Home Forums Discussions General Discussion Venting!

I need to vent. I have been awaiting the PM module almost 3 years! I have not purchased a PM system for that reason. If I would have known that AC would take this long I would have purchased a more robust COMPLETE package! I really feel at this point I may have to change EMR's and this coming from a HUGE AC fan and a person who has personally traveled twice in last two years to AC conferences! I understand that the PM module is a bear and we need to function well, but office staff work is ten times harder without it and I personally think I may be done with AC if this is not released as promised in the first quarter! Jon any updates we have not had one-positive or negative since 01/27/2012! I have referred many people to AC, it would be sad to see me change EHR's!

We really need this too. It can't happen too soon for us.

Can I ask nicely how your staff works ten times harder? And what are you using now for billing?

As I have said on this forum before, I'll say again now. If you need a billing solution today, then go buy one today. Amazing Charts' first priority will always be their EMR. It's their bread and butter. Sure, they'll have a PM system tacked on sooner or later, but there is no guarantee you'll like it. Not to mention the fact that, as Hateful Use 2.0 kicks in, where do you think AC's attention will go yet again?

I don't say these things to bash AC, not at all. Despite the set backs of the past few months, I think AC has done a great job. And I have yet another client looking at AC right now.

I say this as a matter of paying homage to the three ruling forces of the Universe:

1. Logistics
2. Statistics
3. Economics

Amazing Charts will always first and foremost be an EMR. Everything else vies for second place.

A PM module for Amazing Charts is still months away. If you need something now, then get something now and interface with it.

JamesNT

Couldn't have said it better myself. We have no idea what the PM will be like. What if it is buggy. When was the last time Medisoft or Lytec's billing software didn't work. I have upgraded eMedware over six times with nary a glitch. And, I certainly don't email everyone I know with Medware asking if it is stable. Again, like James said, not bashing AC. But, you can get away with a slow script writer or not being able to use your TSP800 printer, but your billing program has to work

Get a billing program and use it and then if you like AC's PM and it is stable, then switch.

I've been sole proprietorship since July 2005. I had PM before I had any EMR. In fact we had the PM in place before we assembled one single patient chart. PM is key, you can't function without it. I've been using AC since January 2008. If I had been waiting for a PM, I would have gone bankrupt by Feb 2008. I really don't understand how anyone could attempt to practice one day without PM, let alone 3 years??? Is that even possible???

I use a great little PM software package called Medware by Sage. It's affordable, robust, customizable, and most importantly it works. Customer support is fantastic and for the rare problem we've had, support remotes in and fixes the issue right on the spot. I've never once had to fix a problem myself, they literally always remote in a fix it. Even if I have an issue with an upgrade, they go right in and fix it.

No offense to the hard working staff at AC when I say this, but I don't care if it takes another 3 years to make a PM component to AC. For my practice, it's not something I'm going to use. No offense intended to Jack when I say this either, but I just can't understand how you could wait another 3 hours, 3 days, 3 weeks, or 3 months for a PM.

My advice may not be welcome, but for the sake of your business, just get a PM and stop being frustrated.

Jack,

Again, no offense. But, you probably should have bought a more complete package. There are many out there like Centricity, eMDs, eClinicalWorks, NextGen. You can buy 10 billing programs for the price of one of those.

If you don't mind, what is your flow now? We simply have three things:

AC, a Superbill and a billing program. Why would you not be able to exist like that. What have you been using for the past few years?

I know you didn't expect to hear this and probably wanted to hear better things from your fellow ACers, but if you have been to two conferences and you are using AC for that long, you have to know that deadlines and predictions aren't their strengths.

Like Adam, I had a PM (Medisoft) before AC. Like Jack, I couldn't wait for AC to get their own PM so I could ditch my Medisoft. During my 3 year wait, I've come to realize that having 2 separate systems isn't all that bad, and for me, may be preferable. Although I pick my own ICD-9s and CPTs in AC, it is my in-house biller who dots the i's and crosses the t's (adds modifiers, insures the proper units get recorded, etc.) and the result of that is that I am billing at full capacity with hardly a rejection. It's not really a hardship on the practice since AC, and EMRs in general, have forced me to take on more and more of the menial tasks I used to pay people to perform. Since purchasing an EMR has allowed me to hone my nascent skills as a transcriptionist, coder, Rx refiller, lab reviewer and occasional scheduler, I can't imagine what opportunities for career advancement an integrated PM module would provide me. So, for now, I'm content to do just everything in the office except billing. Call me lazy.
PS. Adam is right. Get a PM. Sage sounds good.
Dave
FP

And, I was wrong?

