Medical Billing Forum

Starting a Medical Billing Business => Starting Your Own Medical Billing Business => Topic started by: mrsjcksn on October 06, 2008, 02:12:20 PM

Title: starting a medical billing business
Post by: mrsjcksn on October 06, 2008, 02:12:20 PM
Hello,

   I just sign up as a new member for this forum. So far, everything I have read has been great. I want to start my own medical billing company, but not from home. I will be in a office with about 4 employees including myself. My question is, with the bailout suitation & the economy being like it is, it is safe to start a new business?

Thanks,
Melissa
Title: Re: starting a medical billing business
Post by: Michele on October 06, 2008, 07:43:57 PM
Of course I can't possible make a guarantee that all will be fine, although I am an extremely optimistic person who's glass is always more than half full.  However, medical billing is a service that is needed, no matter what the state of the economy is.  Doctors will still treat patients, insurance companies will still pay claims, etc.  There will be a need for billing services. 

Good luck!    ;D

Michele
Title: Re: starting a medical billing business
Post by: mrsjcksn on October 06, 2008, 09:23:48 PM
Thanks. That's exactly what I needed to hear. Again thanks. I'm so happy I found your site.

Melissa  ;D
Title: Re: starting a medical billing business
Post by: gderilus on December 12, 2008, 09:27:23 PM
Hi Michelle and Alice I'm starting my own business and I have some questions about the patient statements. When you send out the patients statements, does your address show( billing company) on the bill or the doctors address. If it is your address, how would the patient know who they are dealing with.

Thanks very much
Title: Re: starting a medical billing business
Post by: Michele on December 14, 2008, 03:02:52 PM
The patient statements that we send have the Providers name and address on the statement but it has our phone number for billing inquiries.  Also, the envelope has our return address.

Michele
Title: Re: starting a medical billing business
Post by: PURPLELADY on January 25, 2009, 11:49:02 AM
Hi all...

I am in the process of starting a medical billing business from home and it will also include a/r collections.There are so many questions I have and dont know where to begin. I am trying to get the "set-up" together.  I do have a business partner and we are registered w the state and have a tax id#. I have the business license, llc, and npi apllications ready to be filled out (I may need help with these)  We plan to do manual and electronic billing.  Trying to be cost efficient(in case things dont work out). We are seeking a way to bill ins co directly without a clearinghouse (if possible). Is there a software that will give us this capability?  I am currently reviewing the software from ezclaim for 30days (so far it seems okay for manual billing and reports and patient statements).  I would also like to know what are the current fees to charge per claim the primary care Doctors and the percentage fee to charge the specialty Doctors?
I would greatly appreciate any help I can get.  After reading some things on this site it looks like this is the "one stop shopping for me".
THANKS



Title: Re: starting a medical billing business
Post by: Pay_My_Claims on January 25, 2009, 12:57:59 PM
PurpleLady,
There really isn't a "set" fee to go by. You may want to research your area and find out what is UCR in your area. Also fees differ on what you are offering the client. Some are doing just billing only while others are doing full service Patient Management. There are various software that you can use. No you don't have to have a clearing house, although I prefer to utilize one. If you are concerned about cost, look at Practice Mate and OfficeAlly, both are free (to a degree). There can be a charge if I believe 50% of your claims are Medicare, then its 19.99 a month fee. I am not endorsing them, just giving you some leads. Google Medical Billing Software and you will come up with a lot. Some have clearinghouses that don't charge a per claim fee, if cost is what is keeping you from using one.
Good Blessings
Title: Re: starting a medical billing business
Post by: Michele on January 25, 2009, 03:19:58 PM
Congratulations on your decision to start your business.  We wish you the best.

First, I noticed you indicated you were prepared to apply for an NPI number.  Billing services do not need NPI numbers, only anyone who is providing a medical service and billing insurance companies for that service.  All of the providers you bill for will need NPI numbers, but not your business.

Pay_My_Claims had some good suggestions for you on software.  I have heard of both of them but never used either personally. 

You can submit claims electronically directly to insurance carriers (as opposed to going thru a clearing house) but it usually requires a separate software that works with your practice management system.  So it will depend on which software you go with.  For example, we use Lytec and we purchased a separate software, ClaimManager, which allows us to submit claims directly.  The ClaimManager software is quite costly (almost as much as the Lytec) but for us it is worth it due to the volume we have.  However, we are currently working with a software company that is developing a webbased software that is going to be very cost efficient yet the features are very nice.  It will be available in March. 

As far as fees, Pay_My_Claims was right.  There are no 'set fees'.  You have to go by your area, the services you are providing, etc.  We have found that nationwide the percentage can be from 5% - 13%.  We have also seen per claim fees from $1.50 - $5.00 per claim. 

Hope the information is helpful.

Michele
Title: Re: starting a medical billing business
Post by: PURPLELADY on January 26, 2009, 06:38:41 PM
Thanks to Pay My Claims and Michelle for your input.  Your points are well taken. I am so excited that I stumbled on this site I just dont know what to do!!! (smile).  Now, I need to know about the process of payments. We are having pymts sent to the Docs directly. Are the eobs sent to the Docs or billing service? Or both?  Should the Docs be billed bi-weekly or monthly?  We also will be accepting credit card payments over the phone. We have the quickbooks simple start software that also includes accepting credit card payment thru them. I feel that there fees are much to high so we decided on using pay pal since it is well known and a trusted site by clients.  Is this a good idea or can I do better in this area?  Oh, I almost forgot....We would like to create a "packet" for the Docs to review about our business or should I keep it simple with just a brochure? It was suggested to me that my first Doc should be charged half price or free since we will be trying to iron out any kinks there may be. What do you think?  Forgive me for jumping from one thing to another. Maybe I just need a definite process to follow
as to how the business should be set up. I have been in this business for almost 29 years with different positions and I love it.  I think I need a mentor. 
Title: Re: starting a medical billing business
Post by: Michele on January 26, 2009, 08:02:13 PM
EOB's are usually attached to or in the same envelope with the checks so if the checks are going to the docs then the eobs will too.  They will not send out more than one copy, you will have to get yours from the docs.  We bill our providers monthly.  I have used paypal and never had any problems.  Currently we are set up with a merchant account.  I don't have anything to do with that part (partner handles it) so I can't really comment on fees.

As far as packet or brochure, 6 of one, 1/2 dozen of the other.  There is no right or wrong, but you should consider cost.  Honestly I don't think providers make up their minds on how good your brochure is, they usually ask for one when they are trying to get rid of you. 

I don't know if I would recommend offering a discount (or free) to your first client.  Even though they are first you are providing them with the same service.  Also, what if you don't have any kinks to work out, what if it all goes smoothly.  And I hate to break it to you but you're going to have kinks 10 years from now.  They seem to keep popping up here and there!   :D
You can always discount their monthly bill if you have something big happen, but if you start at a discount it would be hard to change.

