Medical Billing Forum

Medical Billing Software => Medical Billing Software Reviews => Topic started by: arcbilling on May 04, 2010, 04:45:19 PM

Title: Suggestions for Billing Software
Post by: arcbilling on May 04, 2010, 04:45:19 PM
Hi.  I have been running my own small billing business for 4 years now.  I started off with Medisoft and it was OK for when I started.  But it seems like each year the upgrades get more expensive and they change the features that I like most.  So basically the quality goes down while the price goes up.  This last upgrade was the straw that broke the camel's back.

I am ready to be dome with Medisoft, but I am overwhelmed by all the choices there are.  I would love to hear about the software that others are using, what they like about it and what they would change about it.  If I could get a list of 5-10 software, then I would have a more manageable place to start.

Thanks for your help.

Katherine
Title: Re: Suggestions for Billing Software
Post by: jcbilling on May 04, 2010, 08:21:06 PM
I recommend looking at Kareo.com.

I started using their web based software in Jan and have been very pleased.
Title: Re: Suggestions for Billing Software
Post by: Michele on May 05, 2010, 12:36:55 PM
We had the same issue with Lytec.  (sister software of Medisoft).  We've used it for 15 yrs, but had the same issue you did.  Updates are expensive, and never go smoothly.  We recently researched other softwares as we were very interested in web based.  The web based softwares are live Blue Ray DVD's compared to VHS tapes.  The problem we found is that many web based softwares are not cost effective for billing services.  We did find one however, that has all the bells and whistles, but only charges per seat (computer) instead of per provider.  It is <a href="http://www.xena-health.com/?referer=SMB">Xena Health</a>.  They have a promotion right now.  If you sign up for a year you get the 13th month free.  Just use promo code "SMB001".

Best of Luck!  Switching software is never easy.

Michele
Title: Re: Suggestions for Billing Software
Post by: PMRNC on May 05, 2010, 05:12:59 PM
I like Kareo too.  User friendly, and I've never had a problem. The only thing however is that I wouldn't recommend them to a new billing company with no experience, they really don't do much in the way of training. Their Support is so/so I really have not had to use their support but once.
Title: Re: Suggestions for Billing Software
Post by: BREWERBILLING on March 02, 2011, 11:46:26 AM
We are currently using AdvancedMD for two offices.  Two providers in each office and paying about $800/month per office. I am the only biller.  What would you suggest and how hard would it be to transition the data to a new software?
Title: Re: Suggestions for Billing Software
Post by: Michele on March 02, 2011, 12:42:37 PM
Wow, that seems pricey!  I would definitely look into switching.  I am not that familiar with AdvancedMD.  I've looked at it, and I know it had lots of bells and whistles.  Any transition is not easy, but if you prepare the best you can, it can be done fairly smoothly.  I would check with the software you are switching to, and see if they offer data conversion.  If not, try your tech guy. 

Good luck!

Michele
Title: Re: Suggestions for Billing Software
Post by: BREWERBILLING on March 02, 2011, 01:13:47 PM
lolol...I am the tech guy...The posts I've been reading are from 2009.  What is the leading software out there now?  When I good medical billing I get all the 'educational opportunities'. 
Title: Re: Suggestions for Billing Software
Post by: PMRNC on March 02, 2011, 01:39:17 PM
I don't think I would ever presume to call any one software a "leader", at least not anymore. However i do think to make a true informed decision you have to really put the software to the test. I think it really takes a good amount of time too. I see some completely happy with their Medisoft and I particularly don't care for it at all. And when you say "leader" some will answer that based on what's widely used vs. a true high performance practice management system.  One thing I would look at is growth. If I had it to do ALL over again, I would NOT have made "cost' the most important thing. I have been through multiple data conversions and they are just NEVER EVER smooth, anyone that says they are either lying or not experienced enough to see the problems with a conversion.

Another thing I think billing companies should consider when using software is that today, they have to be multi-trained and diversified. I've seen many new billers throw away potential prospective clients because they had their own software. I only have 2 clients that utilize my software, the others I work off their systems.

Just my .50cents worth :)
Title: Re: Suggestions for Billing Software
Post by: QueenAlicia on March 02, 2011, 06:33:47 PM
If you are billing for someone who has different software how do you access their info?  Do you learn their system and bill on the system that you have?
Title: Re: Suggestions for Billing Software
Post by: PMRNC on March 03, 2011, 06:14:46 AM
Yes, I will remote access their host computer. I either use windows remote login or Logmein.com  Yes I eventually learned most/many of the PM software's out there, from Medisoft to Medical Manager, If I run across one a little more difficult I will usually call the company up and see what they have in the way of training. Once you have experience and have worked on one or two different systems it's a quick learn for another. I can't say I've ever let a prospect go because they wanted to use their own software. Many practices have already put expensive systems into place and it only makes sense they don't want that cost going to waste.
Title: Re: Suggestions for Billing Software
Post by: pattil88 on March 03, 2011, 09:41:27 AM
I also like Kareo - reasonable price and user friendly. You may also want to check out a company called Sage  - they're out of Tampa, Florida. A potential client of mine currently uses this product and it's pretty slick. The charge entry screen mimicks a 1500 form and you can toggle to bring up a split screen w/a copy of the patient's insurance card that the practice scans in. You know exactly what fields you're populating for billing and then it gives you all the options of filing electronically, dropping a claim to paper (if necessary), etc. Not sure what they charge for set-up or upgrades but the practice is pleased with the support they get from this particular vendor. You can checkout their website (www.sagehealth.com) for more info.
Title: Re: Suggestions for Billing Software
Post by: rofakamd on March 18, 2011, 02:01:28 PM
i thoroughly like sage/emdeon.. they have several diff softwares that can be compared they have excellent training and support.. $500 yr... extra fees for ebilling...
Title: Re: Suggestions for Billing Software
Post by: sagemb on March 20, 2011, 02:24:56 PM
We've only used AdvancedMD for the past 4 yrs and have loved it. It's got everything i need AND has 1st class tech support. However, they're priced outrageously & i'm stuck with them. They have at time over billed on top of thier own high price & it took 3 months to resolve AFTER they acknowleged the issue. I have an absolute love/hate relations with them. I'm stuck and they know it.
Title: Re: Suggestions for Billing Software
Post by: TxJFP on March 20, 2011, 04:22:36 PM
I have gone through over 10 demos and to be honest, Kareo was the best one and I feel cost wise, is best for small businesses ;)