Hi Adam,

Can you provide a link for Medware by Sage? The Sage site does not seem to have this. I found one other download site, but the link was dead.

Were they bought out by another company? Name change?

Thanks. Gene

I am much the same. I started with DOS to Windows Medisoft. Eventually my the company I used for support convinced me to use their billing service. I still needed Medisoft up to V11 or 12 (aren't they on V465,000 by now, each with a $1000 upgrade.)

I then left them for MTBC about 3-4 years ago, after the first AC conference. They were lousy, but have improved over the years. I still would not recommend them. All my staff has to do initially is output a file and upload it to them. We then have to do clean up in the background.

I too, have been eagerly awaiting a PM system, but you have to have something in place to keep the money flowing.

There are several vendors who work with AC who have no long term contracts. Perhaps you should consider going with them for a 6-12 month period. I do truly hope and believe that the PM will be in place by then. It's the only reason I have remained to MTBC this long.

Absolutely not! (Unless you mean PAPER superbill).
Dave

Man I feel bashed, now that I have been kicked a few times while down Don't worry isn't that the tradition with docs against docs! LOL

My story:

I started my practice with AC and excel spreadsheets and it grew fast! I use excel spread sheets and a great biller and AC. That is all. Now I am frustrate because I have been awaiting PM for 3 years and last I looked it was $6,000 for a PM module and I felt waste of money due to AC coming out with a PM module. However, 3 years later I now wish I had obtained the PM module and that was one of my mistakes I will accept. However, I only want AC to state it will actually be out soon so I DO NOT waste $6,000 now, and I do not have to double enter and if it is out soon that would confuse the transition from my old to new PM (3 systems AC, PM module, than AC taking over PM would be a mess!)

I hope you understand my frustration and I also have a unique area where Medicare/Medicaid is not seen and the MU and all the rest of that stuff means nothing to me! So that has also been a source of frustration. Oh btw I use OA as my clearinghouse and paper when needed!
Jack

Sorry if you feel that way. It's just that we all feel very strongly about waiting for the PM. No one supports AC more than I, but we have all seen this before. Double entry, in the end, is better than no PM at all. The PM may be out in a month or may be out in October.

Since you asked the question, we gave our advice. If that's being kicked, sorry.

Gene,

There is something about this thread that has me completely passive-aggressive, so I warn you before this post.

Is it OK if I give the link?

If you want Medware, you have to go to www.viterahealth.com. Then type "Medware" in the top right corner. That will allow you to download it. There is a Contact Us for the phone number.

Sage makes a ton of products, and there website has never been easy to find especially since they have sold out to Vitera.

Jack,

We also are not Medicare/Medicaid, and MU means nothing to us also. We have been using Medware since long before we started AC. Because its use is so ingrained, I doubt we will switch even if AC comes out with its version. Medware is totally stable, I won't get caught in any "Post beta testing" nightmare, and as mentioned above, it puts a human in the loop between what button I push in AC and how a claim actually has to be coded for payment. We have a skilled coder who knows a lot more than I do about those issues. Additionally, a real PM system has a bunch of reporting functions built in that allow you to compare income from various sources and time periods, which helps in making practice decisions. Yes, I know it can be done in Excel, but it seems easier to use a pre-formatted report.

I also would strongly encourage the view that you will be much happier in the long run to get a standalone system like Medware in place and then consider switching to the AC system a couple of years from now if it still seems important.

Echo David G's sentiments exactly, using MediSoft for many many moons!

Exactly. I have never understood all the excitement over the PM. Without it, AC could be a LOT more time into maintaining and improving the EMR. Medware just works, and I pay my staff to do double-entry, and no, it doesn't cost me anything extra. It just isn't that hard.

Yes, Bert. You were wrong.

Sorry, couldn't resist!!!

