately if something is being bundled. We then file a complaint with our state bureau of insurance and also I alter my exam habits. For instance, when Humana refuses to pay for a Pap done on the same day I see a diabetic, hypertensive with depression who comes in for their annual exam(because they claim it is included in the 99215 charge) I tell the patient we cannot do the Pap that day because of their insurance. The patient must then reschedule the Pap and pay another co-pay. This makes the patient mad, they put some heat on Humana and, finally, Humana quits bundling (as of this month!!) I can't tell you how many local teachers who have Humana badgered, called, and complained both to their Teacher's Union and to Humana. I simply refused to let Humana insinuate that my doing a Pap was not worth a dime while a gynecologist would get paid every time and that a complete exam on a male who did not get a Pap required the exact same amount of time, skill, sample processing and test review and therefore should be paid equally. Once again, gang, if you continue to let the insurance companies make up the rules, we shall all suffer. Anyway, back to the billing discussion...no one has more concern and interest in your bottom line than do you.

Leslie

Leslie, is that my wife you have as your biller?

We have fought over a 3 cents claim and indeed, we have gotten checks as low as $0.03. It cost more money to cash these checks (but it costs the insurance company money plus postage to process a 3 cent check, too... LOL). If we don't fight each and every claim, the reimbursement starts to slowly drop (and I believe that this is a deliberate tactic to see if we are on our toes).

Recently, I have been trying to sign on with CIGNA. They will not commit to a fee schedule. They gave us a laughable "Market Fee Schedule" with only two E&M codes that we actually use. There is a fee schedule that this may not be respresentative of our reimbursement and that the reimbursement changes with market conditions!!!!! After reminding them that they got into trouble for non-disclosure of fee schedule, they stopped corresponding with me. I will turn them over to our medical society and see if they have broken any of the settlement agreements with physicians. The sad part is that there are people graduating from medical school who are stupid enough to sign agreements without an actual agreed fee schedule.

OK. My turn at a conspiracy theory... (ready for this one, Hockeyref?).

Medical schools and residency programs are part of a conspiracy run by powerful people who want to perpetuate keeping physicians stupid, poor, and powerless. My residency program mentioned to me that no one really goes into private practice but they begrudgingly gave a half-assed practice managment seminar because they were mandated.

When you think about it, residencies and medical schools are essentially run by powerful people that employ physicians (it's a way to keep the labor supply up so they can continue profiting off the sweats of their graduates).

I would love to see a medical school and residency program that has a goal to send all of their graduates into private practice. This may be the only way to keep the integrity of this profession from sliding further.

Roy or is that "Elvis"?,
Glad to see you haven't lost your touch. Actually the conspiracy goes much further up. Do you know the present source of Residency salary funding??? $25 gift certificate to the ER in a major metropolitan area of your choice...... CMS, HHS, that's right? "Jonny tell them what they've won...." "A free trip to years of indentured servitude, at over 100 hour per week under the false pretense of teaching them something useful..." (applause)

Yes, this is a way of funding cheap healthcare for all our Medicare and Medicaid patients in major hospitals. There was a total collapse in Residency funding, GME money, graduate medical education, so around 1968 or 69 what is now basically CMS stepped in to fund the salaried slots in residency programs. So these large instititions are getting these slaves almost for free. Now my wife likes to point out that it costs alot of money to run one of these programs, but goodness knows how many office visits and hospital admissions these guys get to bill for under the suppervised doctors. You had Rx writing privilages by then didn't you? You were Dr whomever by then, right? Probably got to bill at full fee schedule for all your visits and admissions, while our gov't paid your basic salary. Why do you think that even then they busted your chops about documenting and coding the visits. For your education???

I think that Docs all across the country should go back to their med schools and residency programs and share the real horror stories with these poor young sheep being lead to slaughter and tell them the truth. I'd love to see all these programs have a lack of people to fill there slots, by very large amounts. You should all join your alumni associations and tell these kids where it's really at. Seriously, anything less is unethical. At least they should be going in eyes wide open, right? Better yet get them in pre-med before they are already sort of committed. Imagine if all of a sudden the line of new docs suddenly dried up to the point that most schools and residencies were under enrolled by 20-30%. Just what do you think would happen? There would be mayhem in the streets as all sorts of folks couldn't get basic medical care at large hospitals. Good Nurses really run the show, and the residence are the slaves labor that keeps it all going....Then we can continue to outsource another line of work, medicine...Oh that's right; we already are! With nighttime uploads offshore of radiology pictures and images with over night reports and telemedicine. And you thought you were immune....

Oh and try to avoid CIGNA. They just abandoned CNY, I kid you not. We now bill our last few rememaining CIGNA patients thru a NYS based plan called MVP. In the short run that is better for us, because MVP is easier to deal with and has a better fee schedule, but what nuts to just up and leave an area as a national carrier. They won't even try and stay and fight our overly controlling BCBS. And doens't that say something about the monoply like control of our local blues. Now perhaps as much as 65% of our local market; so says our BCBS provider rep.

Will the last American with a good paying job please remember to turn off the lights on your way out the door please? Thanks.

I agree...avoid Cigna. Many of the local docs here dropped them about a year ago as they refused to negotiate with us. Meetings were scheduled and they never showed. If enough docs turn their backs on plans the employers who choose the healthcare for their workers will eventually HAVE to choose other plans. It is working here, but very slowly. Mainly because, as Paul said, there are still young, uninformed, unindoctrinated docs coming out of residency signing up with any and all plans.
And, what is my take on the projected shortage of physicians in the very near future?? Rainy and others, I sincerely apologize to you for the forthcoming comments but, this is just what the large corporations want. That way, they can justify putting physician extenders in every corner drugstore, Wal-baums, etc. These providers do not generally get paid what a physician does. I can legitimately speak from both sides of the track as I began my medical career as a Physician Assistant. It scares me, people. We physicians are cutting off our noses to spite our faces. As Primary Care Physicians fade into oblivion, I urge you all to think 2-3 times before handing your colds, sprains, comedone extractions, etc. to a physician extender.
Now I know I have really made some enemies so I shall shut up.

Leslie

I would like to educate the public with the "representative Market Fee Schedule" that Cigna puts out. They consider this (and their laughable contract)"proprietary and confidential." As long as I don't sign on to them, would I actually be in trouble for disclosure of their unethical and perverse business practice.

In fact, I want to template their contract and go get a nice meal at the Space Needle after having the restaurant sign a contract that states I would pay my Market Fee Schedule and display a representative schdule that doesn't have anything that they serve on their menu. I'll decide what to pay, when I want to pay, after my meal (within 365 days).