GOOD LUCK!!  :)
Title: Re: Suggestions for Billing Software
Post by: QueenAlicia on March 20, 2011, 04:31:52 PM
I like Kareo too.  When I am bringing in income I may switch to them.
Title: Re: Suggestions for Billing Software
Post by: PMRNC on March 21, 2011, 06:35:23 AM
Quote
I have an absolute love/hate relations with them. I'm stuck and they know it.

Why are you stuck? And more so, why do THEY think your stuck?  Many companies are capable of doing conversions today, now granted there's no such thing as a smooth and glorious conversion, a few bumps along the way, (I've done 4) but you can get through it and be better off for it if you are unhappy with the software now.
 
Title: Re: Suggestions for Billing Software
Post by: sagemb on March 21, 2011, 06:43:01 AM
... Kareo was the best one and I feel cost wise, is best for small businesses ...

I'm just waiting for my next client & this time it'll Kareo for me as well.
Title: Re: Suggestions for Billing Software
Post by: sagemb on March 23, 2011, 03:57:24 AM
Quote
I have an absolute love/hate relations with them. I'm stuck and they know it.

Why are you stuck? And more so, why do THEY think your stuck?  Many companies are capable of doing conversions today, now granted there's no such thing as a smooth and glorious conversion, a few bumps along the way, (I've done 4) but you can get through it and be better off for it if you are unhappy with the software now.
 

stuck because its either them or going with a new system and learning a new sw all over and who knows if that go well after a while. And data conversions are messy... I should know... I used to do conversions for old dos based medisoft.

I know these might sound like excuses but i abhore learning new software. It takes away so much time.
Title: Re: Suggestions for Billing Software
Post by: PMRNC on March 23, 2011, 06:29:10 AM
Quote
stuck because its either them or going with a new system and learning a new sw all over and who knows if that go well after a while. And data conversions are messy... I should know... I used to do conversions for old dos based medisoft.

I know these might sound like excuses but i abhore learning new software. It takes away so much time.

I'm just going to play devil's advocate for a min ;)  What if a client wanted your business to do his billing but he wanted you to work off of his system?  If you have experience, yes looking at another software at first seems like a lot, however in today's economy, some business is better than none and there are always going to be those practices that have spent all their money on PM software systems and you don't want to let them go because you don't know their software. i only have 3 on my own software now, the rest I work from their systems. If you know ONE software and you have experience, it's not as hard as you think!
Title: Re: Suggestions for Billing Software
Post by: Michele on March 23, 2011, 08:40:14 AM
Good point Linda.

Also, it may take time to learn up front, but how much time is it going to save you???  If the software is better, more efficient, has more options, etc, the time you will save once it's learned is priceless.

Title: Re: Suggestions for Billing Software
Post by: Brenda09 on March 23, 2011, 09:51:20 AM
When you use your clients software instead of your own do you lower what you would normally charge?
Title: Re: Suggestions for Billing Software
Post by: PMRNC on March 23, 2011, 10:59:38 AM
Quote
When you use your clients software instead of your own do you lower what you would normally charge?

No, ONLY if they would not have to pay any costs associated with using my software for example Per provider setup fee, etc.
If they are going to go ahead and pay clearinghouse costs then I would deduct that expense from my monthly fee. My monthly fee is derived of "time".  Oh and you do not want to charge for the cost of doing business such as learning their software. Again, JMO, but once you have experience it's not too difficult to learn many of the other software's and in most cases they are usually the ones most widely used. Over time if you find your client would benefit from going to your software you can bring this to the provider's attention by showing them the cost reductions and benefits.
Title: Re: Suggestions for Billing Software
Post by: Brenda09 on March 23, 2011, 12:20:00 PM
Hello Linda,

I used DAQ with my medical billing course and will use that when I get my company started. I am going to check out some free demos of other software just to become familar with some of them.
Hopefully, I will find some of the clients willing to use my software, I know beginners can't be choosy :).
Thank You,
Brenda
Title: Re: Suggestions for Billing Software
Post by: QueenAlicia on March 23, 2011, 06:31:44 PM
Hi Brenda,

I used DAQ too for my billing course and liked it but I do not like their prices.  I don't want to settle low right now but the cost is an issue for my start up.
Title: Re: Suggestions for Billing Software
Post by: Brenda09 on March 23, 2011, 10:06:23 PM
Hi Allicia,
I purchased the user licence through the medical billing course, so I believe we got a more resonable rate. When  I actually start using it I may find the monthly fees are too costly also, but I will give it a chance.
Good Luck with what ever you decide.
Brenda
Title: Re: Suggestions for Billing Software
Post by: sagemb on March 23, 2011, 11:29:29 PM
I'm just going to play devil's advocate for a min ;)

You're not being the devil's advocate, you're talking common sense. And I'm learning a lot just reading up on your posts. It makes sense, pure and simple. Okay, it does sound harder but only in the start. I suppose after learning a few widely used billing sw that are in play now, the learning curve will settle and efficiency will begin.

