Home Forums Discussions Feedback and Recommendations Billing Program

We currently use an out of house billing company and want to bring the billing back in house. We currently use Amazing Charts EMR. I have checked the list of programs that will work with Amazing charts. I know we have to use the X Link. I am wondering if anyone is using one of these programs and if you are having any complications. Most of these companies want us to just switch to their EMR programs as well. They will charge to do the conversion. We want something that will be compatiable and simple for the staff to use. We would like to be able to access reports as well. Do you have a billing program you love? Any ideas?

We have been using EZ Claims for two years. It is pretty user-friendly. You simply export data from AC to EZ and go from there. We bill electronically thru EClaims (a clearinghouse unrelated to EZ Claims) which works very well. There are some problems with EZ Claims as far as simple data exported(names backwards, insurance ID's flip-flopped) but your biller can correct these when reviewing charges for claims. It's cheap, some bugs, but for the price, it's fairly adequate on a small scale where you have the time to correct simple data imported. I know there are others out there who will add their experiences with different programs...

We tried using Medisoft several months ago. Despite having it professionally installed and spending thousands of dollars on tech support, the program never functioned properly. 1 out of every 3 patients was dropped during transfer and subsequently not exported to the clearinghouse, equalling no patient encounter being billed. After 6 weeks of having tech support remote in and working on the software, we had to abandon this method. It never worked and we were behind in billing for the entire period. I love Amazing charts and do not want to change my EMR, but need the practice management component. Any suggestions to a system the works well with AC?

We use Emedware by Sage.
It works reliably for us. We use this separate from AC, they do not interface.

If you want cheap that interfaces then EZ Claims is probably the ticket. It may be a good place to hang out until we all see what 4.0 (great Jeep engine the 4.0) can do... I'm hoping that it's delay means that it will be fairly good first time around. That Jon is trying not to have a flop on his hands and so he is waiting until it is at least half way presentable.... That's what I would do, wouldn't you???

One of my buddies uses OfficeAlly and he says all he needs out of AC is Accounts Receivable and Aging analysis and he would be satisfied.

We are looking at exporting AC billing info into our billing software (Wisdom). The major problem (in our opinion) is that AC only has a standard fee schedule and no Medicare fee schedule. It appears to us that each MC encounter would have to be changed to the MC fee which is very labor intensive in my practice. Is that correct, or am I missing something?

Ron

Our office bills the same fee schedule to everyone and then the companies do their contractual write offs, etc. We aren't allowed to have a different fee for Medicare than the others - is it that you want to charge different or just keep their allowable amounts in the computer ?

I share the same question as Steven.

My practice manager tells me that it is illegal to have different fee schedules for different cariers.

I know that this is one of my long posts, but it really is full of important information, that we paid dearly for to learn via membership in the IPA/PO as well as consultants, and now you get to share in on it for free as my starving friends here at the AC user board. So don't say we never gave you anything. Anyway, read careful and understand. BTW, you're welcome....

I think the problem the confusion here is that people tend to use the same term for two separate but similar concepts. We the providers have our "fee schedule" our bottom line, "charges". This is the term to use to distiguish your fees verse anything else. As the law basically states (which is a complete joke, but the f'ing cartels own our gov't and so here is the intent of the law) we must "charge" everyone "Equally". Now obviously we don't because these bastards demand and force upon us whatever they are willing to pay. We can't sit there and say, "screw you I charge $75 here for this level 3 pay up or shut up", nor can we even balance bill the patient for the difference between our $75, the carriers cheap@$$ $50 for a difference of $25. But all of that not widthstanding, we MUST charge everyone equally, as though we are treating people separate and unequally, really no CCHIT. So the safe and basically legal thing to do, is NO MATTER WHAT, all invoices, bills, 1500's must have the same charge for the same code on them... Period short the end. To do otherwise is to risk the almost certain wrath of hell from the carriers and the gov't alike. (we will get back to that in a moment)

Now there are also the carriers' fee schedules (although try calling them up and actually getting a full print-out or excel file with your "agreed upon rates" even though you have a contract that states this contracted rate exsists! Simply Amazing. This is allowed to continue like this, they are anti-trust waived while we have those same laws strickly enforced upon us for these corporate giants).

So most quality PM modules, programs will allow you to enter various fee schedules for all the carriers and even products (since there is usually a difference even amoung these too) too. Different programs have various different levels of control, reporting, and FLAGGING, of your charges verses the carriers payments or fee schedule. I am in the process of investigating for purchase and perhaps even becoming a VAR for a particular product because I believe as memory serves me, they even had a good "Flagging" of these differences and write-offs. So let's use the same numbers again.

