Member Forum

Topic: Billing

1.  Billing

Posted 15 days ago

Hello all,
I was hoping to get input on people's experiences with billing services vs hiring employee to do billing.

We currently have a billing service that charges 8% of everything that's collected, (including what we collect in the clinic for copays etc.)  The service is good and I like the reliability, but it is pricey so I am contemplating hiring an employee to do this.

Anyone have thoughts on this?  Anyone know if you hire an employee, can it be a smart competent person, or does it have to be someone with billing experience--i am not sure how hard it is?   I know our EHR (Eclinical) offers billing services but I haven't been very happy with their customer support so not eager to use them.
Thanks!
Jessica



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Jessica Rongitsch, MD, FACP
Capitol Hill Medical
Seattle, WA
98104
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2.  RE: Billing

Posted 15 days ago
I use athena and have an experienced back office person that fixes any issues.  helps a lot, my ppl work virtually though as contractors so they are not my emploees.

--
Amy Adkins-Dwivedi, ARNP
Stepping Stone Pediatrics
15650 NE 24th St, Suite C-1
Bellevue, WA 98008
(425) 941-9540
(425) 633-2281

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3.  RE: Billing

Posted 15 days ago
Thanks Amy
Just to clarify you use Athena as your biller, but you need an employee to oversee it?  I guess I'm wondering if you switch to a service like Athena do they handle all the minutiae like you forgot a modifier 25, or that patient needed a referral from a narrow network plan to see you etc..  It sounds like you still need an employee on your end monitoring? Do you know what % Athena charges?

I assume you use Athena EHR?  We are also considering switching to a free or cheaper EHR like Practice Fusion or Office Ally.

Thanks!
Jessica

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Jessica Rongitsch MD, FACP
Capitol Hill Medical
Seattle, WA
98104
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4.  RE: Billing

Posted 15 days ago
DON'T use Office Ally EMR.  Terrible.  Cumbersome, lots of clicks. (Their billing clearinghouse is free, and ok)
PF is ok, Amazing Charts is good, but take a look at Praxis.
The biggest cost of EMR is the time it makes you and your staff waste.  If it saves you 10 minutes a day, that's $300/month.

One picture worth 1000 words:
http://www.aafp.org/fpm/2015/0100/p13.html


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Peter Liepmann MD FAAFP MBA
My mission is to fix US health care www.PCMHpcc.com
Bakersfield CA
5183026006
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5.  RE: Billing

Posted 14 days ago
We recently dumped Athena because the total cost was 7.5% and the customer service was abysmal. We we call with a question regarding a billing issue and often be on hold for 20-45 minutes. The suggested fixes for a billing issue were not helpful, more generic that how to actually remedy a coding issue. I know we left money on the table while using them as I am not a coder or biller. The new EHR is eCW and we have a live person available as a resource! The RMC service is 2.9%. (EHR use is separate.) Overall, satisfied with the change.

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Tracy Baum
Mountain Sage Family Clinic
Dubois, WY
307-455-2807
baumnp@gmail.com
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6.  RE: Billing

Posted 15 days ago
8% seems pretty steep to me.   I've seen 6%, and that still seems high.

At least 95% of your claims, probably 98%, should get paid without any human intervention at all.  So your 'biller' should only come in for the 2-3% problems.  Even collections agencies take no more than 30-50% of that 3%, so it should be pretty small, if your EMR is producing the right codes.  Take a look at Praxis- it has some AI that helps w coding.

Your front office staff should be collecting copays, reminding people about balances when they call for refills, appts, etc.
You should only need one full time biller for every 3-6 providers.
If your EMR will create batch HCFAs, you can upload them to OfficeAlly clearinghouse free...

BTW, if your billing people aren't your employees, you need a Business Associate Agreement with them.