Thanks Again.
Title: Re: Suggestions for Billing Software
Post by: PMRNC on March 24, 2011, 09:58:27 AM
Yes and as Brenda mentioned, you can start a collection of demo's to work with :)  Some of the most widely used I've run into are:  Medical manager (does require a bit more of a learning curve),  Medisoft (if you can chew gum and walk at same time you can work Medisoft), Lytec (not so bad to learn at all) AdvancedMD (pretty user friendly) Then there are a few specialty softwares out there. I mostly specialize in mental health and pediatrics so I come up against Therapist Helper all the time, which is easy but god awful as a software.  I also have a client on CollaborativeMD which is online and really good software actually.   So get some demo's and in your spare time get familiar :)
Title: Re: Suggestions for Billing Software
Post by: rdmoore2003 on March 24, 2011, 02:47:33 PM
I have never liked MEDISOFT.......
Title: Re: Suggestions for Billing Software
Post by: sagemb on March 24, 2011, 03:52:37 PM
So get some demo's and in your spare time get familiar :)

Will do Linda, thanks for the sw titles. I'm looking up each one. As for the person who doesn't like Medisoft...I'm so with you on that. I had to deal with Medisoft for a few years back when..

They would suck the money the money out of my pockets any way they can. Everything they do costs me more money and everything I did on Medisoft end up costing me in some way. That's why I recommended that my client (MRI Center) change over to my own custom software that was exactly what they needed.

I think it depends on your need. I'm sure Medisoft does fulfill needs for some and doesn't for others like all sw. Choose what works for you.
Title: Re: Suggestions for Billing Software
Post by: Tech_Billing on March 24, 2011, 04:19:01 PM
Michele,

Is the clearinghouse included in the fee fo Xena.

We had the same issue with Lytec.  (sister software of Medisoft).  We've used it for 15 yrs, but had the same issue you did.  Updates are expensive, and never go smoothly.  We recently researched other softwares as we were very interested in web based.  The web based softwares are live Blue Ray DVD's compared to VHS tapes.  The problem we found is that many web based softwares are not cost effective for billing services.  We did find one however, that has all the bells and whistles, but only charges per seat (computer) instead of per provider.  It is <a href="http://www.xena-health.com/?referer=SMB">Xena Health</a>.  They have a promotion right now.  If you sign up for a year you get the 13th month free.  Just use promo code "SMB001".

Best of Luck!  Switching software is never easy.

Michele
Title: Re: Suggestions for Billing Software
Post by: Michele on March 24, 2011, 07:22:58 PM
Clearinghouse fees are not included.  They are connected to both Office Ally and Availity, both of which are free.  Ones that have fees, the fees are the liability of the provider/billing service.
Title: Re: Suggestions for Billing Software
Post by: PMRNC on March 25, 2011, 09:54:53 PM
I have never liked MEDISOFT.......

ME EITHER!!!!!!  This was my start off mistake when I started my business. Even the newer versions are not much better. I don't know how anyone works without pulling their hair out of their hair with it!
Title: Re: Suggestions for Billing Software
Post by: billingandscanning on June 28, 2011, 01:04:28 AM
If I use my clients software as the billing company, do I still need to sign a contract with the clearing house? How would I proceed if I use my clients software, what would my next steps be?
Title: Re: Suggestions for Billing Software
Post by: Michele on June 28, 2011, 10:47:16 AM
If you are billing from the provider's software and they are already enrolled with the clearing house then you are just an extension of that (I believe! ~ now I'm having brain freeze!).  You could contact the clearinghouse to be sure, but I believe if the provider already enrolled their software and you are submitting from the same system you don't need to enroll separately.

Title: Re: Suggestions for Billing Software
Post by: radiojohn on August 12, 2011, 07:03:17 PM
I'm heartened to see all these good reviews of Kareo . I've been looking them over and I've been looking for reviews. Guess I came to the right place. I've got some other software to look at but your comments are very helpful.
Title: Re: Suggestions for Billing Software
Post by: lvleeday on December 06, 2011, 08:21:48 PM
I see no one has recently posted anything about Kareo. I am an existing Kareo customer and have had multiple headaches from this software. I have extensive billing experience, many, many, many, years and seems to me Kareo's software is written primarily for physician billing and facility billing was a second thought.

I have a significant role at a billing agency and it was my responsibility to choose a software. I researched and researched before I chose Kareo software and now I am having major regrets after (4 months) in using it. We are still billing through Office Ally because I keep hitting brick walls when it comes to Kareo's "Encounter" feature. It absolutely sucks. Why I have to go thru Soooo many screens (uncheck this) enter data here to manipulate info way over there) is simply ridiculous to complete a simple billing task/change/adjustment...you know the common daily nature of this business.

Yes I do have experience with many different billing softwares and never have I had so many headaches that Kareo has caused. I find their staff to be inept (having no real billing knowledge) but rather being trained just enough to be able to tell you what the software should do but never being able to offer any suggestions/solutions/customizing to fit our specific billing needs.