You charged $75 for a level 3, you have entered $50 as your excepted payment (minus co-pays of course) for this code (99213) for a certain carrier (@ETN@) but the sob's only sent you a payment of $45 dollars (assuming no copay here for the moment) a really good program should do some form of "flagging" of this under payment (which they do all too often, hoping that we won't notice buried in a large EOB and batch of payments, no less do we really want to waste $10 of staff time fighting for $5... But this is a fair fight right?) so you can be aware of it and hopefully attend to it. I swear that their software must even have randomiszed under payments in it so it goes out very sporatically so it is hard to spot a trend except between practices and because we are not allowed to talk (except in certain IPO/PO type situations where both sides have agree to commom terms and conditions for all members of the group). Nice right? But these guys are the victims here, of us terribly criminal, stealing under hadned providers??? Yeah, right!

Now the real issue of breaking the law is to "charge" different people of companies, carriers differently. So like so many of you probably do, (which we really and honestly never do, I will not put my wife the mother of my kids at risk to save someone $10) is to give let's say a cash paying customer a $10 discount for cash on the barrel at time of service, even if you DO NOT PAR with this person's carrier or product.

Because the gov't and the carriers will come back and throw those 'discounts" in your face and claim that you don't really charge $75 for a 99213, you are really only charging $65 for this code, based on your collection from cash patients. Now whether they must at least or you can get them to at least do some sort of add and divide math here, to balance out all your charges is another matter, because you are already back on your heels playing defense at this point trying to hold off the tidal wave coming at you.

They will try and will probably will win, give backs for your "over charges" even if you don't actually get in legal trouble for insurance fraud for "over charging" them even though they only paid you $50! No CCHIT. And how do they finally get you and your expensive lawyer to agree to all these undeserved give backs??? Obviously with the threat of charges of insurance fraud held over your head, that's how. So even though they don't even pay you enough to make up the difference here, they will use this ammunition against you, and they will. These SOB's do it everyday....

Trust me on this, and it varies from state to state. The word around NYS is they are very big in prosecuting these types of things here in our fine state. And then there is the worse kind of fraud charges that come from Medicare and Mediciad. And don't forget because you have contracts and have legally signed on with all these various products and programs the carriers and the gov't have full "rights" to come on in and look at almost anything they want at almost anytime they want to. You have no real choice in most situations but to let them in to look at the charts and the billing too. Now obviously if and when any of you ever get that terrible phonecall or letter stating they are coming and want in NOW, don't let them in right away, stall for time just a bit and call both your private healthcare attorney, possibly your inept medical society and your malpractice carrier's legal dept too.

So the bottom line is there are your charges, what the sob's will pay, and that is the difference in fee schedules. But even for the carrier that pays you $50 for your $75 99213, always submit a bill, an invoice, a 1500 for your always the same charges of $75. And if you care to stay safe and our of the reach of these SOB's still charge even your cash on the barrel patients the same. No cash discounts, no matter how much this pulls at your heartstrings. Where will any of these folks be for you when Medicare comes and tears you and your office apart? No where to be found...

Well on that happy note, have a great weekend and enjoy taking it up the shoot on all your charges.....

Paul

Hockey, I had nocticed in some programs the ability to set different fee schedules for different insureres, but my gut told me "don't you do that." And you just voiced what my gut was warning me about.

We would like to (if we could actually afford to) charge some of our low-income, unisured patients less, but I think to legally do it I would need to 1) set up a special fee schedule for them, and 2) Ask for alot of personal information (like their income, etc) and then save it in case of some type of audit I can show this is a formal program based on "ability to pay." But I really don't have the energy to set it up. Or to even research it to insure I set it up properly.

Wayne in order to legally do what you are seeking, do something called "date of service payment discount." This is set up in your office as a simple written policy.

For example: 'For 99213, Pay our office on the same date of service and our standard $85 fee is reduced to $50.' This policy applies to all insurers, uninsured, underinsured, etc.

If Medicare and Aetna and Anthem and all the rest would actually pay you at the point of service, you would reduce your charge the same as you would the cash pay/uninsured patient, according to the samply policy above.

HOWEVER, You and I and everyone else knows that the insurance carriers will NOT pay at point of service, so this effectively singles out the uninsured patients and cuts them a deal. The way this benefits you is that you see your money that day, not 3-6 months from now.

