Medical Billing Forum

Starting a Medical Billing Business => Starting Your Own Medical Billing Business => : johnny January 29, 2013, 12:37:38 PM

: I have some questions!
: johnny January 29, 2013, 12:37:38 PM
Hi everyone! I'm new to the forums, but I have been lurking around here for a while reading what you all have to say.

I've completed a program online and have read every possible book I can get my hands on about medical billing and starting a medical billing company. I feel as though I'm ready to start marketing.
I have a few questions, if anyone could please answer them?

Does anyone use logmein.com to get patient information from the software practices are already using? The course I took seemed to have missed that step. Even though I am aware of what I have to do with the software program, they didn't make it clear on what to do. For example, do I purchase the program they're already using? Do I use my own and log into their computer remotely and use theirs as well? I feel as though something like this would save money and time for both the biller and practice.

Also, how do I figure out what to charge practices? I have a forumla with my course on an hourly rate I would calculate, but what if I were to charge them differently?

Should I come up with different plans, like plan a, plan b, or plan c based on what type of practice they run and how many patients they treat every day, etc?

If there's anything anyone could do to help me out a little bit I'd be so appreciative.
Thanks,
John
: Re: I have some questions!
: Christy January 29, 2013, 02:28:51 PM
you would use logmein to work on a client's existing (non web based) software from your location. all info would be shared on that PM system, so you would not have to purchase your own copy of the software or duplicate information.

If a client has web based software, you can get your own log in and password and you would not need logmein. Again, all info would be shared on one PM system...

there are a lot of threads re pricing services here, do a search...also, Michelle on this forum has written many wonderful books to assist in all facets of the biz....I have purchased 2 of them and have been thrilled.

Good luck to you! :)
: Re: I have some questions!
: johnny January 29, 2013, 02:57:09 PM
Thank you so much, Christy!

I'm glad to know there are people who are willing to help me out.

It really does mean so much to me.
: Re: I have some questions!
: RichardP January 29, 2013, 03:03:28 PM
Microsoft sells Server software, so they disabled the ability of the Windows operating system to accept more than one log-in at a time.  You have to buy their Server software to be able to do that.  As a result, I believe that all "dial-in" software solutions take over the computer that you are dialing in to (can handle only one user at a time).  If you want more than one person to use a single computer at one time, you will need to buy Microstoft's Server software.  Someone can correct me if I am wrong.

Point is - you would need to have a dedicated computer - one that is connected to their network - at each client location if you are going to dial in to their location.  If you want your client(s) to each dial in to your location, you will need a dedicated computer - connected to your network - for each client who will be dialing in.

Aside from that caveat, dial-in software works - and makes the experience just like you were sitting at the computer your are dialing in to - no matter where in the world that computer may be.  I do things like file transfer and printing, and GoToMyPc seems to handle these things for me better than the other dial-in softwares do.  Your mileage may vary.

http://www.gotomypc.com/remote_access/remote_access
: Re: I have some questions!
: johnny January 29, 2013, 03:23:01 PM
Hi Richard!
Thanks for the input.

So, do most practices use web based programs?
This seems the be the only stump in my way right now. It's the one thing I don't fully understand.  :-[

As a medical biller, how do you normally get into someone's program with all patient information?

Do a lot of billing companies use servers, like Richard suggested?
: Re: I have some questions!
: PMRNC January 29, 2013, 04:17:41 PM
So, do most practices use web based programs?
This seems the be the only stump in my way right now. It's the one thing I don't fully understand.  :-[

No, not all use web based software. If you are going to start your own business you will want your OWN web based PM system. That is NOT to say you won't encounter physicians who want to keep on their own systems, be it web based, server based, stand alone, etc.   Today's billing company should be ready for either scenario (they need you and your software or they want you but want to use their PM system/software)

Logmein   is one of the safest out there.. the thing I think that makes it stand apart is the ability to log off/on the host computer  and change LOGIN's which is a HIPAA requirement and you must have your own login credentials for both the HOST computer and the PM system, this is not only a HIPAA requirement but is used for audit trail purposes.  Logme in is installed on the host computer and is tiered a few layers of security which is awesome. I use it to access a few of my clients systems.  But again, I can't stress enough how you MUST utilize your OWN password to both the HOST computer (the clients computer) AND your own network and the PM software login.