Completely frustrated---- business is booming and yet I dont have the adequate software I need  >:(       Kareo has really fallen below all my expectations!
Title: Re: Suggestions for Billing Software
Post by: PMRNC on December 07, 2011, 05:10:50 AM
I always tell people looking into Kareo (as they are even up front about this) they will not be able to help you with medical billing. They assume all users are experienced, So they def are NOT the software for someone needing further help OR the new billing company. As for the other things, I've never used another program that allowed me to work so quickly and efficiently PLUS produce the reports I need. Perhaps that is where some billing centers differ. To get the best reports there need be more input and more customization, some would rather have less input/screens and sacrifice the reports, depends on what you need. I've moved clients over to them with great ease and only had some glitches when it came to data conversions on a few not so data conversion friendly.  I don't do any hospital or facility billing so i really can't comment on how they handle that. 
Title: Re: Suggestions for Billing Software
Post by: sherry27 on December 16, 2011, 02:18:36 PM
I think Total MD is the way to go. I think its awesome. I have not seen a better software. Their ability to do practically any report and customize reports is amazing. It is perfect for a new company. I have been in business for over 2 yrs now, and have been with Total Md for over a year and i have no intentions to ever going to anything else because they have all I need and great customer service. And if you are just starting. It is $99 month per user and you can add all the practices and doctors you want, but when you have more people working at the same time as you, then you will need to add another user. I just think it is great, and I so much wish someone would have told me about this software when I began. It would have saved me alot of headache!
Title: Re: Suggestions for Billing Software
Post by: PMRNC on December 16, 2011, 04:45:42 PM
My top vote is Kareo as well.  I always recommend going with the LONG term goal because in long run, conversions are costly, expensive and NOT without headaches!  Make sure you get a few different demo's and think of the future of your business.
Title: Re: Suggestions for Billing Software
Post by: Hamza on February 28, 2012, 03:51:36 AM
I am going for MTBC Ehr, i have heard it is superb software with all the features, plus they have some excellent services in reasonable price.
Title: Re: Suggestions for Billing Software
Post by: blegate on July 27, 2012, 10:09:40 AM
Sorry for chiming in so late, as I am new to the forum.  Let me suggest one that I do not think has been mentioned -- Nuesoft Technologies product called NueMD.  I would recommend demoing any product before purchasing.  Here is a link to their free 4-minute quick demo http://www.nuesoft.com/forms/request-demo.html
Title: Re: Suggestions for Billing Software
Post by: juliemedex on July 27, 2012, 03:51:33 PM
We started our billing company 8 mths ago and have three substance abuse treatment facilities we bill for using Medisoft.
We are still have issues sending claims electronically and I'm not sure if it's the software our the back up support trying to resolve the issues. Especially diificult sending to BCBS because they want all billing both medical and counseling on the UB-92.
I am trying to decide if we should switch to something else. This is a specialized field and it's  a litttle different than the typical doctor or doctor's office billing. I have a competitor using Collaborate MD and he's happy with it.
Any other feedback would be apprecited
Title: Re: Suggestions for Billing Software
Post by: Michele on July 31, 2012, 07:07:02 AM
Does Medisoft allow you to bill in the UB04 format (they replaced the UB92's several years ago)?  What clearinghouse are you using?  I would go to the clearinghouse and start there.  It is hard to advise because we don't know what the actual issues are.  I wouldn't recommend switching without knowing the specific problems you are having.  It would be like throwing away the lamp because the bulb blew.   :)
Title: Re: Suggestions for Billing Software
Post by: davidharvey on December 04, 2012, 12:40:02 AM
I have used several different softwares.  Advanced MD is my favorite so far.  This product is a very mature practice management system.
It has the features needed for larger group practices including:
batch processing
claims manager
denial tracking
collections module.
Title: Re: Suggestions for Billing Software
Post by: gurumedbill on December 04, 2012, 08:38:05 AM
I think AdvancedMD is also a very good software, probably top 5 out there.  My main problem with them is price for billing services.  There are options as good or maybe even better (depending on the needs of the billing company) for significantly less money.
Title: Re: Suggestions for Billing Software
Post by: henryn on February 26, 2013, 03:59:15 AM
Yeah i am using advanced MD software. It is great and i would like to recommend it to every one to save thier cost and time.
therapy billing software (http://www.clinicsource.com/)
Title: Re: Suggestions for Billing Software
Post by: henryn on February 26, 2013, 04:03:56 AM
You can take a tour to this link. They will help you in getting a reliable and robust billing software. Try it.
therapy billing software (http://www.clinicsource.com/)
Title: Re: Suggestions for Billing Software
Post by: gurumedbill on February 26, 2013, 08:48:40 AM
If you can get the doctor to pay or if the doctor already has it then AdvancedMD is a great option but their pricing is out of control for a billing service that is looking to grow.  Things have even gotten worse since they got bought out by ADP.  I'm not surprised because that was my same experience when I used to use Medisoft and they went from being privately held to being purchased by NDCHealth.  Those corporations just want to make as much money as possible and try to make people fee they are trapped and don't have any options.
Speaking of price increases I noticed that not longer after Kareo added their billing service they also have gotten rid of their less expensive pricing options from their website and only have the $299 a month plan listed.  Is that all they offer now or do they still offer the cheaper plans and just not show them on their website.  If you are paying $299 a month per provider for a billing service that can get pretty pricey as well.
Title: Re: Suggestions for Billing Software
Post by: PMRNC on February 26, 2013, 10:22:29 AM
The $299 is a bit pricey for the smaller billing company, however in regards to those that are growing, and keeping in mind that is for unlimited claims there are MANY providers that spend that in clearinghouse fees alone. They also give you a discount for mid-level (non physician) providers of 50% monthly taking into account the lower reimbursements. Depending on the structure of your billing company and your clients that $299 can be passed on to the provider OR you could split it.   The clients I have on Kareo pay their own fees. I do everything else. I really do not utilize ONE PM system, I go with what my client has, wants or needs. I found sticking with ONE vendor makes a provider feel like they have to switch, they are more apprehensive. I will tell you this. OF ALL THE VENDORS out there.. BY far Kareo spends the most on marketing, you will see their AD's EVERYWHERE..they know how to market, so there is a VERY good chance the doctors already have it.. like mine did.  I have not run across a physician who has not heard of Kareo.  But on the flip side, I would not use Kareo if you are new to medical billing. They are not a company that is going to hold the newbie's hand.. get your feet wet with other solutions first.   I also tell people.. you don't OWN your medical billing software, you lease or license to use it. Always keep that in mind. 
Title: Re: Suggestions for Billing Software
Post by: best biller on March 21, 2013, 01:43:10 AM
does anyone have some good suggestions beside kareo? I am looking for a good software for my just started billing service, currently i have one client and i want a web based software for a low price.

