Medical Billing Forum

Starting a Medical Billing Business => Starting Your Own Medical Billing Business => Topic started by: carnilent on September 17, 2009, 07:48:08 AM

Title: Help!
Post by: carnilent on September 17, 2009, 07:48:08 AM
I started with my first client in May of 09.  ( family practice )

Since the beginning it started off on the wrong foot.   The girls at the office ( 2 of them) are totally
uncooperative.   they fax over the superbills,  with little or no patient demographics.
which causes us to produce a list of patient names that need complete demographic info. when this list is faxed over we are told she already faxed the info to us.   ( which we have not received anything )

On July 17, we had a meeting with the Dr. and her staff ( 2 ), we advised that we needed for them to send us complete demo. information on every patient.

They don't even tell us when payments have come in so that we can post them.
 ( we get reports from ins co. saying they are paying)  All payments started coming in August.

 I have spoken with the Dr. and she says that her staff is trying their best,
 but she is aware that they are not giving us the appropriate information that we need.

 What can we do at this point?     I have superbills in folders that can't be billed because of no demographics info.   If I fax a list of the names to the client's office they get all bent out of shape because they have to pull the chart.


Any suggestions will be apreciated.

carnilent  :-\


Title: Re: Help!
Post by: Pay_My_Claims on September 17, 2009, 08:17:20 AM
They may feel threatened. You need to convey your position is to assist. Ask for their input on implementing a plan of action that will help them be able to get you the information you need without interfering too much with thier daily routine.

Do you have the insurance information??? Often you can get all the information you need from the insurance carriers system when you verify the plans (if you are doing that). I'm not suggesting that this should be the answer to your problem, but it can be a way to assist you until you can iron out the issues you are having. Being it is family practice you should start seeing a lot more of repeat clients who are already loaded in your system

If they are using a system generated SuperBill that doesn't include client demographics you should have all that included. If it does have it on the superbill and it is an issue of not updating the system, that is where you will need to get some direct assistance from as well.

The superbills that I get have the ins. info, demo, and all pertinent info on it, so I guess I'm blessed
Title: Re: Help!
Post by: carnilent on September 17, 2009, 09:10:54 AM
thank you.     Their superbills are hand written and they have to fax us a copy of the patient's face sheet
along with copy of the ins. card ( which we don't get all the time. )

 
thanks for helping.


carnilent  :)
Title: Re: Help!
Post by: PMRNC on September 17, 2009, 09:52:19 AM
I have had unorganized clients with unorganized staff and this is where you become the "educator". What I usually do is go in for a meeting with a complete description of the problems AND solutions. For example one of your problems is receiving the EOB's. For this I would actually go into the office and create a work flow which would guide the office staff every step of the way.. an Out box next to the fax machine with a coversheet all ready to go works well, they put the EOB's after being opened, check being detached and deposit logged into the "out" box face down. The daily coversheet is first in the box. Another problem they have are the handwritten superbills. Offer to create them one or point them to a reference where they can order them.   Organize everything in easy to implement steps and then set up your meeting. Fax over a copy of what you will be going over with them ahead of time to let them prepare.  Use your judgement on whether you should charge for this as a consult. I usually offer them the consult with a 10 day clause that if they don't get their act together the consult fee will be charged.  If after all of that they are still not compliant, refer to your contract and act accordingly, some practices are just so resistant and they are not willing to be taught and you just have to let them go.
Title: Re: Help!
Post by: carnilent on September 17, 2009, 10:14:19 AM
thank you.    their staff is very reluctant to any ideas,  we haven't even been able to send them our first invoice.   Because we do not have the EOBs.   I might be setting them up with a monthly flat fee for billing services.   ( I wasn't aware of the florida split fee law. ) 



 carnilent  :-\
Title: Re: Help!
Post by: PMRNC on September 17, 2009, 10:26:41 AM
Well the first thing I would do if I were you would be to correct your contract AND your method of charging FIRST! Going flat is good because you can then decide what you want to make for your time.. you can then explain this method to the provider thereby offering him an incentive to get the office to work with you. For example you might be spending 30 hours on this account and possibly 10 of those hours could be saved just by having them get their act together.