Good luck
Michele

Title: Re: starting a medical billing business
Post by: PURPLELADY on January 26, 2009, 08:38:17 PM
Thanks Michelle.  What about the superbills or charge slips? Do we provide the office with them? Also, what about the diagnosis and procedure codes?  We just bill what the Docs put on the charge slip right?  What about rejections? I plan to contact the office for them to send me a corrected charge opposed to taking the correction over the phone. Am I correct in doing that?  Another thing, when seeking approval from the payors to bill them, is it better that I call and get the applications myself or should I allow the clearinghouse to do it? We are doing A/R "soft" collections.  I plan to make calls and send 4 statements to patients and return the A/R to the Dr for possible referral to a collection agency. Do you think I should show the Dr what letters I'm sending?
Title: Re: starting a medical billing business
Post by: Michele on January 27, 2009, 06:27:09 AM
If a dr doesn't have one they are using sometimes we offer to provide one.  Sometimes we use them as a tool to get the provider to sign.  The provider should give you all dx's and procedure codes and you should bill them as given.  If you see a problem with something you should notify the provider.  Rejections depend on the level of service you are providing.  We handle rejections for any provider that we do full insurance billing for.  If we take info from a provider's office over the phone we document it in the computer.  We send out 3 pt bills, then refer them back to the provider for hard collections.  As far as getting set up to bill with a payer you will have to follow the rules of the payer/clearinghouse.

Michele
Title: Re: starting a medical billing business
Post by: PURPLELADY on January 27, 2009, 08:22:19 PM
Thanks Michelle, you are wonderful!!!!
When doing the soft collections how should the process go? Am I setting it up on excel? Also, if payments are going to the Dr, how would we know if they were pd? Can I really rely on them faxing me a copy of the eob?  If i wanted the payors to pay me instead, what would i put on the hcfa form to have it done?
Title: Re: starting a medical billing business
Post by: Michele on January 28, 2009, 06:42:29 AM
We keep track of our patient billing right in the practice management system that we use.  Yes, the dr must notify you of all payments.  If he doesn't then his patient gets another bill and patient's don't like that.  They call the dr and they aren't happy, so the dr learns quickly that they must notify you of payments.  If you want payments to go directly to you it has to be set up with the insurance carriers as the correspondence/pay to address.  You can't just enter it on the CMS form.

Michele
Title: Re: starting a medical billing business
Post by: Pay_My_Claims on January 28, 2009, 02:03:58 PM
Superbills-most of the providers I know generate 1 with the check in process. ( I deal with most family physicians, and some specialty clinics). They are generally 2-3 copy encounters, 1 for the phy, 1 for the patient, and the 3rd for referrals/labs.

EOB's A lot of the software that you can choose has it where you can sign up to view the EOB's online. There are some billing services that will make the deposits etc for the physician, but most prefer to keep the cks themselves. This way the MD see's his money, sees the eob' and has a copy in his office.


Good Blessings.
Title: Re: starting a medical billing business
Post by: PURPLELADY on January 28, 2009, 08:51:38 PM
Hi ladies and thanks for the info!! 
Office Ally says if my system has print image file and/or nsf format I will be able to file claims with them. Are they saying if I can physically print claims then I can use their service? I'm not familiar with the "lingo" nsf format or print image file.   
I plan to use gotomy pc to have access to my computer via blackberry phone which also will be my business tele#. Do you think its okay since both partners are working during the day? Any suggestions? Also is anyone familiar with ezclaim software? I'm looking to purchase the 395.00 software. I'd appreciate any scoop you may have.   Thanks
Title: Re: starting a medical billing business
Post by: Pay_My_Claims on January 28, 2009, 09:34:16 PM
Its the way the files are formatted..you should ask your software company about the specifics of your program.

http://www.redix.com/hipaa_to_nsf2.htm

I personally wouldn't use my blackberry, but my vision isn't as good as yours probably..LOL I'm not the biggest fan of gotomypc. I just prefer having my own software, and transferring the data from his pc to mines. I do plan to utilize the Iphone for urgent issues (he calls, i am away and he needs me to look at something). I want to have access to all my information should we terminate. I can clean up the files and send his final reports. Also what happens is you are using gotomypc and he terminates your service and you have outstanding claims that you proccessed and need to get paid for???

Title: Re: starting a medical billing business
Post by: Michele on January 29, 2009, 07:39:39 PM
Good point Pay_My_Claims (on the gotomypc and terminating services).  I actually love gotomypc, but for different purposes.  It works great for me to connect to my personal computer at the office whenever I'm traveling or even just at home.  That way I'm always in touch with my data.  And we have one provider that we access his info thru gotomypc but I download the info into my computer then put thru my PM system so even if he terms me I'm covered.

Michele
Title: Re: starting a medical billing business
Post by: Pay_My_Claims on January 29, 2009, 08:30:46 PM
Thanks Michele. If I wasn't planning to use a web based program, i would be using gotomypc also I am sure.
Title: Re: starting a medical billing business
Post by: Michele on January 30, 2009, 08:56:26 AM
We are actually going to be moving to a webbased software also, but I still love the gotomypc because I can access ALL of my computer, email, word documents, etc.  But the webbased softwares have some great features!

Michele
Title: Re: starting a medical billing business
Post by: PURPLELADY on February 04, 2009, 08:04:08 PM
Hi Everyone,

Well, I'm still filling out forms and researching. Where is the simplicity? (lol)  I'm still in touch with office ally clearinghouse.  This seems to be a good place to do business. They require that I obtain the pre-approval from insurance companies to bill.  Should this be done before purchasing software or after?  Also, do I just call the insurance companies and ask for the forms?  What does one do? What questions will they ask so I can be somewhat prepared for them?

                                              Thanks
Title: Re: starting a medical billing business
Post by: Pay_My_Claims on February 04, 2009, 08:30:06 PM
PurpleLady...just so that you can be aware, make sure you know what carriers office ally is set up to send electronic payments too. When I looked they didnt have enough providers for me to even contemplate using them.
Title: Re: starting a medical billing business
Post by: Michele on February 04, 2009, 08:41:35 PM
I have never heard of a pre-approval form so I can't even begin to advise you.

Sorry.  :(

Michele
Title: Re: starting a medical billing business
Post by: PURPLELADY on February 04, 2009, 09:17:50 PM
Thanks Pay my claims, good lookin out!!!  I will email them with that question.  Office Ally also says I really dont have to have software.  I can fill out their version of the CMS 1500 form on their site.  What do you think about that?  Michelle, maybe I'm saying it incorrectly.  I want my company to be able to submit claims to insurance companies.  There is a form they provide that lets them know we are a billing co.  It asks for our tax id#, biz license, company name, address tele#, etc. 

Ladies, thanks so much for all your input.  I think I'm getting "burnt out" and frustrated with all this business stuff!! I may have to step away from this for a minute.  Has anyone ever felt like that? What did you do about it?  I'm not giving up. I think I need a break.
Title: Re: starting a medical billing business
Post by: Michele on February 05, 2009, 07:12:21 AM
We submit claims to insurance companies for over 60 providers daily.  There are a couple that require paperwork from us if we are going to submit electronically.  It's called EDI paperwork to become a submitter.  They usually assign a submitter number.  Maybe that is what they are referring to.

We all reach a point that we feel that we need a break.  Actually having a partner has helped us out tremendously.  When one of us needs a break, the other is there to pick up the ball and carry it alone for a little while, or provide some encouraging words to get the other one back on track.  Sometimes this field seems overwhelming.  You just need to step back and take a big breath.  Then look at things one at a time.  It doesn't seem so overwhelming that way.  If you look at the whole picture all the time you will definitely get overwhelmed.

Michele
Title: Re: starting a medical billing business
Post by: Pay_My_Claims on February 05, 2009, 08:07:22 AM
We submit claims to insurance companies for over 60 providers daily.  There are a couple that require paperwork from us if we are going to submit electronically.  It's called EDI paperwork to become a submitter.  They usually assign a submitter number.  Maybe that is what they are referring to.