Thanks for any advice
Title: Re: Suggestions for Billing Software
Post by: PMRNC on March 21, 2013, 10:32:50 AM
Look into collaboratemd  www.colaboratemd.com   Good reputation, good pricing and I've never heard of any complaints.
Title: Re: Suggestions for Billing Software
Post by: gurumedbill on March 22, 2013, 09:45:52 AM
I like TotalMD (www.totalmd.com).  The software is super easy to use and the pricing is the best I've seen.
Title: Re: Suggestions for Billing Software
Post by: desheba on April 12, 2013, 04:37:56 PM
The $299 is a bit pricey for the smaller billing company, however in regards to those that are growing, and keeping in mind that is for unlimited claims there are MANY providers that spend that in clearinghouse fees alone. They also give you a discount for mid-level (non physician) providers of 50% monthly taking into account the lower reimbursements. Depending on the structure of your billing company and your clients that $299 can be passed on to the provider OR you could split it.   The clients I have on Kareo pay their own fees. I do everything else. I really do not utilize ONE PM system, I go with what my client has, wants or needs. I found sticking with ONE vendor makes a provider feel like they have to switch, they are more apprehensive. I will tell you this. OF ALL THE VENDORS out there.. BY far Kareo spends the most on marketing, you will see their AD's EVERYWHERE..they know how to market, so there is a VERY good chance the doctors already have it.. like mine did.  I have not run across a physician who has not heard of Kareo.  But on the flip side, I would not use Kareo if you are new to medical billing. They are not a company that is going to hold the newbie's hand.. get your feet wet with other solutions first.   I also tell people.. you don't OWN your medical billing software, you lease or license to use it. Always keep that in mind.


I have a question...If the client has been doing fee for service and now wants to bill insurance and wants me to find the software to use, should I be researching the software for me to purchase as a billing company or for the provider to purchase and I would be the user?  I am not sure if I should incorporate the costs into my fees or if the provider is responsible? Also, if I purchased the software under the billing company, would the provider be considered a user?  if this relationship ever terminated, how would the provider get the info I have billed under my software?

In suggestions or comments are greatly appreciated

Desheba
Title: Re: Suggestions for Billing Software
Post by: RichardP on April 12, 2013, 11:13:45 PM
I've been thinking for some time about writing this.  desheba provided the opportunity / excuse.

1.  desheba - the phrase fee-for-service commonly refers to when a provider receives a fee for each service such as an office visit, test, procedure, or other health care service.  This is the most common form of payment for solo practitioners and doctor's groups.  Starting to bill Insurance Carriers does not change this.  Did you mean something different?  Like, maybe your client has been cash-only up til now, but now wants to bill Insurance Carriers?

2.  Electronic Medical Records (EMR) stores the data that a provider would normally place into a paper chart.  Practice Management (PM) software is the new name for what used to be called billing software.  In some software solutions, the EMR and PM are built together and share a common database.  In most software solutions, the EMR does not have a PM system built into it.  The EMR stores the patient's chart info in its own database.  The billing must be done out of a PM system, which has a separate database.  If the EMR and the PM won't talk to each other in electronic language (which most won't for now), demographic data and billing codes must be taken out of the EMR database and entered into the PM database before any billing can take place.  An example of this setup is Practice Fusion (EMR) and Kareo (PM) before their relationship broke up.

In the near future, CMS is going to start paying doctors less for Medicare charges if they are not using an EMR.  CMS is paying doctors up to around $50,000 over a number of years to help them pay for an EMR.  If your client has Medicare patients, is your client maybe talking about this situation and using the term "billing program" because s/he doesn't know better - when what s/he really wants is an EMR?

3.  The (old) billing software that I/we use can create multiple databases.  So we can bill in one of two ways.  We can have a separate database for each provider/doctor, and switch from one database to another when we switch work from one doctor to another.  Or, in a single database, we can have Doctor 1, Doctor 2, Doctor 3 .... Doctor n.  In that single database, we specify which doctor number we are working on, and the data input is applied to that doctor number in the database.  Given this setup, we can have as many doctors as we want when we create a separate database for each doctor.  Or - we can have multiple doctors, but only up to the limit that the program will handle, when we have multiple doctors in one database.

In practical terms, we are not limited by our old software as to the number of providers we can bill.  However, the terms of use state that the main program can only be installed on one hard drive at a time.  So, for example, I can install the software on my computer hard drive.  I can have, say, 300 providers that I bill for.  But I am limited to only one user - since only one person can sit at my computer at a time.  Or, for example, I could install the software on a server, and have multiple users dial into the server to work on billing for the 300 providers I have (in this example).