The formula I use is

Decide on hourly rate
Deduct Costs (clearinghouse fees, forms, postage, etc)
Hours per week this acct will take

You can create a sliding scale based on increase of hours by account or by the account itself.

I like this method MUCH better than % because I am getting paid for everything I do which is especially helpful when you do come across those types of clients.  Hitting them in the "pocket" usually does the trick. When I charged on a % I used to increase the % for accounts I had to research due to the practice not sending me what I needed so they usually learned pretty quick <g>  For chronic offenders that I just can't seem to educate or get to cooperate I begin charging them another fee based on the extra work I had to do from them not sending me what I needed.  Of course all this has to be spelled out in your contract.
Title: Re: Help!
Post by: Pay_My_Claims on September 17, 2009, 10:38:56 AM
Good ideas Linda. Organization and preparation are very key. Good blessings to you C.
Title: Re: Help!
Post by: carnilent on September 17, 2009, 01:36:38 PM
very good,  thank you  :)
Title: Re: Help!
Post by: carnilent on September 17, 2009, 06:24:52 PM
How do I go about letting my client know that we are going to change to a flat rate?
Do I let her know about the split fee law?

carnilent  :-\
Title: Re: Help!
Post by: PMRNC on September 18, 2009, 06:04:13 AM
If your contract is not able to be changed according to the terms then yes I would present the issue by writing a letter.
Title: Re: Help!
Post by: carnilent on September 18, 2009, 06:38:01 AM
Thanks Linda.
Title: Re: Help!
Post by: carnilent on September 18, 2009, 05:18:24 PM
I'm stuck with the hourly rate. I am confused as to what rate to charge.

I'm trying to charge my client an hourly rate that is below what she would pay someone to work in her office.     Right now I am spending 40 hrs per week  9am _ 5pm mon - fri.

What would be the going hourly rate for a medical biller in Florida?
is it between $12-$15.?   

 

carnilent  :-\
Title: Re: Help!
Post by: Steve Verno CMBS, CEMCS on September 18, 2009, 07:12:56 PM
You have at least 2 choices.

Meet with the doctor again (without the two staff members).  Show numbers of lost income.  yours and his.  Show him how his staff could open him to possible audits, and investigations.

terminate your relationship with the doctor.
Title: Re: Help!
Post by: Pay_My_Claims on September 18, 2009, 07:46:15 PM
I'm stuck with the hourly rate. I am confused as to what rate to charge.

I'm trying to charge my client an hourly rate that is below what she would pay someone to work in her office.     Right now I am spending 40 hrs per week  9am _ 5pm mon - fri.

What would be the going hourly rate for a medical biller in Florida?
is it between $12-$15.?   

 

carnilent  :-\

I'm not sure what the rate is for FLa, but I know what my rate is and my worth. What are you doing to cause you to spend 40 hrs on 1 client?? This is something you need to address in order to make your business successful as well.
Title: Re: Help!
Post by: carnilent on September 19, 2009, 04:29:07 AM
You're right, I need to make some changes.   


 Thanks
Title: Re: Help!
Post by: PMRNC on September 19, 2009, 09:15:23 AM
I agree, 40 hours for one client seems rather high, you need to address the issues causing you to over work yourself on the account, then figure out the time YOU should be spending on the acct.. just a tip but going flat fee you can ackomplish your hourly rate goal but at the same time the value perception will be greater to the client.. meaning it will look better as flat fee rather than hourly because you want to remember the benefit/reasons of outsourcing. Also you can figure in expenses per client. 
Title: Re: Help!
Post by: carnilent on September 19, 2009, 10:06:44 AM
ok, they were three months behind in their billing and I have been overworking myself.
Title: Re: Help!
Post by: jaymeetme on October 12, 2009, 09:52:14 PM
Ask both of them to join you for the dinner to a very good restaurant and order their favourite food and see the magic after that day!!!
Title: Re: Help!
Post by: carnilent on October 13, 2009, 10:05:36 AM
I appreciate all your help.     I mailed a letter to my client advising of the split fee law.

she called me saying she agrees with me. ( she did some reasearch -  and she would like to meet with me at my office ( home office)
well, we're meeting on Thursday here at my house,   to this date she hasn't paid me for all the work I've done since May.     I am really disappointed with her.  I'm going to see what she is going to tell me.