We all reach a point that we feel that we need a break.  Actually having a partner has helped us out tremendously.  When one of us needs a break, the other is there to pick up the ball and carry it alone for a little while, or provide some encouraging words to get the other one back on track.  Sometimes this field seems overwhelming.  You just need to step back and take a big breath.  Then look at things one at a time.  It doesn't seem so overwhelming that way.  If you look at the whole picture all the time you will definitely get overwhelmed.

Michele


Amen Michele!!!
I have a partner and I couldn't imagine doing this alone. This way we can have our vacations and still conduct business.
Title: Re: starting a medical billing business
Post by: gderilus on February 06, 2009, 08:28:17 PM
hello
I have a question about patient statements. when you print out the patient statement, can you use regular paper to print it or do you have to buy papers that are made for that.

Thank You
Title: Re: starting a medical billing business
Post by: Michele on February 07, 2009, 08:03:28 AM
It depends on how your practice management system is set up.  Ours just uses plain white paper.

Michele
Title: Re: starting a medical billing business
Post by: gderilus on February 07, 2009, 11:59:37 AM
Hi Michelle
Can you advertise your business by sending the doctors emails. I don'te know if it's legal especially some if they have this sign "NO SOLICITATION". Can you email them your advertisement materials if you don't want to drop by their office.

Two more questions
As a new medical biller with no experience, do you think it's a good idea to go for the chiropractors first. I know they deal with lot of workers comp patients, would that be difficult for someone with no experience.

Also for the CMS 1500 forms, do you need some kind of paper to print them out or can you use regular white papers.

Thank You
Title: Re: starting a medical billing business
Post by: Michele on February 07, 2009, 03:47:50 PM
Hi,
   As far as the email thing I really don't know on the legal aspect.  I do know there are companies out there that sell email lists of Drs, so I don't think it is illegal.  However, I don't know how effective it would be.  Personally, I don't even look at my spam emails.  I would think they wouldn't either.  If it comes in an email they have no idea who you are, you could be anyone.  I just don't personally think it could be that effective.  However, I could be wrong!  :)

  Some people find that chiros are easy to start out with.  We actually did end up with a couple of chiros for our first clients.  I don't think the comp patients make them any more difficult, even for a newbie.  There are only a couple of cpt codes, and the diagnoses are also a small range. 

The CMS forms have to be on the preprinted red & white forms.

Good luck
Michele
Title: Re: starting a medical billing business
Post by: Pay_My_Claims on February 07, 2009, 07:02:38 PM
gderlius, do you mean no experience as in you have never worked as a biller, but have been trained, or you have never worked or trained as a biller..............just curious
Title: Re: starting a medical billing business
Post by: gderilus on February 08, 2009, 07:41:05 PM
I have never worked as a medical biller before but I'm currently working on my Associate degree and I'll graduate in 4 months


I'm thinking about starting my own business, but I have a communication problem. I'm not a sale person and I don't really know how I would present my business to a doctor and persuade them on signing the contract with me. I was wondering if there are people out there who can act as a sale person on behalf me. If there are, how does it work, do we pay them a percentage on every contract they signed.
Any help please.
Title: Re: starting a medical billing business
Post by: Pay_My_Claims on February 08, 2009, 07:58:17 PM
Honestly, I am not for anyone trying to have a medical billing business that has never worked, or at least trained in this field. So many people think its just some data entry field and its not. For every person getting in this field, not knowing the business it makes it literally harder for the ones with the experience because providers don't trust outsourcing as much. If you are financially able to, maybe you should become the partner. Get an experienced biller who knows the field, and go into it with them,
Title: Re: starting a medical billing business
Post by: Michele on February 09, 2009, 05:39:58 AM
There are people out there who will market for you and they all charge in their own way.  Some will charge you an hourly fee, some will charge per appt, etc.  More recently it is becoming popular to charge a % of the contract signed.  But it can be done.  There are some people on this forum that do it, so maybe you can hook up with someone.

Good luck

Michele
Title: Re: starting a medical billing business
Post by: Michele on February 09, 2009, 05:48:03 AM
I didn't read Pay_My_Claims response before I posted, sorry!

I understand Pay_My_Claims concerns, they are very valid.  Unfortunately there are a lot of 'experienced' billers out there too, that also give billing services a bad name.  When we started, my mother (and partner) had no experience in medical or billing at all, but I had worked at an insurance company for several years.  Looking back though, I didn't have 'billing experience'.  It can be done but as Pay_My_Claims stated this is NOT just a data entry job.  You really need to know what you are doing and be the type of person that is going to do it right. 

In my opinion it is more important that you take your job very seriously and treat it as if you are collecting your own money, not the doctors.  That you do whatever you need to to learn what you need to know.  Sometimes experienced billers are closed to learning anything new because they already know everything and that can be a huge handicap. 

But there is no better training than actual experience!

Michele
Title: Re: starting a medical billing business
Post by: Pay_My_Claims on February 09, 2009, 11:11:46 AM
You really nailed it Michele. You may have not been a biller but oh my!! insurance experience is such a key part of the process. Knowing the rules and regulations of insurance especially Medicare, Medicaid, Tricare, and Work comp is essential. Yes the experienced biller does kill us, but her experience doesn't make her qualified. He/she has just been doing the job for a long time and the provider is probably frustrated at the insurance company for low reimbursements instead of realizing his experienced, but not knowledgeable biller isn't doing the job. What I wanted to convey to the poster was don't go into this business just because of what you may have heard on the internet, tv commercial or by word of mouth. I know cosmetology is big business, but I know its not for me. Not only am I not qualified, but its nothing I want to do every day 8 hrs a day. For anyone, find out what you enjoy doing and learn how you can do it and success is at your finger-tips. I love my work, and I know things will happen for me!!

Thanks Michele!!
Title: Re: starting a medical billing business
Post by: Michele on February 09, 2009, 11:38:42 AM
Very true.  When we interview to hire we always look for someone who 'loves' billing.  You either love it or you don't.  There isn't much room in between. :)

Michele
Title: Re: starting a medical billing business
Post by: PURPLELADY on February 25, 2009, 08:21:52 AM
Hi All !!!!

  The purple one is back!!! (lol)  Now, all we have left to do is the business license and the business
bank acct.  I am currently working on the process of how we do business.  My question is what should my invoice include when billing the dr for our services?  Is it pt name, $ he received from ins co, etc.  Also, when picking up the charges from the drs office, should I confirm the amount of charges received before leaving his office?  We will be using Paypal merchant services @ 30.00 per mth and 3.1% +.30 for ea transaction.  Should we include the transaction fees when billing the dr or is it something we just have to
take?  Hope to hear from you soon.
Title: Re: starting a medical billing business
Post by: Michele on February 26, 2009, 06:57:42 AM

Welcome Back!  :)

When we invoice our providers we just include the amount owed and any previous balances they may still have.  If they want more detailed information I provide them with a report that shows all the transactions for the month including patient names, amounts billed, amounts collected, etc.

For the number of patients that are billed/pd on in a month, I couldn't possibly list all of them on the invoice.

Depending on the size of the office and the format you are given the information, it may be impossible to confirm the charges prior to leaving the office.  Some of our offices don't have the charges listed (amounts) on each claim, and it could take you some time to manually add them all up.

As far as the paypal fees, that is really up to you.  I personally feel you should just make your fee to the doctor enough to cover ALL of your costs of doing business.  I don't like charging a fee for my service, and then a fee for paying for my service, etc.  It looks like you're nickel and diming them to death.  Just my personal feelings.