This is the common configuration for billing software / Practice Management software being licensed today.  The main part of the program, along with its Provider database, is installed on a server.  Users / billers then dial into the server from their own workstations.

4.  In today's sofware climate, both Electronic Medical Records (EMR) and Practice Management (PM) systems are offered at a price per provider and users.  A common offering would be $XX.XX for the first provider and three users.  That means the software and database is set up on a server, you can do billing for only one provider/doctor, and three billers can dial into the server from their workstations at any given time to work on that one provider's business.  You pay extra to enable more than three billers to dial into the server at the same time.  And you pay extra to add the ability to do the billing for additional providers - although the fee for these additional providers is normally less than the fee for the first provider.

The structure of $XX.XX for the first provider and three users would stay the same, regardless of whether your client purchases the system or you purchase it.  The provider is the provider, and the billers are the user, regardless of who purchases the system.  If you have ten clients, it would be cheaper overall for you to purchase the system at the full price for the first provider, and then pay for each additional provider at a reduced price.  Total price to you would be less than if each of your ten providers bought the system for themselves at the full price.

5.  When pricing billing software, ask if the software can create multiple databases (new databases).  If you pay for only one provider, that might mean only one provider in a single database.  If you want more than one provider in that single database, you will have to pay an additional fee - the Doctor 1, Doctor 2, Doctor 3, Doctor n in-a-single-database thing.  If you can create multiple databases with the software, you might be able to create a database for each new provider (like my billing software can do) without having to pay the additional fee for an additional provider.

6.  If you buy the PM system, I think it is fair to charge your next client whatever amount it costs to add him as a provider to your system; and if you need to add an additional user to process his billing, he should pay for that as well.  Spread the cost of the software out over 24 months and include it as a separate charge on your invoice you give him.  (If you are using Software as a Service such as Kareo, that extra monthly fee to add him as an additional provider will never go away.)

7.  Because CMS will soon reduce payments to doctors who bill for Medicare patients but don't use an EMR, you might want to consider whether to purchase an EMR and offer that as a service to your client(s) (for the appropriate fee of course).  In using your EMR, they won't get the payment available from CMS (neither will you), but they won't get their Medicare payments dinged.

8.  You asked if this relationship ever terminated, how would the provider get the info I have billed under my software?  Let's focus on billing only first.  Your client should have all his patient demographics, insurance info, and procedures / charges - either in his paper charts, or in his EMR.  The charges (codes) in your billing software should reflect / be a duplicate of what is in your client's paper charts / EMR.  The thing you will have that your client won't is how much each patient owes him at the time your relationship ends.  Others can chime in here, but my understanding is that it is common for the biller - when the relationship ends - to bill no more insurance claims, and to continue sending patient statements for the next four months (for a fee).  At the end of the four months, you would print out an age report and give it to your ex-client.  From that point forward, it is up to your ex-client to make efforts to collect what is still due him.

If you are also providing your client with an EMR, and your relationship ends, you have a much more difficult problem to solve.  See Point 9 for a discussion.

9.  Under the paper chart system, the paper chart was the legal record.  Even if the provider used an EMR and/or billing software, the electronics were not the legal record.  What was in the paper charts was the legal record.

Consider the paperless office.  No paper charts anywhere.  Only an EMR.  All data is there.  That is now the legal record.  When the doctor is charged with billing for work that was not done, the EMR is the legal record.  When he goes to court to defend himself against charges of billing for work that was not done, he will defend himself with what is in his EMR.

  a.  What if the IT tech missed the last backup and a technical glitch or virus wipes out all the data in the EMR?  With what will the doctor defend himself against charges of billing for services not provided?  At this point, he has no paper record or electronic record available to him.  Yet the insurance carriers he billed have detailed records of the bills he submitted to them.

  b.  What if you are providing the EMR to your client for a fee, he runs a paperless office, and you and your client have a falling out?  You own the EMR.  The doctor technically owns his data that is in your EMR, but how do you get that data to him in a form that is useable?  Again, with what will the doctor defend himself against charges of billing for services not provided?  At this point, your ex-client has no paper record or electronic record available to him.  Yet the insurance carriers he billed have detailed records of the bills he submitted to them.

  c.  I have a client who is putting data into the Practice Fusion EMR.  Assume he runs a paperless office and has no paper charts as back-up.  Assume a technical glitch or virus wipes out all of the data in the EMR, or assume the company goes bankrupt and shuts off power to their servers, or assume my client and Practice Fusion have a falling out and sever their relationship.  How can my client get his data out of a system that is no longer available to him?  With what will my client defend himself against charges of billing for services not provided?  At this point, he has no paper record or electronic record available to him.  Yet the insurance carriers he billed have detailed records of the bills he submitted to them.  (In reality, my client who uses Practice Fusion is also still using paper charts.)

With these three scenarios as a starting point, I'm sure you can think up your own situations where a provider will be screwed if he has all patient information in an EMR that he can no longer access, with no paper backup anywhere.  We have several former clients who have put themselves in this position, and that is why we let them go as clients.  How can we defend ourselves against charges such as billing for services not rendered if the data in the client's EMR becomes unavailable for whatever reason, and the client has no paper backup?

If a client insists on having an EMR, I emphasize that he should own it outright and have it installed on his own servers - for the reasons just discussed.  I cannot in good conscience recommend that any provider put his client's data into an EMR provided by an SaaS company such as Practice Fusion, and rid himself of all paper charts.  As fragile as electronic bits and bytes are, and as succeptible to bankruptcy and other mishaps as companies are, putting all patient data at the mercy of others just makes no sense to me.

