Few Questions....

[laurajean412]

Hi everyone! I'm in the process of starting my own Medical Billing Company and I have a few questions!

1. I currently use NueMD at the medical billing company that I work for. Does anyone have any thoughts on using this software for an at home based company?

2. I'm trying to figure out what is the best way to receive super bills, pt info, reports, eob ect. from the Dr. Does a network work best or is it just as efficient to have all the information faxed?

3. If I use a different software then the Dr's is that okay? Do they need to provide me with any more information other then the pt info, insurance info and super bill?

4. Right now I work for a specialist and a lot of times the insurance requires medical documentation and reports. Do you think this is something I should have the Dr's send me for every pt. or should i request them from the Dr. on a need bases.

5. Does Office Billing differ a lot from Hospital Billing if the Dr. provides a super bill. I have only ever done office billing but I know a Dr. who sees pt both in is own practice and at the hospital?

Thank you so much!! This is a great website!!

Laura

[PMRNC]

Hi everyone! I'm in the process of starting my own Medical Billing Company and I have a few questions!

1. I currently use NueMD at the medical billing company that I work for. Does anyone have any thoughts on using this software for an at home based company?

NueMD has two versions, one is for doctors offices and the other is their medical billing company, I have only worked on the physicians version but it was not bad at all, the reports are pretty nice,

2. I'm trying to figure out what is the best way to receive super bills, pt info, reports, eob ect. from the Dr. Does a network work best or is it just as efficient to have all the information faxed?

You will find that this will depend on the practice, you should be open to several different means of obtaining the information you need, I prefer fax because that saves time for the staff in copying.
I usually leave this up to the client.

3. If I use a different software then the Dr's is that okay? Do they need to provide me with any more information other then the pt info, insurance info and super bill?

This too will depend on the client, if they want you to do it all and you can't work on their system it's best to start off in your software and depending on what you decide a start date is usually chosen and balance forwards are put into the account, there might also be situations where you and the client agree to have you work back claims in which case you will load patients into your software. Another scenario is to work on the providers software via remote access and that can be achieved in several ways.

4. Right now I work for a specialist and a lot of times the insurance requires medical documentation and reports. Do you think this is something I should have the Dr's send me for every pt. or should i request them from the Dr. on a need bases.

Depending on the specialty of the practice, you might find you only need certain documentation on an "as needed" basis. The less "medical" records that leave the office the better.

5. Does Office Billing differ a lot from Hospital Billing if the Dr. provides a super bill. I have only ever done office billing but I know a Dr. who sees pt both in is own practice and at the hospital?

If the doctor is charging for his professional services in a hospital setting you are still going to bill on the CMS1500 but coding will be different as you'll want to get familiar with the appropriate inpatient E/M codes, or any other codes used by that provider.

 

[laurajean412]

That's great, thank you!! Can you explain a little more about what a "remote" desktop is. I have heard the term before but am not quite clear on what it is. Also what is the going percentage rate that you bill the Doctors. I'm planning on charging a % of the amount billed but I have read people charge anywhere from 6%-14%!

The Doctor that i am pursuing already has a great system. Do you think its okay to tell him that I could log onto his software and get the info I need and then input it into my billing software? He has a all paperless practice.

Thanks again!

[laurajean412]

Also is it a good idea to hire an accounant? What types of things would I need an accountant for?

[Pay_My_Claims]

That's great, thank you!! Can you explain a little more about what a "remote" desktop is. I have heard the term before but am not quite clear on what it is. Also what is the going percentage rate that you bill the Doctors. I'm planning on charging a % of the amount billed but I have read people charge anywhere from 6%-14%!

The Doctor that i am pursuing already has a great system. Do you think its okay to tell him that I could log onto his software and get the info I need and then input it into my billing software? He has a all paperless practice.

Thanks again!

remote desktop is just the ability to connect to your home computer/work computer from another PC.

Also I haven't heard of anyone charging a % on the amount billed, but on the amount received. This gives you incentive to know the more you pursue money for the provider, the more money you receive.

[laurajean412]

I'm sorry I meant to say I was going to be charging on the amount collected, my mistake. What percentage is good to shoot for? Also I'm trying to figure out how to word the Contracts, anyone have any examples? Does anyone charge a start up fee? How much is average to ask for a start up fee?

Thanks again!

[Pay_My_Claims]

No problem, we all make slip up's. It would vary on your area. I have seen charges from 3%-8% of the revenue collected. I charge my pediatrician a percentage fee of 5%. I do some flat fee charges for DME since that is a different situation. It's high-end custom Rehab so there is a %fee based upon claims under 10k, and a flat fee for claims over 10K (received) For a DME provider that has a large volume of the high end rehab, I would have to do an overview of his current AR and negotiate a fee.

[PMRNC]

You will also want to make sure you are not in one of the states that prohibit physicians from entering a percentage based (fee-splitting) arrangement/contract.

I've always charged a setup fee, ranging from $100 to $3000 and more, depending on the practice, amount of work involved, etc. My startup fee is also like a security deposit (Only not refundable).
I will discount the setup fee as an incentive for the provider to sign my contract but have never waived it completely.

[gderilus]

how do i find information about which state prohibit physicians from entering into a percentage based arrangements/contracts .
I live in Florida, and I tried to google it but didn't find anything

[PMRNC]

Florida is one of the states where it's actually nearly cut & dry that it's considered illegal fee-splitting. You want to make sure when pricing your services you do not base them on a percentage or even a perceived notion of percentage. The states where there are actual cases on the books and the law is clear is Florida, NY, & Illinois. A few other states have similar laws but with some "grey" area.
 