AND the $50 charge is equal to the $85 charge because your biller did not have to send out 3 statements to the insurer, did not have to get on the phone to argue w/ the insurer, did not have look at that bill ever again and decide if it is 30, 60, 90, 120 days past due.

In fact, I would argue (as would many who run low fee/cash only practices) that you actually keep more of your money by charging a smaller amount of money that you collect at point of service than by wasting staff time (your money) trying to get your larger fee from the insurer.

Your question also addresses the concept of sliding fee scale, i.e. the ability to pay based upon your income level. I may be wrong, but my understanding is that a private office cannot do this. Some or all hospitals can do this and FQHC's (Federally Qualified Health Clinic's) can do this. I believe we are unable to fix our prices according to a person's or an insurer's ability/willingness to pay. But we can provide point of service discounts.

Jeeze. I must have been doing it wrong all of these years. We have been billing what Medicare allows so my write offs don't look so huge.

Adam----thanks! And thanks for saving me the time and effort researching something that we wouldn't be able to do anyway.

Exactly Adam, that is what we do for our cash patients. Works great for both us and the patients. Just have a cheat sheet at the front desk for your reception staff so they know the charges. We also give our cash patients a letter showing the difference between paying on day of services fees versus the standard fees. That alone gets a lot of people to pay at that time rather than be billed. As a matter of fact, when people see the difference and still opt to be billed, we have found these are the folks most likely to stiff you. Funny how it is ok to get service at a doctor's office and walk out without paying, but if you did that at a restaurant, the police could come arrest you. Guess we rich doctors are just supposed to eat that cost.......wow, I am starting to sound like Paul! Must have read too many of his comments!

Guys before you all end up owing, yes f'ing owing these bastards lots of money you are only half right. Yes it is your business and I guess you can do whatever the heck you darn well please in terms of billing and policy but here is where it gets sticky. And worse yet if you end up on the wrong side of this with the carriers or worse the gov't Medicare ya, but state Medicaid (NYS loves this Wayne, please be careful) you could be in serious hot water. Please I don't want to hear of any of you getting raked over by some state AG or something. You have been officially warned as of this next statement!!

Let's use that same 99213 with the $75 charge in a typical PAR practice. Now lets assume like here in CNY that Medicare pays approx (public infor no discloser and talking issues here) approx $57 for this charge so now you charge $75, get $57 and write off $18. So far so good, right. Meanwhile let's just say for arguments sake your local BC/BS pays about $65 for that same code, so you Charge $75, get $65 (no copay for now) and write off $10. Everybody with me so far.

So in come little Sally Single Mom with a McJob and she has McBenefits (none). So seeing that the gov't only pays you really 80% of $57 that you then need to do a double claim on just to get your full $57, and none of your local carriers meet your charges anyway, let's say for argument sake again you charge her $50 cash on the barrel, Paul and Nancy's favorite, PIFATOS (pay in full at time of service). Well since these SOB's are a real CARTEL and can and do talk among themselves and share all sorts of data, they are going to try and track your claims. So they want to see how you charge EVRERYODY!!! Well it turns out that you really aren't charging "everybody" that same $75 for these level 3 est patient visits, you are really only charging some and not all people, especially insurance carriers and the gov't!!! Red flags and lawyers everywhere!!! They can and will argue that you frequently only charge $50 for this 99213 code especially to private pays and only charge the carriers your full $75 charges. They can and will force you under threat of insurance fraud charges to reduce your charges to some form of any average between the two of $75 that you have been charging only the carriers and the $50 you have been charging your PIFATOS patients for cash on the barrel.

If you are lucky you will only have to borrow tons of money from friends and family (the bank certainly won't here) to give these bastards their "give back" for over charging, as well as pay your team of lawyers and quite possibly a nice tidy fine too. And good forbid CMS and the Gov't gets wind of this, now you are really in a world of pain, NO CCHIT! Now most of us will probably never under charge past Medicaid and only those who accept and charge straight Medicaid really have to worry about that, but if you should ever be on the wrong side of this same issue with your state medicaid, just slice your wrists and get it over with, because you are truely screwed then. There is no prosecution against a doc that is more extreme and you are going up the river then a state medicaid fraud charge, trust me. You never even want to be only one step on the correct side of this on. Never give them half an inch to get near you. Always avoid anything that can remotely seem like you are messing with these guys, because if they ever get a hold of you, you are toast!