On the other hand, there are always backups.  And we know that backups are always performed.  And we know that backups never fail.  Not.

You might also read the last paragraph of the post at this link:

http://www.medicalbillinglive.com/members/index.php?topic=7254.msg22376#msg22376
Title: Re: Suggestions for Billing Software
Post by: tallmanusa on April 13, 2013, 02:18:48 PM
Richard, thanks for a well thought out posting.
However Practice fusion is used by 150,000 providers, that is just one EHR system, most providers using EHR  that I have seen have no paper records.
PF integrates now with Nuesoft and CollaborateMD. You are correct that an integrated system is preferable.
The prices are falling, they are about half now what they were as little as three months ago; and they would drop more.
Your caveats are well taken, but people have made hundreds of millions of dollars in this business (Jonathan Bush of Athena Health is one), I assume they were not so afraid of " what if? ". The current system is Godsend for savvy business people.
Title: Re: Suggestions for Billing Software
Post by: PMRNC on April 13, 2013, 03:42:11 PM
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If a client insists on having an EMR, I emphasize that he should own it outright and have it installed on his own servers - for the reasons just discussed.  I cannot in good conscience recommend that any provider put his client's data into an EMR provided by an SaaS company such as Practice Fusion, and rid himself of all paper charts.  As fragile as electronic bits and bytes are, and as succeptible to bankruptcy and other mishaps as companies are, putting all patient data at the mercy of others just makes no sense to me.

Richard, I def agree with you on this one! Even with PM system, I have my clients sign all the agreements with them directly.
Title: Re: Suggestions for Billing Software
Post by: RichardP on April 13, 2013, 06:58:22 PM
PF integrates now with Nuesoft and CollaborateMD. You are correct that an integrated system is preferable.

This is just a technical point, but it is important.  An integrated system is preferable over a non-integrated system.  But integrated means only that the systems can accurately pass data back and forth amongst themselves.  At least in this thread, the point I was making was single database, not integrated.  EMRs and PMs that share a single database are preferred over an EMR and a PM system that each has its own database.  Unfortunately, not many single-database EMR/PM systems exist yet.  Practice Fusion and Kareo each had their own databases, but were supposedly integrated.  A great many posts on the internet testified to the many ways in which that integration failed.  Had Practice Fusion and Kareo shared a single database, those problems would have been non-existant.  Practice Fusion and its new partners may do a better job of integrating their data-sharing functions, but I believe they will still each have separate databases, not a common database that Practice Fusion and its partner can each access.

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... people have made hundreds of millions of dollars in this business ... , I assume they were not so afraid of " what if? ".

That quote is looking from the perspective of the businessperson making money by leasing the system to providers.  What is at risk for the businessperson if their provider client is charged with submitting claims for work that was not done and the data in the EMR is not available for the provider to use to defend himself?  The total risk is to the provider, not the businessperson.  So why is it relevant to us what the businessperson thinks?

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The current system is Godsend for savvy business people.

There is no denying that this is true.  And it will continue to be a Godsend until the moment it stops working.

What got me to thinking about what I wrote in my previous post above was physically standing one day by one of our ex-clients who had scanned all of his charts into his brand-new EMR and sent the charts out to storage.  I can still see him standing in the examining room, laptop in hand, as he began the polite banter that takes place before examining the elderly man.  His words were directed at the patient, but his eyes were scanning the screen on his laptop, as he began to familiarize himself with the patient's history.  Suddenly, his internet connection went down, and his screen went blank.  Patient in front of him, patient history at his fingertips for a quick review before questioning the patient, and then suddenly it wasn't.  Doctor had nothing in the office he could turn to to review the patient's history.  The doctor was dead in the water.  He had to cancel patients for the rest of the day.  Fortunately for the doctor, his internet connection was restored in time for the next business day.

In addition to my personal experience, I have read stories where there was a dispute over dollars owed to the software vendors by the providers.  Providers believed they didn't owe certain charges, vendors believed they did, and promptly blocked access to the providers' EMRs until payment was made.

Both of my examples here prove the concept of a provider being held hostage by those providing the computer technology.  In a paperless office, no access to the EMR is serious busines.  That reality needs to be accounted for before an office goes paperless, no matter how much of a Godsend the technology might be.
Title: Re: Suggestions for Billing Software
Post by: tallmanusa on April 13, 2013, 11:49:43 PM
Richard you write well.
There are EHR and PM that work on single data base.
At least three come to mind; MD Online, Mastermind MD, and Total MD,( in a few weeks). All of these are relatively inexpensive, about $150 per month for both.

It is my impression that in our business there is tremendous demand, the demand outstrips the supply of RCM companies. It is no accident that Athena Health has 30% annual growth rate. That being said the doctors are not going to hand over their livelihood to someone working out of their suitcases. The doctors are looking for full services, including credentialing, coding advice, meaningful use help, HIPAA compliance etc.  Every time we have been contacted, it is because the doctor needed help with something other than just billing.
Title: Re: Suggestions for Billing Software
Post by: RichardP on April 14, 2013, 01:50:55 AM
Thank you for your kind words.  Office Ally and Practice Mate, the EMR and PM systems offered by Office Ally also work off a single database.
Title: Re: Suggestions for Billing Software
Post by: DMK on April 15, 2013, 11:05:44 AM
"What got me to thinking about what I wrote in my previous post above was physically standing one day by one of our ex-clients who had scanned all of his charts into his brand-new EMR and sent the charts out to storage.  I can still see him standing in the examining room, laptop in hand, as he began the polite banter that takes place before examining the elderly man.  His words were directed at the patient, but his eyes were scanning the screen on his laptop, as he began to familiarize himself with the patient's history.  Suddenly, his internet connection went down, and his screen went blank.  Patient in front of him, patient history at his fingertips for a quick review before questioning the patient, and then suddenly it wasn't.  Doctor had nothing in the office he could turn to to review the patient's history.  The doctor was dead in the water.  He had to cancel patients for the rest of the day.  Fortunately for the doctor, his internet connection was restored in time for the next business day."