Michele
Title: Re: starting a medical billing business
Post by: PURPLELADY on March 01, 2009, 08:39:53 PM
Thanks Michelle, that was good info.  Now, I'm trying to get some "order in the campsite".  Can you please help me with putting things in order???  I would really appreciate it.  Here's our current status... We are going to purchase the ez claim software for 395.00 + 145.00 (for print image format module).  We have decided to go with office ally as our clearinghouse.  I havent signed with them yet, we are still confirming electronic transmissions between the insurance co and office ally, so far so good. Do I really need both? Office ally charges for submiting claims on paper and  sending statements to patients. So I figure ez claim would be good for that along with any reports I'll be sending to the docs.  Just how important is that print image format when sending claims to office ally?  Do I really need it?  Also, should I request the drs info in our contract or use another form for their credentials, facility location, tax id#, etc?
Just to confirm...our billing service info goes in box#33 and ein in box#25 on a hcfa, right?  Do you have any good suggestions for marketing and or creating websites?  That"s all I have for now. Hope to hear from you soon and THANKS SO MUCH TO MICHELLE AND ALL WHO HAVE ASSISTED ME WITH THIS PROCESS, I REALLY, REALLY, AM THANKFUL.  GOD BLESS YOU ALL!!!!
 
Title: Re: starting a medical billing business
Post by: Michele on March 03, 2009, 06:37:02 AM
Sorry it took me so long to respond.  We had an unexpected death of someone in our church Sunday night, and it really knocked me out. 

Anyway, I will try to help you out, but I'm not familiar with EZ claim so it is hard for me to comment on that.  Also, I've not used Office Ally so again I'm not familiar with the way they work.  From the way you are explaining it, you need a software to prepare the claim file to be submitted to Office Ally, so it sounds like you may need both. 

As far as Box 33, that would be the practice that you are billing for's billing information.  For example, if you are billing for Middleville Family Practice and the checks go to you then you would have:

Middleville Family Practice
Your Street Address
Your City, State Zip

But if the checks still go to them then you would have:

Middleville Family Practice
Their Street Address
Their City, State Zip

And their tax ID goes in box 25, not yours.  Your tax ID should never be on a claim.  The money isn't being paid to you, but to the provider, even if the checks are mailed to you.

Michele
Title: Re: starting a medical billing business
Post by: Pay_My_Claims on March 03, 2009, 11:31:49 AM
Sorry it took me so long to respond.  We had an unexpected death of someone in our church Sunday night, and it really knocked me out. 

Anyway, I will try to help you out, but I'm not familiar with EZ claim so it is hard for me to comment on that.  Also, I've not used Office Ally so again I'm not familiar with the way they work.  From the way you are explaining it, you need a software to prepare the claim file to be submitted to Office Ally, so it sounds like you may need both. 

As far as Box 33, that would be the practice that you are billing for's billing information.  For example, if you are billing for Middleville Family Practice and the checks go to you then you would have:

Middleville Family Practice
Your Street Address
Your City, State Zip

But if the checks still go to them then you would have:

Middleville Family Practice
Their Street Address
Their City, State Zip

And their tax ID goes in box 25, not yours.  Your tax ID should never be on a claim.  The money isn't being paid to you, but to the provider, even if the checks are mailed to you.

Michele


You were right about officeally, you can use your own, or practice mate (who they partner up with)
Title: Re: starting a medical billing business
Post by: PMRNC on March 03, 2009, 12:47:17 PM
What is reason behind purchasing EZClaim?

When you are just starting out.. I like to recommend one important thing.. DO NOT fix/price your services. instead (and it's a marketing edge) base your charges/fees on each practice and doing a thorough practice analysis first. As a new billing company you could lose big time by creating a price/fee schedule too early. Too many variables are involved when you are a third party billing company. You want to be competitive and you also want to base your services on the type of practice, volume, current A/R ..etc. In all the years I've been doing this I've noticed that doctors take you more seriously when you tell them you need to examine the practice first before you give them a quote.

Linda Walker
PMRNC
www.billerswebsite.com
Title: Re: starting a medical billing business
Post by: PURPLELADY on March 15, 2009, 09:12:59 PM
Thanks for the info.  I want to purchase ezclaim to print self-pay statements, reports for dr, and claims (540.00). Office Ally has a fee for everything that they have to print to paper and send.   

I am also offering pre-collection services.  What should I charge for that service? It includes mailing stmts,
phone calls, researching bad addresses and then referring accts to collection agency (dr choice). Should it be 20% like the collection agencies?

When I get my first client, Along with the contract, I need to have all the dr credentials, what insurance are they par with, facility info, tax id, etc so I can set it up on my software and clearinghouse.  Is there a form established for that or do I have to create one?  Thanks
Title: Re: starting a medical billing business
Post by: Michele on March 16, 2009, 06:11:44 AM
I've never been involved in pre-collections or collections so I really can't comment on what to charge, although it sounds as if the 20% would be in line.

I'm not aware of a form out there for gathering all the info from the provider.  We made our own, that way we know that we are getting exactly what we need.  It's not a lot of info so it's an easy form to create, and you can make changes easily as things arise (i.e. NPI number!).

Good luck with that first client!

Michele
Title: Re: starting a medical billing business
Post by: PURPLELADY on March 16, 2009, 05:52:58 PM
Thanks Michelle. You are truly a blessing!!!
We are registered with the state, waiting on the LLC to come back, have a p.o. box address, notarized our partnership agreement, financial software, fax#, computers, office supplies, etc.  We plan to file for our business license and open a business bank account next month. All we need now is the billing software, set up merchant services, ontomypc, and a business phone.  Here is the problem....it was suggested that we use a cell phone as a business phone. Then a suggestion that we get a phone installed and foward calls to the cell phone. What do you suggest?? My partner does not want people to speak to voice mail. We both work full time jobs (getting in about 6:00).  Also, do you think I should sign up with the clearinghouse and medicare/medicaid now (just to get it over with) even without the license yet?
Is there a basic contract for dr/billing service? or should I create one myself as I go along with each dr? What should be in the contract? Do you know of a brochure template I can download?
Title: Re: starting a medical billing business
Post by: Michele on March 16, 2009, 07:38:44 PM
If you are able to answer the cell phone during the day it sounds like that might be a good idea.  But if you would not be able to talk (at work) then it probably wouldn't.  I don't have a copy of any standard contract.  We designed our own.  Contracts vary greatly from very basic, to very detailed.  I would recommend that you have your lawyer review your contract before you use it.

I've always used Microsoft publisher for designing brochures.  There are a few templates available with publisher. 

Michele
Title: Re: starting a medical billing business
Post by: PURPLELADY on March 16, 2009, 09:15:24 PM
Thanks Michelle.  Do you think I should sign up with clearinghouse/insurances even though I have no biz license or clients?  Or do I wait until I get my client.
Title: Re: starting a medical billing business
Post by: PMRNC on March 17, 2009, 06:26:21 AM
If your clearinghouse charges per transaction and doesn't have any monthly or setup fees then it wouldn't hurt to get enrolled, however it's ok just to have your enrollment papers ready for when you get your first client.

