Medical Consulting

[ChristineS]

Hello, I have a client that is interested in consulting. They would like me to go out to their location and increase profit. They currently have on site billers and want to keep it that way. I have never considered doing consulting. I am not sure how much to charge or how to go about averaging my fees. Anyone out there have any information that would be of help, I would greatly appreciate it.

Thank you!

Chris

[Steve Verno CMBS, CEMCS]

Im sure you mean someone who wishes to become a coding and billing consultant vs medical consulting performed by a physician.

Wanting to be a coding and billing consultant is not something someone with no training, certification or experience should be doing.  You have to be an expert with lots of experience. You have to be able to quote and show policy and laws.  Certifications add credibility with a consultant.  A consultnt has to know every aspect of the practice and the provider's specialty. 

Two years ago a friend of mine wanted to get into consulting.  She went to a practice in Las Vegas.  She called me almost every hour with questions. (Can you look up the Nevada HMO law and let me know if the doctor can balance bill the patient; the patient works for the Belagio and all their insurance will pay is $13.78 on a $500 bill, what can I tell the provider to do because he says that this insurance company is contracted with all the hotels and this is all they will pay a doctor here in Vegas.)  Then came, (Can a chiropractor bill an office visit and CMT?)    I had to inform her that if she wanted my help, she had to pay for it.  The phone calls stopped and so did our friendship.  She blamed me for her failure.  Yet, I warned her not to do it.  She didnt know Nevada laws, she didnt know the specialty and she didnt know alot more. She just finished her basic training in billing. 


A consultant could charge anywhere from $50 to $250 per hour and more depending on alot of factors.  This doesnt include transportation, lodging, and meals.

A practice I worked for back in 1996 hired a consultant to look at the company I worked for to see if we were doing all we could be doing to being in revenue or if we wee doin somthing illegal.  The revenue we brought in went from $400,00 per month to $800,000 per month.  The consulant came in on Saturday and Sunday.  She met wit every manager in the company.  SHe finished and submitted her report.  The practice caught her in a lie in her report. She took a previous report and just cnaged the names.   Her reptation as a consultant was ruined. The people who requested her help teminated their requests.  She basically dropped out and stopped consulting. 

[PMRNC]

They would like me to go out to their location and increase profit.

You are going to need to be a lot more specific with what they want. Also what is your training/background?

[ChristineS]

Thank you. I am a medical biller/coder. I have also been a practice manager. I have no doubt I can increase their collections. My concern is that... I operate a billing company from my home office. I have not gone to another office outside my city to poke my head around and look for errors. I am thinking it would be done the same as if I was billing from my home office. Making sure they are charging the right amounts, the right codes are being used, etc. I do not want to turn away this client but if I can not help him in the ways he is looking for I do not want to tell him I can. When going into consulting what all is done? He wants to collect faster and make sure he is collecting what he should be. He also wants to know if his billers are doing a good job and if he really needs the amount he has. This is for a physical therapist.

Thanks

[Michele]

I would get him to specifically outline what he is looking for you to do (which it sounds like he may already have done).  If you feel that you are experienced in the areas he is looking for you to check out, then you should be fine.  Anything that you encounter that you are not sure of, right down and research from your own office and get back to them on.  Basically it sounds like he wants someone to come in and check out how is people are doing, and suggest any areas that they can improve on.  One big thing I tend to see when I go into an office like this is that they don't do regular follow up and do it thoroughly, and/or they aren't taking care of rejections or missing information issues.

Good luck

Michele

[Steve Verno CMBS, CEMCS]

A good practice thermometer is the insurance aging report.  I look at that and it tells me the financial health of the practice.  I pick out 20 charts at random.  I perform an audit of the documentation vs codes submitted.  I also look at the payment/adjustment report and compare that with the deposit report.  I also want to see the practice financial plan. 

Regarding Making sure they are charging the right amounts.  It is not my say so regarding how much the provider charges.  The problem is that if you say to an internal medicine specialist that other internal medicine specialists charge $125 for an office visit, so his charge of $200 is too high.  That could be considered as possible price fixing.  I do look to see if the provider is charging too low.  I look at provider contracts to see if the contracted insurance company is paying correctly.  One provider I audited ended up being paid $5 per visit based on the poor contract.  The $5 was usually applied to the deductible which she refused to collect.  Her complaint was she wasnt making any money.  In the end, she closed her doors for good.  She lost her medical license and was sanctioned from Medicare, Medicaid and every commercial carrier that had a Medicare/Medicaid product.   She moonlighted at a clinic.  The providers there were not par or enrolled with Medicare or Medicaid, yet, they saw Medicare and Medicaid patients.  The biller sent their claims using her Medicare and Medicaid number and put her down as the provider who saw the patient.  Medicre caught this and stopped all payments wile they did an audit.   She and the clinic providers were brought up on charges of fraud and sbuse.  The biller was also sanctioned.  Her excuse was she was told to do this by the office manager.  My problem as the consultant to the doctor was that she didnt want to listen to me.  She didnt want to redo her poor contracts an she refused to bill her patients for their copay,deductibles and coinsurance.  You can only go so far.  Its like leading a horse to water.....
I never tell a doctor what to charge.  iIf I see multiple fees for a service, my only recommendation is to have one fee.  The fee selected by the provider is up to the provider.

[Michele]

It is absolutely amazing what you can find by just looking at the insurance aging report.  I went into a practice and pulled an insurance aging report from their PM system, (which his office manager told the Dr couldn't be done) and in five minutes I found that NO inpatient hospital visits were being billed, NO nursing home visits were being billed, and NO medicaid was being billed.  All just in 5 minutes of looking at the insurance AR.  This practice had 3 DRs, 3 NP's, and saw all their own patients at the hospital (daily!) and was the director at FIVE nursing homes.  Funniest part  -    Office Manager (and Biller) still has her job!

Michele

[Steve Verno CMBS, CEMCS]

You have the old saying:

Screw Up and Move Up!

[ChristineS]

Thanks everyone!! I appreciate the help!