Home Forums Discussions Coding and Billing Billing Companies

Which billing company do any of you recommend? Some I've heard of are PGM, Cascade Billing, Diversified Health Care Mgmt.

Dr. James Webb
K.C., MO

Why not do it yourself? Why give 6-10% away. Look at Office Ally or its other component Practice Mate.

Unfortunately, I'm new to this area. I'm the boss now in a solo FP practice. I inherited a business person, but I have found it difficult to get my questions answered.

Dr. James Webb
Solo FP
K.C., MO

Why would you want somebody to count YOUR money? Office Ally works for me.

The inherited business person should have some decent thoughts on this. Did you inherit a biller? They MIGHT have some decent thoughts too.

We used to have a nice biller, with a great below-market price (Alice was her 2nd client and was grandfathered)but even at her prices we decided to go internal. Alice completes her coding immediately after she writes up the chart. She sends me a message. If you do this, THEN all you need is a clearinghouse. I chose a free one (Office Ally). You also should have some type of PM program. You can use Office Ally for that (PracticeMate) but you will have to enter all new patients manually. Or you could try EZCLAIMS as your billing software, or Availity. There are some others.

In order of preference since I am lazy.
Have your wife learn how to do the billing
You learn how to do the billing
Hire someone part-time that will help you do the billing
Hire someone that does the billing
Get a billing service.

The billing service will have tons of reports and certainly can answer any question, but at a significant cost. 6% of receipts can pay for a lot of help. If you do get a billing service you have to watch where you stand on their priority list, as you can drift downward.

This is really the crux of being in business, and we have to know everything about it, since this is where embezzlement and the money falling through cracks are located.

I've heard that only 85% claims are eventually paid, so watch your aging like a hawk. This is where insurance companies make a lot of their profit. It is the shoplifting of the medical industry. You and your wife are really the only ones who are motivated to fight for every claim to be paid.

Here is my experience,I run my practice with only my wife(front end) and myself (back end). We do/did it all used Lytec for PM we were very good getting initial bills out to ins companies(posted/scrubbed/submitted/accepted/paid usually within 2 weeks).
Problem came with billing the secondary insurance or patients for the remaining balances after the EOB's came in. It was more time consuming and would go way back on the back burner ie not done in a timely fashion.
We then had a hard drive failure on main office computer only to find that the backup system setup by the Lytec certified reseller had never backed up the PM information so we were left hanging.
Decided at that time to look into a billing service @7.5% of collections. They are better at getting the secondary bills out but are not faster getting the initial bills out which may be a system problem and not all on their side. I am awaiting AC7and def consider bringing it back in house maybe hirer aparttimer for 12 -16 hrs a week to free up my wife for concentrated billing time. We will see if the SGR cuts go through who knows how that will change the picture?

Medicare now does a much better job of crossing claims over to the secondary payors than in the past. Rarely anymore do I have to copy the Medicare EOB, print a HCFA and send it to the secondary. Still, the biggest headaches are the claims that are denied for no good reason, like the guy who has to have his cerumen removed every 8 weeks or so or he can't hear and Medicare says that it won't pay because it deemed the procedure unnecessary. Those you have to call on and that's where a lot of time is spent. I have a retired biller come in one day a week to handle those annoyances, probably could get by with once every two weeks, but she also does all the scanning of the mail.
You still need some kind of PM program that does the accounting and reporting. I am using the same one I have used for almost 15 years but, if I were looking to start new, I would look closely at Practice Mate.

We have made so many mistakes over the last 20 years with billing. Now, I look at it as a profit center in the business. My wife probably doubles our income.

There is money falling between the cracks so we have to decide whether it is cost effective to get it. Primary, secondary, patient remainders, it all takes continuous quality improvement to stay profitable.

If your spouse is involved, use them for auditing, supervision, troubleshooting, and the highest value/time functions and hire help for the repetitive stuff.

Before I get started in my reply, let me disclose the fact that I work for a billing company as software development and IT support.

Whether or not your outsource your billing is depedant on your situation. For some, they would rather do it in-house. Billing for their speciality is easy enough, they have the expertise, and they have the time.

For other practices, life isn't so simple. Perhaps their speciality is more complicated, they are seeing too many patients a day so they don't have the time (unless they don't want to get home until midnight every day), and they don't have the expertise.

It all depends on your situation. Based on the data I see every day, our clients have neither the time nor the expertise so contracting with us was the right thing to do. For the larges practices, it's cheaper to go with us and pay that 6 or so percent than hire full time staff at ~$25,000 - $35,000 a year or more.

Think about the situation you are in. If you don't like your current billing solution, get another one. It's your money.

JamesNT

I found it was an issue of staffing. I could probably get by with a receptionist in the front office and MA in back but found having a 3rd person to do the billing and also allow for coverage of the other positions made more sense to me. If someone is on vacation or out ill I can get by with the other 2 and do not have to worry about finding a temp on short notice.
We use Office Ally along with EZ-claims and are waiting for V7.