Any advise?

( my husband says I should get paid on Thursday and then let them go. )

 :-\
Title: Re: Help!
Post by: Pay_My_Claims on October 13, 2009, 12:19:54 PM
did she know going in that you were based out of your home?? A lot of them don't take "home billing services" serious
Title: Re: Help!
Post by: PMRNC on October 13, 2009, 12:26:11 PM
There's no reason you have to ever disclose you are home based, that's up to you to decide whether to disclose it or not and of course taking into account the status of your office setup, business, etc. I've had clients who knew and never had a problem and then i have and had clients who may not have known, she's been with you and owed you money since May? I would have cut her off in June. You should probably inform her right off the bat that you expect a check for whatever she owes you at that meeting. If she does not have the check, there's no reason to meet and I would talk to your attorney and go from there that's 4 months.. I hope you have not been working the account this whole time.
Title: Re: Help!
Post by: Pay_My_Claims on October 13, 2009, 12:29:22 PM
There's no reason you have to ever disclose you are home based, that's up to you to decide whether to disclose it or not and of course taking into account the status of your office setup, business, etc. I've had clients who knew and never had a problem and then i have and had clients who may not have known, she's been with you and owed you money since May? I would have cut her off in June. You should probably inform her right off the bat that you expect a check for whatever she owes you at that meeting. If she does not have the check, there's no reason to meet and I would talk to your attorney and go from there that's 4 months.. I hope you have not been working the account this whole time.

I agree with you Linda *faints*, and I have personally NEVER disclosed that I was home based. i have had only one client ask me that specifically and I have been honest with them about that. I also agree that you should not continue to work when they owe you. Doing so makes them feel you 'NEED' the money. Just as in this business if a client has an outstanding balance he does not receive future service until that balance is met. Now you are in months behind in payment.
Title: Re: Help!
Post by: PMRNC on October 13, 2009, 12:31:40 PM
Yup. If I can't pay my mortgage after 90 days I'm getting an ACT 91 in the mail (1st step in foreclosure)
it just stands to reason any business would have limitations. 4 months without getting paid is way out of line and personally IMO I wouldn't have let it go on and if I was in your shoes right now, I wouldn't meet with them unless the check was in their hand at the door. JMO  My attorney would be right there with me.
Title: Re: Help!
Post by: Pay_My_Claims on October 13, 2009, 12:45:31 PM
Yup. If I can't pay my mortgage after 90 days I'm getting an ACT 91 in the mail (1st step in foreclosure)
it just stands to reason any business would have limitations. 4 months without getting paid is way out of line and personally IMO I wouldn't have let it go on and if I was in your shoes right now, I wouldn't meet with them unless the check was in their hand at the door. JMO  My attorney would be right there with me.
AMEN!!
Title: Re: Help!
Post by: carnilent on October 13, 2009, 04:35:25 PM
her receptionist faxed over the other half of the work for Sept.  I haven't even printed the work, I'm not touching anything until I get paid.  She did know from the beginning that we are home based.   

I have billed her a total of $96,000. in claims.  They have been so disorganized and uncooperative from the beginning that it's sickening.     

You're right, I'm going to contact my attorney. first thing in the am.

 
Title: Re: Help!
Post by: PMRNC on October 13, 2009, 06:57:39 PM
You should run a report on reimbursements/collections from June that shows total billed, total collected  attach a FINAL invoice and a termination letter, send it certified return receipt (proof you sent termination) and if you have to send her to a collection agency first. You are better off taking your chances with a collection service if your contract was based on a percentage in a state that prohibits that, than going to court (small claims)
I have a couple of clients I sent over to collections and only one I had to file with small claims but he paid me before we got to court. Doctors don't like their credit messed with.  ;D :o ;)
Title: Re: Help!
Post by: carnilent on October 14, 2009, 05:08:05 AM
How do I word the termination letter?   Is it basically a run down ( in a professional manner) of the way they have been doing business with us? and then the termination?


thanks,   :-\
Title: Re: Help!
Post by: PMRNC on October 14, 2009, 05:21:01 AM
No, in fact the opposite get right to the point and be clear and concise.