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Peter Liepmann MD FAAFP MBA
My mission is to fix US health care www.PCMHpcc.com
Bakersfield CA
5183026006
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7.  RE: Billing

Posted 14 days ago
Thanks Peter and love the meme!  I appreciate your thoughts.  I will definitely do my homework before moving to another EHR (and yes we have a Business Associate Agreement with our biller.) Thank you!

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Jessica Rongitsch MD, FACP
Capitol Hill Medical
Seattle, WA
98104
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8.  RE: Billing

Posted 14 days ago

The  billing in or   contracted out  conversation goes on periodically and people's opinions are always strong
 I would add that as I have watched IMPs over  the tlast decade  those who have lasted have often NOT been doing the billing Billing causes burnout   As to 8 %   that is standard and for the service of someone taking the calls and arguing with  insurers and knowing  the rules  although I make no argument that coding  as it is should even  exist!11, 8% in a small practice might be?? under 10,000 a year  If you have an employee  you pay them and do their payroll taxes and W 2 and w 4 whatever,   need ot think about benefits/ space/ secret santa parties etc And workers comp And supervising them In a tiny practice You need  a person to  take in the deposits and another t o  deposit them for safety. Etc.
--



     Jean Antonucci MD
     115 Mt Blue Circle
     Farmington ME 04938
ph 207 778 3313   fax 207 778 3544
www.jeanantonucci.com

Virus-free. www.avast.com





9.  RE: Billing

Posted 13 days ago
Hi Jessica, as Jean said this conversation comes up now and again. You can search and find the old posts on this system. On my phone the search function appears in the main menu drop down area.

my practice is over 10 years and I'm happy and enjoying. We started with an outside biller but then soon moved to using staff who do other tasks for us. We found that using someone who knows us and our patients s bit- we recoup money much higher.

Over the years we've never hired anyone with billing experience. It's really not too complicated. Maybe we miss some money here and there but from what we save by having our own staff is huge cost savings.

Right now we have someone 10 hours a week. She is also our bookkeeper. She mostly spends time posting payments and invoicing patients. She also does the follow up needed-calling insurance to understand why no payment, calling patients for same reason.

i have the name of a local biller that another local IMP, Bruce Williams, gave me. He loves her. I'll hopefully remember to send you off line in email if helpful.

Melissa

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Melissa Weakland MD
Ballard Neighborhood Doctors
Seattle WA
IMP since 2007
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10.  RE: Billing

Posted 13 days ago
95% of billing is straight forward.  5% drives me insane.

I use Office Ally Practice Mate.  It's separate from my EMR (yes, dual demographic entry) and costs $20/mo (free if >50% of billing is to commercial insurance b/c they get $$ from them).

The 5% that is painful:
- Did a visit at assisted living last month.  Changed the location of service from "11" to whatever it is.  BUT, totally didn't consider that home visits have different E/M CPTs.  I billed 99214 but it should have been a different code.  Now I need to re-work it.
- Getting paid for all the little add ons.  99406 (Tob cessation), 96127 (PHQ-2, PHQ-9, ADHD/Vanderbilt Tools, PSC), 96110 (HYH, MCHAT, Ages/Stages).  It's a pain to understand when to use and when not.  Don't get me started for all the Medicare add ons (G0444, etc).  They make a difference.  If used right, it can be $5-$15 more per visit.  The problem is some insurances pay with no patient responsibility, some pay but goes toward deductible/copay, and some don't.  The problem is, if you bill and the insurance accepts but it goes to deductible, some patients aren't keen on getting a $10 charge for their ACA preventive exam ("no copay or deductible").  It's a minefield that a biller can help with.
- THE BIG ONE: Insurance rejections.  What a PAIN.  Hours of hold time on the phone.  I had one Medicaid customer service person tell me that 99214 wasn't a valid E/M per CPT guidelines so I couldn't bill with the E/M 9938X (preventive service).  I told her that 9938X was a preventive procedure code and 99214 was an E/M code.  She then told me that the computer says differently so I was wrong and don't know by CPT rules.