Their logic is based on your own charges, you don't really charge "X" for these services, you only really charge "Y" for them and so therefore you owe us lots of money and possibly a penalty too. If you are really lucky they may just let you work for free until you have done enough free work for them to equal at their rates not your own, what you owe them in give backs. Heck they do this to folks simply based on poor charting and documentation, you don't think they are just waiting like hungry wolves to catch you doing this stuff. Sure right....

Lastly, each and every time each and everyone of us submits a charge it should be going into the community rate figures that these SOB's collude on all the time. We as a group don't want to be officially reducing our rates ever! This is the main reason Congress in it infinite wisdom gave these SOB's their anti-trust waiver in the first place. To set the community rates and a lot of that is based on what we charge verses what they pay out. This is where Usual and customary is supposed to come from.... So everytime one of us under charges we are really only hurting ourselves.

I'll end on this question..... When was the last time one of you actually bumped up your fee schedule??? Goodness knows that except for one or two charges we have not had good reason to bump ours in over three years now. We set one when we opened, and things went modestly up and so we were slightly undercharging on a few things, I review our schedules from various payors, and made a few adjustments that second year and since then we haven't had any payment increases in the last three years to justify adjusting it again.

We (us and you too) are all probably charging too little as it is, especially in light of all the crap these sob's have us do for them and their "system" each and every day. I refuse to continue to slide backwards from here. My G&E bill hasn't slid backwards, neither has my rent, nor has Nancy's Malpractice (actually here in NYS our has just about doubled since we opened only just about five years ago this coming month) for that matter. Instead of giving in to this backwards slide, we need to insist that the money be redistributed where it actually belongs, not going to CEO's of drug and insurance companies, but to the professionals on the front lines providing healthcare in this must messed up situation here.

Although I may not be cranking Nancy's fee schedule up, I certainly refuse to reduce it one cent. It is time for people to understand that quality healthcare is going to cost some money. And the money for the most part is already there, we are just allowing the non-provider side to steal and keep all of the cream scraped off the top and they are not sharing it with neither the patients in terms of better care, nor you the providers in terms of proper fees. Especially office visit, rubber meets the road type fees. E&M "Management type fees... Screw that. me personally I'm going to try and at least to not slide backwards, I'm going to try and keep U&C at least where it is. My wife worked too hard to get where she is today to be mistreated and underpaid, and disrespected so. Our fee schedule holds, it is not that bad in the first place.

Most lawyers are getting $250 or more an hour these days. They studied at least 4-5 years less than any of you and don't get woken from a dead sleep 3-4 nights a week, they are not on call 24/7 and they are not being hunted my themselves and the gov't at every turn. Don't you feel you are worth at least as much as the average lawyer??? I certainly do....

PS: Dave actually I have always said that about "drive-offs". Funny how the gas station down the street gets to call the county sheriff in someone drives off on them, but we are just supposed to eat it as you so properly phrased it. We had a patient who's spouse called us so Nancy could call the county lockup so she could get her meds while awaiting arrignment for passing bad checks!!! No CCHIT!

And just as you put it, the first words out of my mouth were almost an exact quote of yours. "Why can't we have our taxes go torwards having our public servants and local and state prisons and court system support us in the crimes against us and our payments the way regular retailers are allowed to each and every day???" And really as long as we are in this "free market" system, why are our services considered any different than the supermarket's milk or the gas station's gas???

Simply Amazing......
Paul

One other way around this "must charge the same for the same code" garbage that makes it difficult to be compassionate to a working uninsured, that is done by some who do cash practices (eg. simplecare.com)takes advantage of what we learned from the grocers during the days of wage and price controls.
That is: While it is TRUE that I must charge everyone the same price for a 99213, it does not mean I have to CALL it a 99213. For the cash patient, I can call it a Office visit-medium and it is $50. the same as the discounted fee schedule. Just never CALL it a 99213. or equate the two. It is an uncoded visit.
btw.. you then also do not need to bother with jamming the visit into some icd-9 slot either.
It was medium office visit for sore throat and fibromyalgia... that you charged $50 for - and since the visit never goes elsewhere for claims. NOT coding it not only saves you hassles of coding, it saves you risks from the poor put-upon insurance companies and the Gov't who is here to help....

JAA

This is what folk who do "Pre-Travel Health Consultations" do. Ain't no code for that.
If I could only find a way to non-code "Hepatitis A Vaccination" or "Polio Booster" I'd be golden.