Also some things you missed in your setup.. You will want to be sure your BAA's are ready for the HITECH Act, it's an extension of HIPAA where BA's will now carry the same liabilities as CE's so current BA's will be scrambling to review their BAA's, if you do this now and get them ready you'll have one less thing to stress about next year. You also want to look into errors & omissions insurance and start getting your compliance plan ready.
Title: Re: starting a medical billing business
Post by: PURPLELADY on March 17, 2009, 05:31:02 PM
Thank you.....But I'm afraid you lost me with the BAA'S and the BA'S and the HITECH ACT. Can you break those down for me? What does the initials stand for, what is it,what is their purpose, how do I get it, etc.  Where do I begin to search for the errors and omission insurance? Any suggestions.  Is there a website I can go to for this stuff?    Thanks.
Title: Re: starting a medical billing business
Post by: PMRNC on March 25, 2009, 06:03:42 AM
I had some clients who were just so disorganized that I would have them fax deposit slips so I can match them up to the payments for the week, I had one provider who insisted on doing his banking daily so with him we actually got on track faster by matching up daily.
I know there are billing companies with lock boxes setup who collect/gather the checks and make deposits, I had a hard time selling that to a physician, plus as you grow it becomes too time consuming IMO. Doctors AND billing company both are both bound by state/federal record retention laws anyway so it just seems a bit safer to get them on a weekly schedule to fax over daysheets/superbills, etc. Busier offices might want to do it twice a week. Your contract should have this included in the provider responsibility area of the contract.
As for mistakes... if the office made ANY mistake on the superbill or daysheet, I would fax it back along with a quick form for them to complete and sign and send back. I did that to Cover my butt, doing this on the phone would be too risky, even if I documented it, it's still not proof enough they made the correction or change.

Your BAA is your Business Associates Agreement which is required by HIPAA, you will want to discuss this with your attorney and make sure you research and are very clear on HIPAA regulations. The HITECH Act is going to be an extension of HIPAA next year that will bring forth the SAME liability to Business Associates as it does to Covered Entities. MOST third party billing companies are considered BA's and providers are Covered Entities, however there are some billing companies that are Covered Entities, it all depends on your setup/services. Years ago when HIPAA went into effect and I was billing, I chose to cover myself as a Covered Entity, I guess I saw this coming down the pike.

For errors & omissions you might want to research by your state. Some companies refer to E&O as ; Business liability, business malpractice and Quai Tam insurance. Coverage varies from 1 Million and up. For a 3 Million dollar policy in Upstate NY (I'm not billing, just consulting right now) I pay $866 for the year which I've heard is pretty good. In NJ and PA it was much higher, premiums will vary by state and by the services you will provide. Those coding and actually doing contract negotiations, fee schedule negotiations, etc will pay higher premiums because their liability is greater. The average policy premium for a small to mid size medical billing company providing full practice management can range from $600-$2000 a year, again it depends on your location, liability, services, and amount of coverage you choose. A good start in researching this is to call your home-owners and see if they sell that type of insurance. Just be sure you specify it's "Liability" insurance, don't get confused between that and regular business/office insurance which covers your equipment, and work area.. etc.

Linda Walker
PMRNC
www.billerswebsite.com
Title: Re: starting a medical billing business
Post by: PURPLELADY on March 25, 2009, 09:42:32 PM
Thanks Linda. 

     I  thought that since this is starting out as a home-based business that our LLC and homeowners insurance would be enough.  Thanks so much for the info.  I will look into it asap.

     I'm planning on purchasing the Ingenix code it fast (2008) 1-9 software for 49.95 single user and the icd-9, hcfa and cpt books.  Am I wasting my money? What reference material do I really need? If I need any. I did stipulate in my contract that diagnosis and procedure codes should be on all charge slips.
Title: Re: starting a medical billing business
Post by: PMRNC on March 26, 2009, 07:28:41 AM
You can shop for coding books, I like Ingenix, but there are also others, if you are comfortable with it stay with it, I also do keep the books handy and updated yearly. I like the binders so that I can order updates and just insert them rather than a bookshelf full of coding books. I recommend always having at LEAST the previous year and the current year because many billers can get their feet in the door by offering to clean up A/R which involves older claims. having 3 years (2 previous years and current) is Ideal.

As for your setup, the LLC is to protect your personal assets.. it's not the same as "liability" in your day-to-day work. Many billers think that just because they don't code they don't need Errors & Omissions but that's not true at all. There are many other liabilities out there, the false claims act for example doesn't just say if you submit a fraudulant claim you are libel, how it reads is that anyone who is sending claims "SHOULD" know. To give you an example, I had a client a few years back that was required by law to supervise his biofeedback techs, that meant when biofeedback was done, he had to be IN his office and available. As a billing company I knew that rule, however I was not AT the office, therefore the claims I sent where he WAS NOT in his office and I did NOT know.. were considered "errors" .. Once I found out (he went on a trip to Europe and superbills were being faxed to me by his biofeedback tech) Then it became MY liability because then I knew what was going on. I had to legally report it, stop sending claims and dismiss the client. Medicare actually paid me a whistle blowers fee (2 years later. LOL) and he was sanctioned. IF I had continued to send claims KNOWING they were fraudulent I would have been held JUST as libel as he. Going to court ONE time on federal or state charges will close your doors for business very quickly. Another example is if you are billing charges you know the provider is coding incorrectly and he/she refuses or doesn't change or document, you are again, just as responsible legally.
To go further, if you look at lawsuits involving billing schemes you will find many Office managers and in-house billers going down right along with the doctor.

I am not trying to scare you but I believe when you enter this business, there is more to know than just the fluff of how nice it is to work from home.

If you don't currently have clients, you don't have to purchase your insurance until you do. To be honest I didn't purchase my E/O until I had 2 or 3 clients and generated income. Some associations will offer discounts on E/O, but be careful of them and make sure the discount is worth the membership fee. One association out there charges an arm and a leg and many sign up just to get a $100 discount on E/O but they pay over $500 to become a member. ???
Title: Re: starting a medical billing business
Post by: PURPLELADY on March 26, 2009, 08:46:25 PM
THANKS PMRNC!!!  YOU ARE ALLLLRIGHT!!!!
Title: Re: starting a medical billing business
Post by: PURPLELADY on April 05, 2009, 01:03:43 AM
Question.....

Can I safely assume when charging a percentage per claim that I include the copay that is paid up front at the dr office?  Also, when billing the dr monthly, am I adding all moneies collected for the month and then do the percentage of that or  am I billing a percentage for each claim. By the way, in my previous posts I stated that I was going to purchase ezclaim software for 570.00. Well, they have a software that just prints claims. I will be using that and office ally for starters(office ally charges a fee for putting claims to paper).
Title: Re: starting a medical billing business
Post by: PMRNC on April 05, 2009, 11:51:30 AM
How you charge should be spelled out completely in your contract. If you are going to charge a percentage of collections, just stating that is not enough, you would need to spell out that you willl either be charging a X% of total practice revenue (includes copay's and ALL incoming payments) or X% of insurance revenue..etc.
Typically the billing company should get a % of total practice revenue if they are doing full practice management.
My rule was. .. I touch it, I get paid.

Quote
By the way, in my previous posts I stated that I was going to purchase ezclaim software for 570.00. Well, they have a software that just prints claims. I will be using that and office ally for starters(office ally charges a fee for putting claims to paper).

You are going to find you will be VERY limited in the services you can provide clients. If you are going to use a sub-standard "print/send" claims only software, you will NOT be able to provide your clients with practice management, with claims only they really don't need a billing company since most of the work comes prior to and after the claim is submitted. If your intention is to cut costs starting out, you will find in the long run this will be a very big drawback. If you are looking to get into this business you need to have a full understanding of all services involved with full practice management. I'm afraid most of your claims only businesses are either gone or have figured out they need to do it all in order to stay competitive and in business.
DON'T Skimp on software..it's too important to your business and your clients business, and in the long run you will end up with a harder time trying to compete. Software conversions are NOT fun, and they are extremely costly. Take your time looking for the right PM Software and make sure it does all you need it to do. Going with a software that just prints/sends claims is really going to limit you where there is no need for your services.