As a medical biller, how do you normally get into someone's program with all patient information?

You might get varying opinions on this, but I require my clients to fax me their daysheets/superbills daily or on a schedule we've mutually agreed on. EVEN if I am accessing their system. This allows me to retain my own source documents and protect my butt in case of an audit.  If the client has a web based system I don't need to use logmein, I just access the system with my OWN login credentials.   the only situations I use the logmein is where I am accessing the clients PM system on their computer/server OR I need to check something in our logs we setup.  The clients that utilize MY PM system work same way, I have no need to login to their PC, but they can access their data anywhere and any time with their own login credentials.

 Hope this helps :)
: Re: I have some questions!
: RichardP January 29, 2013, 10:04:37 PM
... the thing I think that makes it stand apart is the ability to log off/on the host computer  and change LOGIN's which is a HIPAA requirement and you must have your own login credentials for both the HOST computer and the PM system ...

I'm not competing with Linda here, and I'm not pushing GoToMyPc (G2Pc below) - just providing some information and context.  I'll speak to what I know.  I imagine other Remote Access software works in a similar way.

G2Pc requires that you be at the host computer to install it.  The host computer is the computer that is networked to the Server where the billing software is installed.  The client computer is whatever computer you are using to log into the G2Pc system.  For this example, assume the host computer is at your client's location.  Assume the host computer is already connected to your client's network at his location.

  1.)  Sit at the host computer and install the G2Pc software.  During the installation, you will name your account with GoToMyPc and establish log-on passwords, etc.  Your log-on ID can be changed at will.  Once registered with G2Pc, whenever you turn on the power to the host computer, it tells G2Pc that it is awake.  So you can turn the host computer off and on as often as you want.

  2.)  Go to any PC, anywhere in the world - but usually it will be your PC where you work from.  Go to GoToMyPc.com, to the log-on screen.  Log on to the GoToMyPC site with your username and password.  The first time you dial into G2Pc, on any given computer,  G2Pc will install a small program on the hard drive of the computer you are dialing in from.  This small piece of software helps automate the dial in process.

  3.)  If you have supplied the proper log-on ID, G2Pc will locate your account - which tells them which computer(s) you have registered with them and where they are located (if they are turned on).  If you have registered more than one host computer with G2Pc, you will be given a choice of which PC to log into.  After you choose your target host computer, you are prompted to type in the user name and password for that target computer.  If you have supplied the proper log-on ID, G2Pc sends a message to the target host computer, telling it to initiate a web-connection with G2Pc (this connection sequence gets around certain corporate firewall issues).  4.)  When the log-on process is complete (takes maybe 30-60 seconds), you have the host computer screen displayed on the screen of whichever computer you dialed into G2Pc from.

  4.  The screen of the host computer is displayed in a re-sizable window on your computer (the client computer).  You can size the window to cover all of the screen, or only part of the screen.  Locate the icon used to launch your client's billing software.  When it launches, use it.  The result will be the same as if you are sitting at the host computer in your client's office.

So - to recap:  Log on to your account at GoToMyPc, log onto target host computer from GoToMyPC's website, log onto target software.  When done, log out of software, log out of the host computer, log onto another host computer somewhere else in the world, log onto the target software, and go to work on another client's business.

Note that with GoToMy PC, you have two levels of log-on before you can gain control of the host computer.  Obviously, the log-on IDs should be different for each level of log-in.

Some links to get you started in educating youself:

http://compnetworking.about.com/od/homenetworking/tp/remoteaccesssw.htm
: Re: I have some questions!
: johnny January 30, 2013, 10:48:40 PM
So, do most practices use web based programs?
This seems the be the only stump in my way right now. It's the one thing I don't fully understand.  :-[

No, not all use web based software. If you are going to start your own business you will want your OWN web based PM system. That is NOT to say you won't encounter physicians who want to keep on their own systems, be it web based, server based, stand alone, etc.   Today's billing company should be ready for either scenario (they need you and your software or they want you but want to use their PM system/software)

Logmein   is one of the safest out there.. the thing I think that makes it stand apart is the ability to log off/on the host computer  and change LOGIN's which is a HIPAA requirement and you must have your own login credentials for both the HOST computer and the PM system, this is not only a HIPAA requirement but is used for audit trail purposes.  Logme in is installed on the host computer and is tiered a few layers of security which is awesome. I use it to access a few of my clients systems.  But again, I can't stress enough how you MUST utilize your OWN password to both the HOST computer (the clients computer) AND your own network and the PM software login.