Dear Dr. Smith, Due to the fact that your payment is now more than 120 days past due, XYZ Billing company will be exercising our termination clause of our contract dated XX/XX/XXXX effective immediately. According to our records our last billed date of service on your account was XX/XX/XXXX. Please remit your final payment in the amount of $XX immediately. Once your payment has been received we will forward all final reports for your practice. We regret that we could not continue to work together and wish you well.

Something similar to that. I usually attach a copy of the contract for their reference and highlight the breached areas. I don't go into details and keep it short / simple (KISS) 
Title: Re: Help!
Post by: carnilent on October 14, 2009, 07:58:42 AM
about the charging;     Since my client has not faxed over the EOBs showing payments received.
I only have record of cigna and blue cross payments received.  which total $136.75.
( Would I be able to charge her a flat fee since July when I first started doing all electronic billing for her?)
being that florida has the split fee law I think she doesn't want to pay me a percentage of the amount collected,   ( I billed her in Sept. for the percentage of the amount collected and she didn't send me a check ( I didn't even get a call reg. not paying it. )

I don't want to lose money, cause I've really been working hard for her.


thanks for all your help

carnilent
Title: Re: Help!
Post by: MBP on October 14, 2009, 10:07:50 AM
So you were only sending claims out, you were not applying payments? you were getting % of what she was making but she never told you how much that was right? i wish you luck tomorrow, hope your contract is bullet proof and she will pay you!!
Title: Re: Help!
Post by: carnilent on October 14, 2009, 10:25:45 AM
yes,,,,   I was applying payments for the claims that I was notified by the insurance companies as paid.

my client told me she's coming tomorrow with all the EOBs that have come in since July.


     ( It was her office girl that was not cooperating with us )  she was to fax the EOBs over and she did not want to bother with any extra work. 

     thanks for the thought     
Title: Re: Help!
Post by: PMRNC on October 14, 2009, 04:03:43 PM
Whether it was the office staff or not isn't the issue anymore.

Quote
about the charging;   Since my client has not faxed over the EOBs showing payments received.
I only have record of cigna and blue cross payments received.  which total $136.75.
( Would I be able to charge her a flat fee since July when I first started doing all electronic billing for her?)
being that florida has the split fee law I think she doesn't want to pay me a percentage of the amount collected,   ( I billed her in Sept. for the percentage of the amount collected and she didn't send me a check ( I didn't even get a call reg. not paying it. )

We don't know what your contract says, the provider has been tipped off on the fee splitting law, you should have consulted an attorney a while ago on this. I really think your only recourse is to re-negotiate and try and get her to do a retroactive agreement for the monies she owes. You will need to be careful how you do this because the fee cannot be based on or interpreted on a fee-splitting basis. You can take what she owes you, add the hours you worked, minus your costs and come up with a flat fee that will reflect a monthly charge based on an hourly rate. But again... this is no guarantee she will pay you. And if you do this and continue billing for her, in my opinion you are just looking for more headaches.
Title: Re: Help!
Post by: carnilent on October 14, 2009, 04:39:11 PM
according to our contract she has to pay us a % of the amount collected.
we were not aware of the split fee law then in May.


I have cancelled the meeting with her tomorrow,  and according to my attorney he said to send her an invoice for the flat fee amount, and to cancel the contract with her by sending her a termination letter.
If she doesn't pay me then he will step in.   


   Thanks to everyone for all your help,

    carnilent :)
Title: Re: Help!
Post by: Michele on October 14, 2009, 08:55:31 PM
I hope it all turns out well for you!

Michele
Title: Re: Help!
Post by: carnilent on October 14, 2009, 11:06:32 PM
Thanks Michelle.  :)