Linda Walker
PMRNC
www.billerswebsite.com
Title: Re: starting a medical billing business
Post by: PURPLELADY on April 06, 2009, 05:51:49 PM
Thanks Linda.....
 
I do have a line in our agreement somewhat saying that we charge a % for any payments paid to dr as a result of our billing which includes insurances, capitation, self-pay, and co-pays (was not sure if I could include it). 
Linda, maybe I'm misunderstanding what full practice management is.  We are utilizing the full service of Office Ally and their software practice mate. I thought purchasing the "bill claim only" software would assist us.  We will offer electronic/manual billing, follow-ups, resubmissions, pt billing, pre-collections on past due balances, provide drs with reports, telephone inquiries, etc.  I thought this was enough for starters until we get our "feet on the ground". Our plan is not to always be home based.  Should we be doing much more??  I guess I'm being aware of cost just in case things dont work out. 
Linda, I greatly appreciate all your input!!  Thanks again!!
Title: Re: starting a medical billing business
Post by: Michele on April 08, 2009, 12:58:44 PM
"I do have a line in our agreement somewhat saying that we charge a % for any payments paid to dr as a result of our billing which includes insurances, capitation, self-pay, and co-pays (was not sure if I could include it)."  (from the last response to this post)

Be careful with that line.  If you are providing a full service then you will be charging your % on the entire practice revenue, not just the amounts 'as a result of your billing.'  Since you will be doing a full service you will need to track ALL patient payments including copays collected at the office by the office staff, which was not as a result of your billing.  If you are tracking it, you need to be paid, and it would be difficult to separate what you collected vs what they collected.  Like Linda said, if you touch it, get paid for it.  If you track it, you need to be paid.  With the line above you are saying you won't be paid for amounts collected in the office and that is a problem.

Also, regarding the software thing, Linda is correct (again!).  It is too important to start out in a Yugo and then try to move up to a Cadillac.  You don't want to limit yourself in your capabilities, especially in the beginning.  You want to do an amazing job so that you get more clinics by referral.  Saves on the need to market.  There is a new technology available called SAAS which is allowing companies to offer a Great PM system at a VERY reasonable price.  Many of the web based softwares are too expensive for billing services because they charge per doc/practice and they have a set up fee for every new provider.  We have found one that charges per seat instead of per provider and the monthly fee for billing services is only $149 per month.  They are comparable to the PM system by Ingenix, and AdvancedMD but at much lower cost.  Most people don't think it's possible, but the SAAS allows them to offer the same features at a lower cost.

Whatever way you decide to go, just make sure you don't skimp on what you can do.

Michele
Title: Re: starting a medical billing business
Post by: PURPLELADY on April 08, 2009, 05:59:34 PM
I'm getting confused here guys.....
Are you suggesting I not go with Office Ally and their web-based practice management system (practice mate) for free?  They also provide the reports needed for the docs. Again, I thought I could purchase the "print send" (145.00) to do my own claims opposed to paying office ally to do it.  So, do I purchase a "full" billing software along with using office ally? Or do I just can the whole thing and start over? I'm bout to loose my mind!!! (smile) I guess I'm being too cost efficient considering there is very limited funds.  
Michelle, I do see what you're saying about the line in my contract.  I will review and correct my 2-page contract it since I'm doing just billing claims, follow-up, patient billing, and collections.
I tell you.....just when I thought I was getting close to starting!!! Where is the simplicity? (smile) I'm so glad I talk to you guys first.  Thank You so much.
Title: Re: starting a medical billing business
Post by: Alice Scott on April 09, 2009, 05:55:16 AM
Alice here.  ;)
I had to comment on this one as I have been researching software for the last six months.  Michele and I became aware that the web based software had much more to offer than a server based one like the Lytec we have been using for the last 15 years.  When I saw what the web based ones can do I really got excited.  I see where it can cut down our data entry time by possibly as much as 50%.  That is HUGE!!!  I set up demos of all the web based programs I could but found them to be way too expensive for us to switch.  It would have been five figures to get started.  Then I found a new company using SaaS (which I had to look up on Wikipedia to understand).  Saas is new and enables this company to offer the same advantages as the large web based companies for a monthly fee of $99 for a doctors office and $149 for a medical billing service.  They don't have a set up fee and they don't charge extra for more than one doctor.  For only $149 a month a medical billing service can have web based software.  The software is in Beta version now, but I have tried it out and it is amazing.  They will soon be accepting early adoptors and will have it fully available sometime in June.  The company is called Xena and I think it's going to turn the world of web based software upside down.  The last demo I did with one web based company had a minimum cost of $3000 per month plus a huge start up based on the number of doctors we bill for.  I've checked and rechecked and Xena is $149 per month!!- no surprises. 

I'm a little afraid of trusting our business to a limited free program which is trying to get you to upgrade to the paid version.  I wanted all the benefits that the web based programs will offer.  Xena offers the full practice management system with the clearing house, reports, and everything else you need plus some stuff you never thought of.

We had an opportunity to go to the HIMSS conference in Chicago this week and it was obvious that server based software is antique.  Anyone starting this business needs to use a web based software and now there is an affordable one.  Anyone still using a server based software needs to look at the advantages of a web based one.  I wrote an article about some of the advantages for anyone interested.   http://www.solutions-medical-billing.com/webbasedmedicalbillingsoftware.html (http://www.solutions-medical-billing.com/webbasedmedicalbillingsoftware.html)  You are welcome to call our office and ask Michele or me for more information. (1-800-490-4299 Eastern time)

Title: Re: starting a medical billing business
Post by: lhough on April 09, 2009, 04:27:01 PM
So are you saying that if I have a client that has a practice with 20 providers, that it will only cost $149 a month no matter how many providers in that practice I bill for?  If that is what you are saying that is fantastic!  I have not signed a client yet and am still looking for a good PM but I know that I want it to be web based but I have been finding that there is usually a monthly fee per provider, which becomes just too expensive.

I have one counselor that has just started her practice and is outsourcing but she is not happy with the biller she is using.  But, until I find a PM software I am on the fence.  I also have my eye on a clinic that has 20+ providers and if I could find something that doesn't charge me a fee for each provider that I bill for then I would be in a position to approach them, but until I can find something that will only charge me say a set fee per database (for each different clinic I bill for) then I am just left out in the cold so to speak!  ???

I have gone to the website you indicated but it really doesn't tell or show anything about the practice management software at all.  Where do I go to find out about the software and the features?
Title: Re: starting a medical billing business
Post by: lhough on April 09, 2009, 04:33:10 PM
One more thing Alice,
with the software you are talking about, does it have unlimited users or is there a fee per "seat"?  The large practice I am looking at has a minimum of 6 staff members and 2 owners that would access at any given time, not to mention the providers would access to look at their schedule (I plan to offer the scheduler feature, to me I would like to have them use my software and they can use the scheduler which I think would be helpful to me as well because then I can see what to expect for the day, week, month, etc.).  If there is a fee per seat that too can get expensive, I really want something that offers unlimited users.

Thanks for any info you can provide. :D
Title: Re: starting a medical billing business
Post by: Michele on April 09, 2009, 08:36:35 PM
It was hard to believe for us at first, but it really is correct, $149 per month per seat for unlimited providers/practices, with no set up fees, hidden costs, etc.  And it has all the features of those other web based softwares that are MUCH more expensive.  They are able to do it because of the SAAS technology. 

