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I recently sign a new client. The former billing service will be working the A/R they are responsible for.

1. What is the average time given to a terminated billing service to do so? I know this is a decision between the provider and terminated billing service but I’m curious. They have stated she will possibly continue for 4 months working A/R prior to my start date of 1/1/2018. Seems a bit generous!

2. I will be using Navicure as my clearinghouse because it is built into the providers system I will be using. If she is using a different clearinghouse is this even possible? If I setup Regence to accept claims through Navicure and then she continues to use say OfficeAlly is this even possible? I’m not familiar with this happening.

3. I should also state that all payments have previously went to her business address. Moving forward the provider has elected payments to be received at my business (locked box) address. This becomes extremely complicated when she continues to work A/R she is responsible for. I offered my services to do so but they have elected that she continues and resolves her accounts (all prior to 1/1).
Coding / Re: 99455
« Last post by Michele on December 15, 2017, 07:32:42 AM »
The 99455 should not need any modifier if billed with an xray.  Xrays are not usually considered a bundled service.

Are you talking about being reimbursed for the completion of the C4.3 form?  I don't believe they pay for that form to be completed.
Starting Your Own Medical Billing Business / Re: Any billers here in the Seattle area??
« Last post by Michele on December 15, 2017, 07:29:21 AM »
OH, and 3 weeks?  Seriously?  No one could know if you were doing a good job in 3 weeks.  What did they tell you as a reason?
Starting Your Own Medical Billing Business / Re: Any billers here in the Seattle area??
« Last post by Michele on December 15, 2017, 07:28:33 AM »
So sorry to hear.  That is a tough one to overcome.  We once lost a very large client VERY unexpectedly and it was a huge blow!  We too had many small and medium clients and this was our first big account.  We worked for them for over a year and did a REALLY GOOD job.  We over doubled their monthly revenue without them seeing any more patients.  That's how bad their billing was before we took over.  One day I walked in and the doctor wouldn't look me in the eye.  He said "I need to talk to you".  I was FLOORED!  But on the same note, not surprised.  The doctor's wife was also a doctor and she never liked us.  He brought us in behind her back.  And she wore the pants!  So even though we did a great job and their income was good, their patient billing was going out regular for the first time EVER and the aging report was being worked, we got fired.  Linda always says if the doctor's wife is involved, RUN!  We actually have other accounts where the doctors wife is involved and it's fine, but in this case we should have known.  Anyways back to Williamsportor, I know it's a tough blow, but learn from it.  Turn it around to make it a good thing.  If you learn the lesson that you need to learn so that the next account doesn't fire you then it will have been worth it.  Look back over the time you had the account.  What condition was it in when you took over?  Did you improve it?  What more could you have done?  What (if anything) did you do wrong?

Kristin pointed out some good things.  Did you have enough time to devote to it?  Do you know what their issues were (why they hired you) and did you make them better?

Even though you started with not much experience you have been doing this long enough that you should be confident in yourself now.  Sometimes when we lose accounts it is not our fault.  In our example above, we truly did nothing wrong (work wise) on the account.  We cleaned it up and got money coming in the way it should have been.  But we still lost the account.  And the person they replaced us with had a 40% drop the first month she took over.  They have lost money due to switching from us, but it didn't stop them.  Why? Because the reason they didn't want us in there was not because we weren't doing a good job, it was because the wife and office manager (Separate people) did not like us.  They were friends and we exposed how poorly of a job the office manager was doing.  (She still works there.  :) )  The lessen we learned was that some accounts are not right to take, no matter how much money they bring in.  And also, it does not ever pay to go around the office manager.  She will find a way to get you out.  I'm not going to publicly make accusations against her so I will just say that she should have been more than fired for the things that she did and didn't do.  But she wasn't, we were.   We had another account years later that was even larger.  After our 1 year contract was up we informed them we would not be renewing.  Some accounts are truly not worth it.  (Dr's wife was the office manager!)

I wish we were closer too!  I don't foresee a trip to the west coast but you never know!  I have never seen Seattle.  If we are heading that way we will let you know!
New! / Re: Timely Filing
« Last post by Michele on December 15, 2017, 07:13:06 AM »
There is no universal time filing limit.  Each company has their own rules.  For example, Fidelis NY only gives 60 days from the date the claim was processed.  You have to check with each carrier.
Let me get this straight.
You " purchased " one client business; so you actually paid real money for this pig in a poke?
What is done is done, you own the business and you have to face the consequences.
One thing you should never do is to go deeper in debt. Don't throw good money after bad.
Message me privately, I may be able to help you.
You can write me at
Starting Your Own Medical Billing Business / Just acquired a Business - Need Advice
« Last post by issey2456 on December 14, 2017, 07:03:08 PM »
I recently purchased a business with one lonely client. Sadly, all was not disclosed as to the scope of work entailed with the client.
I knew about Insurance Credentialing but not the facility. I was curious about the Meaningful Use/MIPS/MACRA stuff but was told "all that was handled" and come to find it was not handled properly and the practice will be taking a 2% Medicare decrease for all of next year and its looking like for 2019 as well. I was not aware that I would be basically acting as the office Billing Director, responsible for all the below and training of office and clinician staff of billing related issues.