As a medical biller, how do you normally get into someone's program with all patient information?

You might get varying opinions on this, but I require my clients to fax me their daysheets/superbills daily or on a schedule we've mutually agreed on. EVEN if I am accessing their system. This allows me to retain my own source documents and protect my butt in case of an audit.  If the client has a web based system I don't need to use logmein, I just access the system with my OWN login credentials.   the only situations I use the logmein is where I am accessing the clients PM system on their computer/server OR I need to check something in our logs we setup.  The clients that utilize MY PM system work same way, I have no need to login to their PC, but they can access their data anywhere and any time with their own login credentials.

 Hope this helps :)


Thank you for the valuable information!

If you could answer this for me?-
How do you work with their pm system via remote access if they're working with their computer? It is now my understanding that only one person can log onto the computer at one time...
: Re: I have some questions!
: RichardP January 31, 2013, 01:31:53 AM
johnny, you asked - so here goes.  Since I don't know what level of understanding you have, I'm starting at the beginning.  Google on "client / server network" or "client / server model" and read a few of the links (you can copy and paste these two phrases, including the quote marks).  That should help with your basic understanding.

Look at the diagram at this link:

http://www.cs.ucc.ie/~dgb/courses/net/period1B/16-clientserver/funclientserver.png

The orange rectangle in the middle is called a switch, or network switch.  There is a picture of what a switch looks like and a bit of a description at these two links.

http://en.wikipedia.org/wiki/File:2550T-PWR-Front.jpg
http://en.wikipedia.org/wiki/Network_switch

                            Client               Client              Client               Client
                        Computer 1     Computer 2     Computer 3     Computer 4          etc.               
                                |                      |                       |                      |                      |
                                -----------------------------------------------------------------------------
                                                           ^
                                                            |
Server                                                 V                                                                         Your
Computer  <------------------------>  Switch < ---------------- >  Internet    < -------->       Office


Assume you do the billing for the doctor's office diagrammed above.  Assume that the lines (dotted or not) in the diagram above are actual wires / computer cables.  Assume that there is a physical computer cable that connects the Server Computer to the Switch.  Assume that there is a physical computer cable that connects each Client Computer to the Switch (each computer plugs directly into the Switch; I've simplified this in my diagram).  All computers are physically wired to the switch.  Computer cables are long enough that these computers could be in different rooms on the same floor.  Or they could even be on different floors of the same building.

Assume that there is a physical telephone cable that connects the Switch to the phone jack (just like a telphone cable connects your phone to the phone jack).   That phone jack is connected to a physical wire that goes outside the building and connects to a physical telephone wire on the street.  It is possible to follow that physical wire on the street all the way to your office, even if it is on the opposite side of the country.  Once inside your office, we could follow that wire all the way to your computer (assuming it is connected to the Internet via the phone jack).

Electric signals can flow both ways along the wires that connect all the computers to the Switch (remember that the computer in your office is connected by wire to the switch also).  The Switch routes all of these signals to the appropriate place (to and from other computers and in from or out to the internet), depending on the instructions carried in the signals.  Thus, another name for Switch is Router.  It switches, or routes, electronic signals among multiple computers in an orderly fashion.

Assume a Server version of the billing software is on the Server Computer.  A little piece of the Billing software is installed on each Client Computer.  With the aid of the bit of billing software placed onto each client computer, all client computers can access the Billing software on the Server computer at the same time.  The information each computer passes to the billing software and receives from the billing software (on the Server computer) is controlled by the Switch.  That way, the signals enter into and leave from the Billing software in an orderly sequence, not in a jumbled mess.

Now, assume that you install the GoToMyPC Host software on Client Computers 1-4.  A small bit of GoToMyPC Client software will install itself on any computer you use to log in to your account at GoToMyPC.  The G2Pc Host software on each of Client Computers 1-4 sends a brief signal to the GoToMyPC Website that says "I'm available, and here is my internet address".  From the computer in your office, you first log into your account at GoToMyPC.com.  Then you choose Client Computer 1 out of the list of Client Computers 1-4 that are presented to you.  The G2Pc software sends a message to Client Computer 1, telling it to "call" GoToMyPC.com.  When it does so, and the connection is established, you will be prompted to log onto Client Computer 1.