JamesNT

Jack,

Glad you vented, because even though our group of 8 docs just recently upgraded our lytec to lytec 11 as our PM, I had a similar question in my mind. I asked our IT guy about switching over to the Amazing Chart PM when it comes out, and he strongly urged to give any new PM a few years, and he said often the software is either strong suited to be an EHR or a PM, but in his experience to do find a product that does both exceptionally well isn't out there.
I have always used a paper superbill and circled the codes manually. But have found that by adding a few quick codes in the admin section, over the past month after dictating my note produce the superbill out of AC and staple to my old paper super bill with all of the demographic data and the gals who do our in house billing love it--easier to read and more efficient with data entry.
So maybe I will be able to PDF the superbill to our in office billing gals in the near future, but for now this is working for me. Maybe you are already doing this but if you choose to go with AC as the PM or utilize another software product, getting into the habit of printing out the superbill from AC seems more efficient and the billers can read the data entry much easier. I hope this does not sound too pedantic, as this is not my intention, just have been amazed over the past month how much easier capturing the billing data doing the superbill this way has been for me. jimmie

Can someone explain something to me. Sorry to be naive but this is my chance at learning. PLease give me a chance to explain my set up. ..yess Bert I am back!

Okay so I started my practice 2.5 years ago and started with AC from the beginning. I have not used a PM. I basically put in my superbills and and print them out and hand them to my biller. She does the rest. she is small and local. i get detailed reports and check them with my deposits and checks and all that.

What are you all using the PM for?

Question: When you hand the Superbills to your biller, what software is she using?

With 4 providers, we benefit from keeping the billing in-house. We did previously outsource this, but billing services also bill for a number of procedure-heavy high income specialists. So, when the choice comes up of working a $300 account from us, or a $3,000 account from a surgeon, you can imagine who got the attention.

Once the billing comes in-house, the PM program is mandatory.. automatically printing insurance forms, electronic billing, etc. It also gives a bunch of reporting functions, like which payor is paying well and which not, in-depth information about accounts receivable, etc.

I don't want to feed your paranoia, if any, but all of our experiences with outsourcing billing ended badly. No one is interested in your money like you are, and if you make your income with a bunch of small charges you are easy to get second rate attention.

Bert:

She uses medisoft. She keeps me posted when she did the newest upgrade but i kind of don't keep track.

Dgrauman: My biller only has 5 of us as clients so every penny counts. So i don't see that i have too much outstanding. I am a solo provider and one part time employee that i don't think i can have do the billing right now.

So far my biller goes after all the money. and i see that. She reports to me when people aren't paid and if i am going to see the patient then i can talk to the patient.

I think i have lucked out. For those that have 3-4 providers, i bet billing inhouse is the way to go, but for me, I think unless I am making 1,000,000 in collections, it doesn't make sense. Unless I can get my wife to do it, but right now she has a full time job.

Any other thoughts on this? Like i should have a PM even if billing is outsourced?

Ketan,
Given your situation I'm not sure a PM program would be all that necessary or useful. You are in fact using your biller's PM program. I assume you can or do get regular reports and can ask for others if you like. Count yourself lucky.

Ketan,
I am solo practice/ sole proprietor, family medicine.
I billed out slightly over 750,000 in charges. Our collection ratio is 62-63% each month which is better than our local average (most are lucky to see 50-55%)

I have an in-house biller who uses Medware. I feel she is very much a bargain compared to what a billing company charges, and I have doubts if they could beat her collection ratio.

I once had a meeting with the few private docs in our region, to discuss ideas and the future of us as a dying breed of physician. We went around the table and asked who out-sources billing v.s. in-house. I went first and said we do it in-house. The next doctor to voice her opinion (one of my former residency attendings and the most condescending person I ever known in my whole life) called me an idiot and in-house billing was the stupidest thing a person could do. Then she said "My good friend does the billing, I outsource it to her. She comes to my office everyday and processes the charges. I pay her a percentage of what comes in."......um excuse me but that is in-house billing. She was the idiot! Of the seven of us that met, only one actually out-sourced, all the others did in-house billing.

I do personally believe that in-house billing can be done for better return on investment than out-sourcing. Plus any insurance questions go straight to her. And my patients like having the billing authority right on site.

Lauer,

I know of a few internal medicine solo docs and some family practices that would disagree with you. Their collection rate is 91-94%.

JamesNT

Hi James,

How are they calculating this?

Medicare is one of our best payers. For Medicare,

99213 we charge $85, they allow $69.31 and pay $55.45.

99214 we charge $120, they allow $102.76 and pay $82.21.

So even if we collect every last dollar of deductable and copay, our collection rate would be 81% on a 213 and 86% on a 214.

Factor in other insurances that pay less, self pays, etc and the percentage drops considerably.

The practices that collect 91-94%- is the denominator what they charge, or what insurance allows?

Thanks. Gene

We obviously aren't comparing apples to apples.

1. How high or low do you set your fees? The higher you set them, the lower your collection rate.

2. How are you figuring your collection rate - are you matching each payment to each date of service that it is allocated to? Are you doing adjustments the same way?