Initially when I took over there were 5 now we are a Three man group.

NOTE: The Prior Owner (one of the 5) was handling claims; however they were not a biller or coder and just submitting willy-nilly therefore; lots of a Denials and A/R cleanup due to this. The prior owner also was donating their personal time and personal finances to keep up with payroll and items listed in 1-15 below. Of course, I was not made privy until after the fact.

I am struggling financially as the reimbursement of the assumed contract is at 5% of monthly insurance payments. I had to take out a startup loan inorder to cover payroll ($10K a month initially, less now) and overhead/taxes. I have to admit, I should have asked more questions. I initially came in as a contractor to help clean up the mess the original billing company left prior this one I have under my frayed wings ($550K+ in A/R) in the old system, Advanced MD. Then I transitioned in to helping the prior owners staff understand how to use EPIC properly which bounced into, hey I am tired do you want to buy it at a great deal… I should had just simply taken more time to ask more questions… SO…

My little experience and gut is telling me that with the list below (as well has the National Percentage average reported by Health Management Billing Association, HMBA), this 5% is severely under billed. And, I need to find some way of expressing this to the practice (along with the courage).

NOTE: Prior Billing Service Owner was a very close friend to this 6 Clinician Practice.

Anyhow, in addition to general claim billing and payment posting, we are basically acting as the offices Billing Director handling all administrative and billing related functions.
This would include:

1) Ensuring proper Dx Coding and Dx Code Ordering per guidelines
2) Review of office and visit notes to ensure proper and all pertinent Meaningful Use coding is entered, as well as appropriate association of dx codes
3) We use a hospital platform with Multicare System, EPIC
4) Liaison between Billing and Hospital IT regarding any billing platform issues
5) Insurance Credentialing - initial and recredentialing
6) Facility Credentialing, hospital and HemoDialysis clinics as needed
7) Handling of any Meaningful Use Audits as needed
8) Ensuring all eligibility is checked prior to all claims submission
9) Reporting to Office Coordinator when claims are denied due to lack of Referrals
10) Reporting to Office Coordinator when patient and/or insurance refunds are required
11) Liaison between Insurance Payors and Office with management of Provider Portals, this would include Onehealthport, Availity, NPPES, PECOS and CAQH updates, reports, management of provider documents and attestations as needed
12) Pt statements are auto generated by the system with the Multicare required statement vendor; the financial responsibility would be the billing companies financial responsibility (additional overhead of $500-$700 monthly). This is of course in addition to handling of patient phone calls to inquire or pay their statements
13) Balance of monthly payments would be against our Bank Deposit Log (provided by our CPA) as well as against InstaMed Patient Payment Log
14) Monthly reporting would include balancing reports and notation of variances between Bank Deposit, Posting Log and EPIC Charges & Payments Reports
15) Monthly reporting of payments by provider per facility - the providers work from two offices, 5 hospitals and 20 HemoDialysis clinics
16) There are still more points, but I think you get the drift here

All of the above, in addition to general claims submission, clearinghouse claim edit fixes (Claim Logic), Electronic and Paper payment posting (Retail Lockbox provides online portal for live checks; all other correspondence is mailed), A/R followup and management of EPIC workques (Claim Edit, Followup Denial, Followup No Response, Credit, RetroReview, Claim Error Pool and Patient Account/Statement Review).

Starting Your Own Medical Billing Business / Re: Any billers here in the Seattle area??
« Last post by kristin on December 14, 2017, 03:11:25 PM »
Wish I was in Seattle, that is my favorite city!

Let me ask you the issue that there just isn't enough hours in the week to keep up when you do land a larger client, and you are still working all the smaller accounts too? Meaning, is there just not enough "you" to go around? If so, have you thought of sub-contracting out some of the smaller clients to someone, or adding an employee to help? I get the feeling you aren't the issue/your skill set, so much as it is a time factor.

One of the billing companies I work for has always had one huge client, and two smaller ones. I have been the only employee, and I handle one of the smaller accounts exclusively. If I was to quit, the owner would have to hire someone else, because it is simply too much work for one person to do on their own. And that is only one huge account and two smaller ones, not eight smaller ones.
Coding / 99455
« Last post by Chiro Billing Collect on December 14, 2017, 03:10:07 PM »
I have two questions regarding NYS Work Comp.

When billing 99455 and x-rays on the same visit, I am assuming the 99455 can not and should not be billed with a modifier because of the additional service?

Also, the form states that compensation for completion of the C-4.3 is the same as a 99245 E&M but I do not see this code on the chiropractic fee schedule. Any ideas what the reimbursement should be? We have always had a set fee and usually receive the full amount.


I've just been fired by my biggest client after 3 weeks. This doesn't happen very often, but feel if I could watch a professional billing company do their job for a few hours, and be able to ask questions, I could become a better and more efficient biller. I do billing for 8 other clients, though smaller, they are all happy with my work. Every time I land a larger one however, I can't seem to live up to their expectations.

Unlike many of you I had little experience with Medical Billing when I started in this business 4 years ago, but feel I've gotten much better. I don't yet have the $$ to travel to the east coast, but if there are any of you in the Seattle area that would allow me to drop by to watch, that would be very much appreciated. It's tough to grow ones business when this happens.
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