Starting Help

[Dzungzy]

Hello,

This site has been incredibly informational! I have a few questions if you would be so kind to give some advice.

Currently, I do all the billing for my optometry office.  I have a brother that needs me to help him with his family physician office.  I don't have much experience billing on the medical side.  I may consider starting a medical billing business if I am successful at this.  I already have someone drawing up a contract between his office and me since there is more than one doctor in his practice.  What are the normal fees that a doctor would incur by hiring a "billing company" such as this?  Is there a set up fee?  How much would a normal biller get paid?  I read earlier about taking a percentage of collections.  Is that feasible?  Or would a salary based wage be better?

Can you give me some tips as far as starting to set up the billing for an office?  They are currently using Medisoft but will change to eclinical by the end of the year.  I want to set up so that I am ready for the transition of their software as well as create a system that will be easy yet efficient for me. Is it best to use log me in?  How would I get superbills and eob paperwork from them? 

I know I had a bunch more questions than anticipated but I would appreciate any help, advice or suggestions you would have for me.

Thanks!
Rachel

[PMRNC]

Since you gave them a contract, it sounds like you want to set this up as a "business" is that correct?  Don't forget your HIPAA BAA agreements and make sure you have registered your business and checked registration requirements in your area (county/state)  As for what's "Normal", this can't really be answered as much now as it used to be. It really depends on what you will be doing exactly, specialty, volume, etc. I don't recommend percentage based billing anymore and in some states it is prohibited for doctors to enter into those types of contractual relationships. I use a flat fee but it's baseline is my hourly salary and again this will depend on the functions I will be doing. Of course you want to average in costs, etc.    You also don't mention if you will be working in-house or not? This will make a big difference in how you setup and you want to make sure if you decide to do like a "private contract" type of situation you cover yourself with Tax regulations as well. It will matter if you are using their software, computers, etc etc etc.   I would say your first step would be to define how you will structure yourself with this first, and then you can go from there.

[Dzungzy]

Thanks for the reply.  I actually just wanted to do it to help my brother but his partners wanted the contract.  Where would I go to find out the HIPPA regulations for that?

I would be working remotely logged on to his server.  What kind of tax regulations would I be looking for?  I'm guessing google would be able to provide some info?

As for the functions I will be doing, seems like I would be strictly sending claims to insurance companies, posting eobs and taking care of denials.  In the long run, I believe that this would change because he wants me to try to restructure his front desk to work more efficiently.  Right now, they have a data entry person that inputs their CPT codes and diagnosis into Medisoft.  Would you suggest me getting their superbills and inputting myself or will the data entry person still be okay?  I don't want to get overwhelmed since I have my own practice to run.

His office has three doctors that see approximately 25 patients a day billing I would say about 90% of the time.  His practice is a family practice so no specialties.

I believe that my hardest obstacle will to be figuring out which diagnosis to piggy back with which procedures.  Is there somewhere that I can go to study this particular topic?  Or maybe find he top 50 codes for a family physicians' office?

Thanks!

[Michele]

Some of these things will depend on your state laws.  Yes, google is a great tool for looking these things up.  If they enter the info will you be getting copies of the superbills?  I would be worried about data entry error.

[PMRNC]

Thanks for the reply.  I actually just wanted to do it to help my brother but his partners wanted the contract.  Where would I go to find out the HIPPA regulations for that?

Well, you are going to need to establish a "business model" since you have given them a contract. That means you need to define your position which could be a Business Associate in this type of arrangement (most likely) I would strongly suggest research and maybe a class in HIPAA requirements because it's extremely vital in this industry.

I would be working remotely logged on to his server.  What kind of tax regulations would I be looking for?  I'm guessing google would be able to provide some info?

Well, first you want to define yourself.. are you going to be a business, private contractor, etc.  That really should have been done before the contract and I would hesitate to make suggestions w/out knowing how that contract was legally setup.

As for the functions I will be doing, seems like I would be strictly sending claims to insurance companies, posting eobs and taking care of denials.  In the long run, I believe that this would change because he wants me to try to restructure his front desk to work more efficiently.  Right now, they have a data entry person that inputs their CPT codes and diagnosis into Medisoft.  Would you suggest me getting their superbills and inputting myself or will the data entry person still be okay?  I don't want to get overwhelmed since I have my own practice to run.

Again, without really seeing what type of contract has been setup, I can't really give advice on what you will offer, hopefully it's outlined in your contract?   To me this sounds like you are setting up for a business type arrangement.  The data entry person is entering from superbills, I presume?

I believe that my hardest obstacle will to be figuring out which diagnosis to piggy back with which procedures.  Is there somewhere that I can go to study this particular topic?  Or maybe find he top 50 codes for a family physicians' office?

That's not quite how it goes. Unless you have a CPC on staff, the provider should be coding all visits with both CPT and ICD9 codes. coding is not a matter of putting the right diagnosis with the right CPT, it's about taking and entering the procedures done and the true diagnosis from the actual medical record, again this should be done by the provider unless there is a qualified and experienced coder on staff as this could spell disaster.