Imagine that a clerk is physically sitting at Client Computer 1, using the computer to access the Billing software on the Server Computer.  Up to this point, nothing you have done from your office has affected this clerk.  But when you continue from the end of the previous paragraph - that is, when you log onto Client Computer 1, the G2Pc Host software takes over and passes control of the Client Computer 1 to you - no matter where in the world you are located (the screen of Client Computer 1 opens in a window on your computer).  The clerk sitting at the keyboard of Client Computer 1 can no longer get that computer to respond to signals from his keyboard or mouse.  He has lost control of Client Computer 1.  Depending on what you have established in the settings of G2Pc, the clerk at Client Computer 1 can either watch his screen to see what you are doing, or the screen will go black and he can see nothing.

Note that, when the clerk uses the keyboard or mouse on Client Computer 1, those signals go to the Central Processing Unit (CPU) of that computer - which then passes them on to the piece of the Billing Software on that computer - which then passes them to the Switch - which then passes them on to the Billing software on the Server Computer (simplified version).  The Central Processing Unit of Client Computer 1 does not care which keyboard or mouse those signals come from.  It only cares that they are keyboard and mouse signals.  When you have taken over Client Computer 1 with G2Pc, all you are sending from your computer to Client Computer 1 are keyboard and mouse signals.  The CPU of Client Computer 1 responds just as it would if you were physically sitting at the computer in the doctor's office.  The path from the CPU of Client Computer 1 to the Billing software on the Server Computer remains the same.

When you log off of Client Computer 1, control of that computer passes back to the clerk sitting there, and the screen goes from black to normal, or normal to normal (depending on what you established in the settings of G2Pc).  That is, the CPU of Client Computer 1 can again receive signals from that computer's keyboard and mouse.  Up until you log off of Client Computer 1, the G2Pc Host software blocks those signals and passes your signals through.

johnny, this was your question: How do you work with their pm system via remote access if they're working with their computer? It is now my understanding that only one person can log onto the computer at one time...

Hopefully you understand a little better now.  Because of restrictions placed on their computer Operating System by Microsoft, only one person can have control of a computer at a time - unless they have Server software installed.  The Server Computer has this software installed, and so it can receive signals / directions from and send signals / directions to multiple computers at the same time.  The Client Computers do not have this software installed, and so can receive directions from only one person / other computer at a time.

Assume that your client needs his clerks on Client Computers 1-4 all day long.  That means you cannot get access to the Billing software on the Server Computer by going through any of Client Computers 1-4, because they are being used.  Note that, because of the way G2Pc operates, you could log on to any one of Client Computers 1-4, and force the clerk to stop working while you did your business.  But that is not the way to keep a client happy. So -- the only solution would be to install Client Computer 5.  Attach that new computer to the network by running a computer cable between Client Computer 5 and the Switch.  Install G2Pc Host software on it.  Now, when you log on to your account at GoToMyPC.com, you will be presented with a list that shows Client Computers 1-5, rather than 1-4.  Since you know that Client Computers 1-4 cannot be interrupted and Client Computer 5 has no one working on it, you log on to Client Computer 5 and go to work.  Keyboard and mouse signals from the computer in your office travel through the phone wires to Client Computer 5.  Those signals are passed to the CPU, which routes them out to the Switch, which routes them into the Server Computer and into the Billing / EMR / PM software installed there.  Signals are sent back through the Switch to Client Computer 5.  These signals are displayed on the screen of Client Computer 5 - which is visible in a Window on your computer, so you see the signals also.  So long as you are logged on to Client Computer 5, nobody physically present at Client Computer 5 can use that computer.  The G2Pc Host software is blocking the signals from the keyboard and mouse physically connected to the computer and is letting your signals pass through.

Note 1:  If Client Computers 1-4 are going to be continually busy, you would not have GoToMyPC installed on them.  Only on Client Computer 5.