Anyway, if the providers want to access their account then you should put that cost onto them.  Xena only charges providers $99 per month/per seat, and they can see all of their data, but the program is slightly different from their view so they don't have access to all of the tools that you do as the biller.  (But they can see all that they need to)  And a seat is a sign on and can be accessed from any computer so each person at the drs office wouldn't be signing on at the same time so they wouldn't each need an individual sign on or seat.

If you would like more info I can have someone from Xena call you. 

Michele
Title: Re: starting a medical billing business
Post by: gderilus on April 15, 2009, 10:14:59 AM
Hi Michelle
Is the contract for your business is the same as the BA or is it two different thing
Title: Re: starting a medical billing business
Post by: Pay_My_Claims on April 15, 2009, 11:53:26 AM
Just my small input on billing software. I disagree with the analogy of getting into a yugo and want to upgrade to a cadillac as being wrong. To avoid going bankrupt, you should start out small and upgrade. Getting into a cadillac when you don't have the payments to afford it would be in my opinion a bad business move. Most people don't quit their job and start out doing their home based business unless they got a nice loan to start them up that will allow them to live until they build the business. Most that I know can't afford to quit their day job, so the business is done at home after hours. I can truly appreciate the benefits to having programs like zena or advancedmd etc, but logically speaking, i can't afford to pay that fee each month and not having a provider to bill for.  I myself started with officeally/practice mate, but hopefully will upgrade once I am assured of having 2 long term clients. Once I move into my cadillac, i don't plan on having to drop back down to my yugo.....:-) I actually had one company tell me they don't even talk to billing services that don't already have clients!!!
Title: Re: starting a medical billing business
Post by: Michele on April 15, 2009, 01:37:34 PM
Did you mean BAA?

Title: Re: starting a medical billing business
Post by: gderilus on April 15, 2009, 05:00:08 PM
Yes I meant BAA
thanks
Title: Re: starting a medical billing business
Post by: PMRNC on April 16, 2009, 07:39:52 AM
Quote
Is the contract for your business is the same as the BA or is it two different thing

Your BAA is your Business Associates Agreement and yes it is aside from your services contract.. very different! HIPAA and HITECH require certain responsibilities of the CE and the BA.  Your contract is between you and your client and outlines responsibilities and obligations by both parties.  Your HIPAA requirements and other things would be included in your compliance plan.  It's always a good idea to have your compliance plan ready when you are marketing.

Linda Walker
PMRNC
www.billerswebsite.com
Title: Re: starting a medical billing business
Post by: fsaxonhort on April 17, 2009, 06:43:24 PM
Hello, my question is where would I find marketers to help me secure my first client.  What search words would I use?  What are the names of these marketers?  Does anyone have any suggestions on people or companies who might be able to help me with marketing?  Thanks Faye
Title: Re: starting a medical billing business
Post by: Michele on April 17, 2009, 09:22:45 PM
I know there are companies out there but I'm not familiar with any.  I'm not sure what to search.  You could try 'marketing company'.  That brought up a few responses, but of course you don't know if they are good.

Be careful.

Michele
Title: Re: starting a medical billing business
Post by: fsaxonhort on April 17, 2009, 10:01:50 PM
Thanks for your response.  Faye
Title: Re: starting a medical billing business
Post by: PMRNC on April 20, 2009, 05:46:03 AM
Be really careful using marketing firms, no one knows your business better than you. There have been many scam marketers who would go around promising providers free computers on behalf of the companies they were marketing for, and of course the client they were marketing FOR had no idea. Outside marketing firms will go out and sell for you but really in this business only you know the benefits you are offering and doctors want to feel comfortable about who they are outsourcing to. JMO

Linda Walker
PMRNC
www.billerswebsite.com
Title: Re: starting a medical billing business
Post by: gderilus on May 24, 2009, 11:35:20 AM
Hi Michelle
I was wondering how you keep track of all the claims that you send so you follow up on them. I know some people use excel, but how exactly would you do it. Would you type all the claims that you send for the month by patients name or providers.
Title: Re: starting a medical billing business
Post by: Michele on May 24, 2009, 02:09:43 PM
My practice management software keeps track for me.  I have the ability to run reports to show all unpaid claims, etc.  I work off of those reports.

Michele
Title: Re: starting a medical billing business
Post by: Denise35 on May 24, 2009, 05:32:14 PM
Use should have a claim management module with reports name outstanding/aging insurance or pending claims report.

So programs have modules you can create a "workflow" and after the claims is not paid in a week, two weeks and/or 30 days, it will show up in your workflow.  And the unique and nice thing about having a work flow, you can set your preferences.

I hope this helps,

Denise35
Title: Re: starting a medical billing business
Post by: gderilus on May 25, 2009, 06:30:39 PM
This is very nice. Can you give me an example of a program that has this kind of modules. This would be very helpful
Title: Re: starting a medical billing business
Post by: Michele on May 25, 2009, 07:23:39 PM
I'm not sure what you are asking.  Can you be more specific?

Thanks
Michele
Title: Re: starting a medical billing business
Post by: PMRNC on May 25, 2009, 07:38:15 PM
Quote
Use should have a claim management module with reports name outstanding/aging insurance or pending claims report.

She meant the PM software should have a reporting module.. if you are wanting to pull reports your PM software has to have the capability of producing the reports from the data.
Title: Re: starting a medical billing business
Post by: Michele on May 26, 2009, 06:35:26 AM
Thanks Linda,  For some reason when I went to answer her question the rest of this post wasn't showing and I had no idea what she was referring to.  Or maybe I should know better than to check the forum after a long day and having a holiday get together!  LOL

Anyway, most PM systems come with some form of report capabilities.  Unless you are using a fill and print, or some of the free softwares.  But here are a few examples:

Xena
Lytec
Medisoft
PerfectCare
Advanded MD
Ingenix

Many more, but that gives you the idea.

Michele
Title: Re: starting a medical billing business
Post by: gderilus on May 27, 2009, 06:04:32 PM

One of the member mentioned that there are programs that have modules to create a "workflow". After the claim is not paid in a week, two weeks or 30 days, it will show up in your workflow.

I was wondering what kind of programs have that kind of modules.
Title: Re: starting a medical billing business
Post by: PMRNC on May 27, 2009, 08:31:29 PM
I'm not sure of the terminology but doing follow-up can be derived from a few different types of reports.  Also you keep mentioning modules and I would just like to point out that MOST of your PM software's (practice management) do at least the "basic" reports and you should not "need" a module unless you want more complex reporting, in which case some software's will have an "export" feature or like you mentioned an added "module".  If you are looking for software you might want to look for one that includes everything w/out the need for modules. If you have a software and maybe you are seeking to strengthen it with a module, it might help us to help you in knowing which PM software you have.
Like Michelle mentioned there are also basic claim only softwares but I wouldn't recommend them to anyone.
Title: Re: starting a medical billing business
Post by: Michele on May 27, 2009, 08:42:44 PM
As Linda said, most programs come with the basic reporting capabilities.  As far as ones that allow you to set a workflow where you can specify when claims should be checked, the only one I'm familiar with is Xena.  I'm sure there are others, but I don't know which ones.