Greg

Over the last 20 years, we have done our own billing in-house with medisoft, outsourced to the local hospital's billing service, outsourced to a larger national billing service, used an web based billing/emr system, and most recently have been using Office Ally in conjunction with AC. One issue I have had with billing services is being Family Practice, with a majority of my claims being worth less than 100$, we didn't seem to get top priority for tracking down secondaries and such...figure if the service had the choice of assigning one of their employees to work on the 5000$ neurosurg claim or the 50$ family practice claim, needless to say, we got moved to the bottom of the pile. So, the 7 or 8 or whatever percent they are taking actually can add up to a lot more than that when you figure in money they let slip thru the cracks. Of course, on the other side, you can run in to the problem I had today when my staff member that does a majority of the billing dropped the "I found a new job and will be done in two weeks" bomb. In a small office, it can be hard to have a lot of cross over training when you have limited staff, so that usually means the billing falls back to me until I get a decent replacement. Two edged sword, but still, with the experiences I have had so far, I would still say we have been most profitable and felt the most in control with our practice financials when we kept it in house. Plus, patient satisfaction has by far been best with us doing our own billing. Being a small practice in a small town, our patients definitely appreciate being able to deal with us about their bill rather than calling who knows where with some 800 number.

A little off topic but anyone using the IPAD square for collecting at time of service???

OK...upfront...we are a billing service...and it amazes me reading in these posts about docs paying 6-7% to a billing service...a big rip-off...We charge anywhere from $1.55 to $2.75/claim depending upon your level of service, and have been in business 18 years. Check out our website, www.mbpros.com, and our references....Depending upon your volume, it may be worth it to outsource. On the other hand, I also tell docs that if you can hire someone who is good and who will be with you for a long time (so you do not have to constantly train new staff), it may be more cost effective to hire one person to do your billing in your office.

Steve

@mbpros but do you guys when a claim is denied automattically resubmit and appeal? or is that a second claim? on average when looking at billing in our area, 1 out of ever 12-14 claims are automatically denied to see if we are watching...

Dr. Jim,

I have inhouse billing staff. We use a product called Medware and subscribe to its clearing house called Emdeon for approx $50-60 per month. claims go through electronically and we are receiving all major payers via EFT (Electronic Funds Transfer), and thus see rapid turnaround time in our claims payments and helps us keep aging accounts at a minimum. Accounts Receivable over 120 days in our practice was 2.1% last month, which any biller will tell you is good.

I prefer to keep billing inhouse because I can SEE the people everyday who does my billing. And I don't have to remain on hold with someone in India who says they are doing my billing when I have questions. I can go right to the source. i also know they are staying on top of my billing because their jobs depend upon it.

Outsourcing may have the convenience of less worry about whether they will quit or retire or move on to another job. But you have the constant anxiety as to whether they are staying on top of your practice, or letting it slide. And when they send you reports, can you trust they are accurate? Do they charge you 6-8% of what you charge, or of what they collect (that's a HUGE difference and VERY important point to delineate)? Are they billing your secondary payers? are they following up on rejected claims/ dirty claims? Or do they only submit each claim once at 2-3% without followup on any claims data? Do they send statements to patients once, twice, thrice? Do they hound the insurance companies that aren't paying? If so, how aggressively?

Be very careful outsourcing. It's virtually always less expensive to do it inhouse and should afford a much better opportunity to stay ahead of the game. Everyone knows doctors are usually bad business people. Lawyers know it, Medicare knows it, and outsourced billing companies know it. the fewer strangers handling your claims data reduces your exposure to fraud being committed unknowingly on your behalf, or embezzlement against your business.

I'd like to answer Dr. Lauer's worthy questions:

And I don't have to remain on hold with someone in India who says they are doing my billing when I have questions. I can go right to the source. i also know they are staying on top of my billing because their jobs depend upon it.

Our staff are all local members of our community. All Americans. You have remote access to our software via Terminal Services and can pull your own reports to your heart's content. Questions are always welcome and you can email/call your account manager at any time. If you do get voicemail, we will call you back promptly.

And when they send you reports, can you trust they are accurate?
Yes. Your checking account should match what we tell you. You can see everything in our system because you have remote access. You can double-check at will.

Do they charge you 6-8% of what you charge, or of what they collect (that's a HUGE difference and VERY important point to delineate)?
We charge a percentage of what is collected. It keeps everyone honest that way. If you don't get paid, we don't get paid.

Are they billing your secondary payers?
Yes. We currently have 685,530 patients in our database across all clients. 157,558 of them have a secondary insurance. 9,663 of them have a tertiary insurance. We'd be crazy not to do secondaries and tertiaries.

are they following up on rejected claims/ dirty claims? Or do they only submit each claim once at 2-3% without followup on any claims data?
We follow up on all claims. We resubmit any claims that need it when we figure out what is wrong with the claim causing it to reject.

Do they send statements to patients once, twice, thrice?
Currently, we send up to three statements to each patient (obviously, as long as they don't pay). If they don't pay we send up to three collection letters. If they don't pay by then, we send the patient to a collections agency. For some clients, we send patients to collections after the first collection letter because they want it that way. We are flexible as long as we follow the laws of their state regarding collection agencies.

Do they hound the insurance companies that aren't paying? If so, how aggressively?
Ever see the movie TERMINATOR?

JamesNT

If that many are denied, something is wrong with the coding or submission. On average only 3-5% of claims should require follow-up work. If you are in the 12-14% range, you may want to look at why you are having problems...Some problems regard coding, some may be incorrect patient demographic info, and some (although very few) may be because of payer error.

Steve

Does it interface with amazingcharts?