Note 2:  The logic of signal control and flow developed above is exactly how a cloud-based PM system works.  Use Kareo as an example (simplified version).  Somewhere, Kareo has a Server Computer(s) that houses their billing software and client databases.  All who are using Kareo in their office are the Client Computers 1-n.  Between the Server Computer and the Client Computers is a switch/router.  The switch accepts the signals coming in from the Internet and passes them to the Server Computer in an orderly fashion.  Likewise, it takes the signals coming out of the Server Computer and passes them to the appropriate Client Computer.  By using appropriate passwords, both biller and doctor are given access to Kareo's EMR and/or PM software as well as the doctor's database.  The electronic signal traffic among Kareo, the doctor, and the biller is controlled / routed by the Switch / Router, based on the log in's used.

Note 3:  Buried in any electronic signal sent out from a computer is the network address of that computer (simplified version).  A switch / router can read that address and pass that address on with the signal when it routes it to the proper destination computer.  When the destination computer responds, it has the sending computer's address buried in its electronic signal.  The switch / router can read that address and pass the response signal back to the original sending computer.
: Re: I have some questions!
: gurumedbill January 31, 2013, 11:45:03 AM
Johny,
There have been some great answers here and I would give a big kudos to RichardP for the time he has taken to answer these questions which, quite frankly, is much more time then I'd give.  To simplify things a little bit I'll give you all the options that I know of (without getting into the nuts and bolts of each) but if someone thinks of something I left out then feel free to jump in.

Web Based Options
1.  You get a log in for the the program they already have.
2.  You give them a log in(s) for the program you already have.

Server Options
1.  You log into a computer in their office that no one is using that is connected to their network.  You use that computer just like you were sitting at that desk in their office.  This is with programs like LogMeIn
2.  You log into their server using Remote Desktop (something their IT guy would have to setup for you with permissions on the server) and it is like you are in their office still.  However, it is different because they don't need to have an extra computer at their office for you to use.
3.  You don't have access to their system but have your own system.  They send over something on a regular basis (usually daily or weekly but you figure it out with your client), like all the superbills, and you input all the information into your system.

I think that looking at all the billers out there the last option is probably still the most popular but also the most time consuming.  However, I do think it is quickly changing to the other options which thankfully are much better for billers in most instances. 

Good Luck!
: Re: I have some questions!
: RichardP January 31, 2013, 03:24:52 PM
... the time he has taken to answer these questions which, quite frankly, is much more time then I'd give.

My wife and daughter were at a Pentatonix concert, so I had some time on my hands.
http://www.ptx-official.com/

It ocurred to me that I was doing overkill, but I don't know what johnny knows or doesn't know, so I thought I'd go for it.  If johnny doesn't need that info, someone doing research later might, so there it is.
: Re: I have some questions!
: johnny January 31, 2013, 03:47:24 PM
... the time he has taken to answer these questions which, quite frankly, is much more time then I'd give.

My wife and daughter were at a Pentatonix concert, so I had some time on my hands.
http://www.ptx-official.com/

It ocurred to me that I was doing overkill, but I don't know what johnny knows or doesn't know, so I thought I'd go for it.  If johnny doesn't need that info, someone doing research later might, so there it is.


The information you have given me in this thread has helped me more than you will ever know! Glad there are still kind people around!
THANK YOU!
: Re: I have some questions!
: RichardP January 31, 2013, 07:32:41 PM
Thanks for your feedback.  I've been helped in the same way, so I know it's value.
: Re: I have some questions!
: gurumedbill February 01, 2013, 11:34:44 AM
RichardP,

I wasn't saying anything negative about your post, but rather that it was great and thorough, and that he should recognize that and be grateful.  It sounds like he is.  Anyway, I felt the response was very good and am also grateful.

I love Pentatonix by the way.  They are a great group.
: Re: I have some questions!
: RichardP February 01, 2013, 02:14:29 PM
No problem.  I didn't assume there was anything negative there.  Thanks for the kudos.
: Re: I have some questions!
: PMRNC February 01, 2013, 02:41:49 PM
Awesome info...  It's interesting to see how things work on the back end :)     I've never really encountered any conflicts with the few clients I have where I access their system, in fact the only issues I ever encounter really is my strong dislike of the PM system they might be using.. <cough> Medisoft for one.   Other than that we use schedules and just communicate on when I am working. ONE of my clients where I access his system and uses Med Manager actually has a server in his office and there is a main computer that isn't used by staff there, so I have free control through server connection.