So I'm hiring a biller.  She charges 6%.  I'm not comfortable with that bc 95% of my claims are simple and paid quickly.  Why should I pay her $8 per claim when I still have to send her the info.  It's just as easy to send my clearinghouse the same info.  So I'm negotiating with her to:
- Work the insurance privileging.
- Do claims audits at an hourly rate.
- Work my rejections at with 12% charge.
- Be available for consultation.

That's my 2 cents ... an more.

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Craig Ross, M.D.
Family Medicine/Owner
South Arbor Family Care
Ann Arbor, MI
M: 734-756-8446
W: 734-707-7075
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11.  RE: Billing

Posted 13 days ago
Craig,

Thanks for your submissions.  Can I pick your brain a bit about Practice Mate.   (I know Peter L. has suggested it several times.)   I just went on web site and had chat session with sales.

Practice mate is both your practice management software and sends claims to the clearinghouses?
Does it do all the things a typical PMS can do?
Besides the double entry issue you mentioned with your EMR and PMS, are there things that it cannot do, that you wish it could?

Can it handle multiple fee schedules?
Scrub claims that are not clean.?
Electronic remittance?
Auto post?
Send out bills to patients?
Run aging reports?

Thanks,
Mike S

Also, I concur with Melissa.  If your "biller" is also doing other tasks - checking out, scheduling next appt. collecting copays and payments, etc, not to mention more clinical issues like vital signs, helping track down missing labs, test results, pharmacy calls, etc. it makes sense to keep all billing in house.  The personal connection with patient is invaluable.

There is definitely a learning curve but it is more so with the software and the insurance game issue.   As the doctor you will need to learn many of those things anyway, even if you farm out billing and pay 8%..

And remember.  Billing companies take 6-8% of low hanging fruit.  Most of that now is just click and send and money appears in your bank account.

You will still need someone to keep an eye on things, especially the claims that are not clean.    That takes time and is the frustrating part.   The doctor can do all of that but I predict will be burning out very soon.   Much better for your mental health to have an employee do that.   If they are bright, they will learn the game with you and give them a thank you bonus.

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Michael S. MD
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12.  RE: Billing

Posted 13 days ago
Hi Mike,

Office Ally has  a FREE clearinghouse (only) solution that will take batched claims.  Their EMR is terrible; I know nothing about their billing software.  (Just to clarify.)

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Peter Liepmann MD FAAFP MBA
My mission is to fix US health care www.PCMHpcc.com
Bakersfield CA
5183026006
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13.  RE: Billing

Posted 12 days ago
Thanks for your thoughts!  Right now we are paying quite a bit for an EHR that we don't love (eCW) and the 8% is painful.  I would never do the billing myself, but will definitely look at other free or cheaper EHR's and we will think about bringing billing in house to save on expenses.  I figured out that, with three providers, if we brought billing in house--even for full time employee with benefits -we would save quite a bit.
Thanks to the IMP group for lots of food for thought!

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Jessica Rongitsch MD, FACP
Capitol Hill Medical
Seattle, WA
98104
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14.  RE: Billing

Posted 10 days ago
Is anyone out there using Praxis?
I'd like to get a first-hand review.

It's the only 'non-template' EMR, AFAIK, and it has an impressive AI/search utility so it can convert plain text to structured data for so-called "quality"  reporting.   The FPM article from 2015 had it with impressive usability and "I like it" scores from docs.

It interfaces with various PMSs.  Since it uses AI to code visits and diagnoses, it's probably more accurate than the average doc, so all you'd need for billing is to send a batch file to a claims processor. Their business model is software sales, with a packaged loan, so it's $259 for 60 months, then some subscription.  They also offer Cloud SaaS.

One of the cool things it does is keep track of staff time 'dealing' with people outside of office visits, so it can directly document (and bill) for CCM, without the user having to do anything explicit re billing.

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Peter Liepmann MD FAAFP MBA
My mission is to fix US health care www.PCMHpcc.com
Bakersfield CA
5183026006
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