Michele
Title: Re: starting a medical billing business
Post by: DavidZ on May 28, 2009, 11:14:42 AM
From what I see in most cases the patiens call the biller with questions and problems and not the provider.
Title: Re: starting a medical billing business
Post by: PMRNC on May 28, 2009, 12:16:42 PM
Well, that's not entirely true.. it depends on what you agree to with each provider. Some Billers do it all and whether they do or don't take patient inquiries..the doctor is always going to the biller wanting to know "where's the money?"  ;D
If you intend on opening a billing company you have to realize there is no "out of the box" way to run it..you have to be flexible and competitive and at the same time not undercut yourself. What services you do or don't do will depend on what you plan to offer, each practice's needs and most importantly ..what you outline in each contract.
Title: Re: starting a medical billing business
Post by: Cindy on May 28, 2009, 04:04:52 PM
To everyone starting a new billing business.    DON'T FORGET ERRORS AND OMISSIONS INSURANCE... IT COULD SAVE YOUR BUSINESS,,,,, ALSO FOR AN LLP OR LLC
Title: Re: starting a medical billing business
Post by: Michele on May 29, 2009, 05:58:04 AM
As Linda said, you need to clarify with the provider if you will or will not be handling patient inquiries when you start their account.  If we are handling them we put our phone number on all statements.

Michele
Title: Re: starting a medical billing business
Post by: vchere6535 on January 10, 2010, 04:38:26 PM
I just prefer having my own software, and transferring the data from his pc to mines. I do plan to utilize the Iphone for urgent issues (he calls, i am away and he needs me to look at something). I want to have access to all my information should we terminate. I can clean up the files and send his final reports. Also what happens is you are using gotomypc and he terminates your service and you have outstanding claims that you proccessed and need to get paid for???

omg, do you really transfer everything from Dr's PC on to yours? what id he has a different software, do you do it manually?
Title: Re: starting a medical billing business
Post by: Steve Verno CMBS, CEMCS on January 10, 2010, 06:19:06 PM
a billing company that worked for one of my providers used expensive software that was timed.  At 4 weeks it went into review mode so someone from the billing company followed through on the claim.  If no one worked the claim, it converted the account from insurance responsibility to patient responsibility.  If the patient didnt respond with payment it keyed the account to go to the collection agency. This was embarrassing with Medicaid patients and HMO accounts.  If they appealed an HMO account, they had to write off the balance resulting in tons of lost money especially because they never followed through with any appeals.

the software ran the billing company. The other problem was the laziness of the billing staff. 
Title: Re: starting a medical billing business
Post by: DME biller on January 10, 2010, 08:03:29 PM
Hello Everyone,

Recently a friend at a DME supplier asked me if I could fill out claims for them & send to their clients insurance.  My experience is not in billing, it is in health insurance claims for many yrs.    Being a non par DME supplier most of his clients pay in full up front.   I would be sending HCFA's to grp health insurance, Medicare, Medicaid etc..., if anything is allowed payment would go to the client, and any insurance questions/EOBs would come to me.  I will not be getting into billing the patient, just sending clms to insurance and monitoring EOB's.

Questioning if I need a license for this, doing business from home after work.

Thanks Much
DME
Title: Re: starting a medical billing business
Post by: kwardbilling on January 11, 2010, 07:13:12 AM
Thanks so much  for all of this information.  I am finding this forum so helpful.  I am encouraged as I seem to be doing things correctly, if nothing else it's given me much more self confidence.  Thanks!!
Title: Re: starting a medical billing business
Post by: kwardbilling on January 11, 2010, 07:20:46 AM
Michele..I noticed in one of your replies you stated that you have seen fees for claims from $1.50-$5.00, is this just for the claim submission?  Just wondering as my service includes authorization/eligibility call, payment tracking, bi-monthly for insurance claims monthly for patient statements, and up to 4 re-submissions for rejected claims.  I have a flat rate for startup fee and then charge $6 per session....I've been tracking my payments and it seems to come out pretty even to approx. 7-8% of payments collected.  Any thoughts?

Karen
Title: Re: starting a medical billing business
Post by: Michele on January 13, 2010, 09:39:18 AM
That sounds good Karen.  When we charge a per claim fee, it usually is for no other services.  If we have to include any additional to just claim filing, the fee goes up.

Michele
Title: Re: starting a medical billing business
Post by: Michele on January 13, 2010, 09:40:36 AM
DME

   In the post right before yours, Steve said his brother is losing his home for not following the laws of his state.  It is crucial that you find out what the laws are for your city/state.

Michele
Title: Re: starting a medical billing business
Post by: wharta on January 13, 2010, 01:45:14 PM
How can we find that out, can we not charge on a % basis for all clients? If we work in Indiana and have clients in Virginia, Texas and California, do we have to have different basis for all states?
Title: Re: starting a medical billing business
Post by: Michele on January 14, 2010, 05:51:16 PM
Many states have fee splitting laws so charging a % may be violating those laws.  You need to know whether the provider is in a state with a a fee splitting law then you shouldn't charge a percentage.  You don't have to have a different basis for all states, but you shouldn't charge a % in the states with fee splitting laws.

Michele
Title: Re: starting a medical billing business
Post by: QueenAlicia on January 23, 2010, 12:10:43 AM
It's 10 pm pst and I just read this whole topic and found it to be VERY helpfull.  I am mad though that Xena charges $149 and I was going to go with NueMed whichs charges $1500 to set up and train and then $100 or so per provider.  I like the fact that it had unlimited users but I am mad that I almost paid that price.  I started my business last may and due to funds have been putting everything together slowly.  I am working on website content, contracts and busness assoc agreements.  I think I will be goin with Xena.
Title: Re: starting a medical billing business
Post by: kwardbilling on January 23, 2010, 10:18:15 AM
As far as the software goes, I have been using Therapist Helper for 3 years, I know some of you haven't liked it, maybe I like it because it's all I know and I'm a small billing servie.  They have been very supportive with any questions I've had. I just started electronic claims with them and it's been going smoothly so far. 

I will probably look into something new when my contract with them ends now that I've heard of so many others, Xena in particular.  I guess I'm afraid to change, I feel like I know this one pretty well.
Title: Re: starting a medical billing business
Post by: Pay_My_Claims on January 23, 2010, 06:01:46 PM
It's 10 pm pst and I just read this whole topic and found it to be VERY helpfull.  I am mad though that Xena charges $149 and I was going to go with NueMed whichs charges $1500 to set up and train and then $100 or so per provider.  I like the fact that it had unlimited users but I am mad that I almost paid that price.  I started my business last may and due to funds have been putting everything together slowly.  I am working on website content, contracts and busness assoc agreements.  I think I will be goin with Xena.

Glad it worked out well for you. One of the most important tools for your business is your software program. Its very important to compare shop. I have seen some run higher than that.
Title: Re: starting a medical billing business
Post by: Brenda09 on February 15, 2010, 09:54:59 PM
Hello Everyone,
I am starting a new billing company also and I appreciate all of you taking the time to share your knowledge. I have more questions if you don't mind.
Do medical billing companies need an agent number (or to register)with the carriers also, or just the clearinghouses? If so, can it be done with the popular carriers prior to getting a client or not until after?

Thanks,
Brenda
Title: Re: starting a medical billing business
Post by: Michele on February 16, 2010, 07:22:25 AM
The only time a billing service needs to register with carriers is to obtain submitter numbers for electronic claims.  This can sometimes be done prior to getting a client, but it depends on the registration process with each carrier (it varies).  Most require some information on the provider that you will be billing for.

Good Luck!   :D

Michele
Title: Re: starting a medical billing business
Post by: Brenda09 on February 16, 2010, 04:32:58 PM
Thank you Michele,
I am so happy I found this forum!

Brenda