With respect, calculating gross collection rates can be very misleading.

JamesNT

Dr. Lauer (and Gene),
I like a general idea of our collection percentage, so run reports about once a month with just overall totals. It isn't exact, but gives me a good idea. I tend to run off of a total that doesn't count the write-off amounts (Medicare or insurance contracts) as I don't categorize that as collectible income. However, even if I don't do that and go off of straight totals, our overal collection rate is 87%. I can't imagine rates as low as you list.
Your amounts may be accurate and may even be the best you can expect, but at least here, they would be extremely lacking.
Amber

Hi everyone,

As James said, I think we are truly measuring apples, oranges, grapes, and maybe kumquats....

From our accountants point of view, the relevant equation is (money taken in/totalcharges).

I agree, from a practice management standpoint, (money taken in/allowable charges) is much more relevant.

Obviously, the % collection will be very different comparing one to the other.

Gene

Gene,
I agree, but even in that scenario of money taken in/total charges, our collection rate is still 87%. Again, maybe not reasonable for your type of practice or area, but percentages under 80% would be extremely alarming to me in any situation.
Amber

Clearly we have two different scenarios (possibly more) but they do go hand-in-hand.

1. This scenario is looking at percentage from a practice management standpoint. In this scenario you will consider things like total charges, adjustments, payments, and so forth over a period of time and you'll even break it down by CPT and carrier (which means you had better be line-item posted payments and adjustments to charges). You use this approach to fine-tune your business (e.g. not taking this insurance anymore, not doing this CPT anymore, doing this CPT more, coding this way not that way, etc.).

2. This scenario is the percentage of how much you have made standpoint. How much you billed out, how much you have coming in. Nothing else matters (possibly). This is all your accountant cares about. This approach is the one you use to determine whether you want to do this crap any more or just go home.

Obviously, you have to have number 1 under control before you have number 2. HOWEVER, number 1 does not guarantee number 2.

It is important to keep in mind that when I talk billing, I am talking number 1.

JamesNT

This always made me nuts when dealing with Medicare/Caid. I would get reports saying we collected, say, 90%, but it would be 90% of what everyone decided they wanted to pay! That's crazy talk. The collection percentage is what I get in cold hard cash divided by my charges. right now without Big Brother it it 90+ %.

Hi Amber,

Where are you (generally)? What type of practice?

Thanks. Gene

Gene,
I do the billing for David Grauman here in Fairbanks, Alaska and he and his associates are internal med. Now, before you point out that he doesn't do Medicaid/Medicare (which is significant), know that before I worked for him, I worked for a non-profit, predominantly Medicaid/Medicare funded public mental health facility. Even there, we kept at least an 80% collection rate (even with billed out/collected in).
Amber

The taxes drive me crazy. If I made $100 dollars last year I get to actually take home $50. Of this, between Medicare/SSI/Income Tax I get to take home $25. Then I have to use this for gas taxes, property taxes, and others. Of the remaining $18 I have to save for retirement, pay off my student loans, mortgage, kids college, etc. When Obama talks about taxing the rich, he is talking about taxing us in small business, not Bill Gates! And people keep voting for more of this insanity! There's my vent!

Welcome to reality.
finally I found someone who came to the same facts, I did years ago.

Chris,
Taxing us to death is what the grand U.S. of A. is doing to working stiffs like you and me.

Amber, Gene, JamesNT.

I would agree we are not likely comparing the same numbers.
As I stated, our local average collection ratio is around 50-55%. By doing private billing we are beating the local averages at 62-63%, AND I'm doing it for less overhead expense than if I outsourced billing. I'm in Maine not Alaska where rules may be different.

I agree with Gene that if you are a practice accepting Medicare, it's totally impossible to have high collection ratios. We bill approx 5% over the best reimbursing insurers. Using this method we get nearly 100% of our asking price from the best insurers. This means that the worst insurer (Medicare) reimburses in our geographic area at approx 50% of our asking price.

My statements were simply statements of fact, not intended to generate arguments about why so-and-so's practice can get 80-90% collection ratios and why our practice is so horrible at collection ratios. The point is simply that we are doing better than our larger competitors. Why? I believe it's b/c we have a biller with a face that patient's can talk to. They are more likely to pay a small practice like us whom they respect, not a faceless entity in another state with whom they cannot speak to the same person twice. At my office they have one and only one certified biller in which to direct questions. thank you.