Here is the verbiage from the Florida Law:

The basis for the final order appears in F.S. 458.331(1), which sets forth a list of acts or
 omissions for which the board may take disciplinary action against a physician's license.
The list includes 458.331(1)(i), which prohibits "paying or receiving any commission,
bonus, kickback, or rebate, or engaging in any split-fee arrangement in any form
whatsoever with a physician, organization, agency, or person, either directly or
indirectly, for patients referred to providers of health care goods and services . . ."

[gderilus]

so basically, I would have to charge my clients a flat fee for for all the services i provide to them. I would be loosing money if that's the case unless I charge them a high flat fee.

[Pay_My_Claims]

Florida is one of the states where it's actually nearly cut & dry that it's considered illegal fee-splitting. You want to make sure when pricing your services you do not base them on a percentage or even a perceived notion of percentage. The states where there are actual cases on the books and the law is clear is Florida, NY, & Illinois. A few other states have similar laws but with some "grey" area.
 
Here is the verbiage from the Florida Law:

The basis for the final order appears in F.S. 458.331(1), which sets forth a list of acts or
 omissions for which the board may take disciplinary action against a physician's license.
The list includes 458.331(1)(i), which prohibits "paying or receiving any commission,
bonus, kickback, or rebate, or engaging in any split-fee arrangement in any form
whatsoever with a physician, organization, agency, or person, either directly or
indirectly, for patients referred to providers of health care goods and services . . ."

Ok, this is such a good topic because I have looked at a lot of information regarding fee-splitting and I just don't see where the services that a medical billing service provides is considered fee-splitting. When i looked on the OIG website it clearly states that fee-splitting is forbidden, but by definition fee-splitting is a kickback not a fee for service. The MD can't give a cardiologist a free physical so he can refer his patients to the MD. Thats a kick-back. The billing company can't do something like this. I bill for a OBGYN, and a pediatrician. I send information to my pediatrician about clients that have or are having babies. I make a financial profit off of that.  I found this on the FS website. Let me know your opinion.

http://www.doh.state.fl.us/mqa/medical/Petitions/DOH-99-0977.pdf

[Pay_My_Claims]

Here is another good article on Fee Splitting. As it stands, 2 states I don't touch Florida & Illinois!!

http://virtualmentor.ama-assn.org/2009/05/hlaw1-0905.html

[PMRNC]

Here is where MOST people get confused.  It is not illegal to charge a provider based on a percentage of collections, however it is illegal for a provider in a state where fee-splitting is illegal to enter into ANY fee-splitting type arrangement.  A percentage of Anything (billed or collected) is fee-splitting.  Using again Florida as an example:

"paying or receiving any commission,
bonus, kickback, or rebate, or engaging in any split-fee arrangement in any form
whatsoever with a physician, organization, agency, or person, either directly or
indirectly, for patients referred to providers of health care goods and services

So many billers try to argue this the wrong way, but not only have I researched this for years but have talked to several attorney's in all three of those states as well as others where there is some grey area on the rule.
The argument is not whether it's Illegal to do.. it's actually on the provider..they are prohibited from entering into such a contract. As for the biller, this could be harmful to their business to have this type of arrangement because if you ever have to go to court over a contract dispute (breach of contract, dr doesn't pay, etc) your contract in those states are NULL AND VOID so winning your case would be moot as you wouldn't see a dime.

In our subscriber area I have some actual case rulings/precedents.

Also you don't have to do just a flat fee, you can do hourly, per claim, per service, etc. As long as you don't COME up with the pricing based on a "percentage"   In NY they actually are more specific with this in wording it so that you shouldn't even CALCULATE fees based on a percentage.  BTW, NY's Law is as follows:

"Section 6530.19 - 19. Permitting any person to share in the fees for professional
 services, other than: a partner, employee, associate in a professional firm or corporation,
professional subcontractor or consultant authorized to practice medicine, or a legally
 authorized trainee practicing under the supervision of a licensee. This prohibition
shall include any arrangement or agreement whereby the amount received in
 payment for furnishing space, facilities, equipment or personnel services used
by a licensee constitutes a percentage of, or is otherwise dependent upon,
the income or receipts of the licensee from such practice, except as otherwise
provided by law with respect to a facility licensed pursuant to article twenty-eight
of the public health law or article thirteen of the mental hygiene law"

[Pay_My_Claims]

I understand totally what fee splitting is, but looking at the case that I showed you, I just wanted your opinion on it. This is what can be confusing for a lot of us. It does not say "billing services can't charge a provider a % of fee's collected in the state of florida". In this case it stated that because the service wasn't responsible for expanding the growth of the medical practice, they don't consider this fee-splitting. Even your post says "paying or receiving any commission, bonus, kickback, or rebate, or engaging in any split-fee arrangement in any form whatsoever with a physician, organization, agency, or person, either directly or
indirectly, for patients referred to providers of health care goods and services

This case states that the billing service isn't receiving any money that would be deemed fee splitting since it is not receiving money from patients that are referred to the provider. This is where it gets confusing, because although it can be deemed "fee-splitting" to charge the % the fee-splitting doesn't come from referrals.

Just for me, before I would take any clients from these particular states, I would be quick to get an attorney to advise me. I feel personally the statute is poorly written, and very hard for "laymen" to comprehend. I did read what you were speaking on in regards to if you enter into the agreement it becoming null and void. With such the billing service wouldn't get monies owed by the physician, nor the physician would be able to get anything back thats being held by the billing service.

such a very interesting topic.....