Awesome Richard!  This is one of the most salient points made on threads regarding EHR software.  This is the nightmare that most, if not all, providers have often.  And for several reasons.  Patients HATE when the doctor is looking at the screen and not them, and the information they have on screen is only as good as the data entry was.  I've worked both ways, and have stayed with paper.  I know we'll have to eventually start to put all the info into an EHR program, but I will retain the paper backup.

I will grant you that files can get misplaced, studies not filed correctly, and there have been disasters that have wiped out both physical and electronic files.  When someone can figure out how to plan for ALL contingencies we'll all be better off.  But for now, we do the best we can with what we have, and roll with what happens!  I will say that the younger people coming into this field NEED to know how to do things manually as well as electronically and to understand WHY they need to know how to do things both ways!



Title: Re: Suggestions for Billing Software
Post by: PMRNC on April 15, 2013, 12:08:00 PM
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Awesome Richard!  This is one of the most salient points made on threads regarding EHR software.  This is the nightmare that most, if not all, providers have often.  And for several reasons.  Patients HATE when the doctor is looking at the screen and not them, and the information they have on screen is only as good as the data entry was.  I've worked both ways, and have stayed with paper.  I know we'll have to eventually start to put all the info into an EHR program, but I will retain the paper backup.

I'm with you guys, and not only for my clients sake but for my own family. I have had two ALMOST majorly critical mistakes with my daughters EHR and to that effect in my state (and in all other states) patients can "OPT OUT" w/out penalties effecting their health care decision making. My family has opted out of any EHR and I don't plan to change that any time soon. I DO not want my doctor looking at his IPAD or laptop when discussing my health. Here's a question to ask your physician " If I opt out, which I am legally allowed to do, will that effect the care I'm given by your facility?"  Love that question, courtesy of my attorney. I did not make that decision based ONLY on the mistakes made in my daughters chart, but also taking into consideration many of my own clients and they seem to have the same opinion. I have some that opted out of govt plans or plan to and I have others who plan to still keep paper. No law exists saying they can't and many many providers in private practice are still old school and don't trust technology.  HEY the CIA and FBI websites along with the white house infrastructure has been compromised on many occasions, you think there is such thing as sure security? The middle east has been the biggest culprit on technology hacking and well I'm not going to rely on my govt to keep my information safe.   PERSONALLY.. I think we'll see more delays with mandatory EHR.. I just know it. The govt has a history of declaring rules/regs and when they see all the loopholes they have to close up delay is inevitable. I'm not saying that if you have to comply, not to comply, I'm simply saying that I listen to my clients on this issue and guarantee them MY own backup and record retention. I've not had a problem.

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doctors are not going to hand over their livelihood to someone working out of their suitcases. The doctors are looking for full services, including credentialing, coding advice, meaningful use help, HIPAA compliance etc.  Every time we have been contacted, it is because the doctor needed help with something other than just billing.

I STRONGLY agree with this as well. Today's billing company had better know the in's and out's of all aspects of the industry in order to compete.
Title: Re: Suggestions for Billing Software
Post by: isabelreyna on October 27, 2014, 05:45:13 PM
can somebody tell me if Kareo is a good soft wear for a Neurology specialist?
Title: Re: Suggestions for Billing Software
Post by: kristin on October 27, 2014, 06:45:23 PM
My experience billing with Kareo is that it isn't "specialty specific", like some software is. It can be tailored for any specialty so far as I know. I use it for podiatry, and I know it can be used for internal medicine/GP billing also, and I am sure almost any other kind of provider.
Title: Re: Suggestions for Billing Software
Post by: isabelreyna on October 27, 2014, 08:28:53 PM
THANK YOU KRISTIN !!!! I TOO LIKE KAREO, I WAS NOT SO SURE ABOUT CERTAIN SPECIALTIES.....
Title: Re: Suggestions for Billing Software
Post by: isabelreyna on October 29, 2014, 10:45:51 AM
PMRNC is logmein.com different then me going through the PM and getting log in and passwords and having the domain administrator adding me as a user? am going to work from my house and going to remote myself in their system.
Title: Re: Suggestions for Billing Software
Post by: PMRNC on October 29, 2014, 02:32:34 PM
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PMRNC is logmein.com different then me going through the PM and getting log in and passwords and having the domain administrator adding me as a user? am going to work from my house and going to remote myself in their system.

If your using a web based PM system you don't need logmein.com   I only use Logmein.com to accommodate clients who are not on a web based system.
Title: Re: Suggestions for Billing Software
Post by: summittech on May 29, 2015, 06:36:48 AM
The cloud-based Doctor and Clinic Management System Software may prove useful to you. It incorporates a very strongly built medical billing and payments module.

You do not have to pay license fees to use this software. The software is delivered On-Demand. You need to subscribe to its services by paying small monthly fees.
Title: Re: Suggestions for Billing Software
Post by: Billingbilling on October 11, 2017, 07:38:49 PM
Has anyone been able to get more reasonable pricing for multiple providers from  H big cloud based vendors (Kareo, advance, collaborate, etc...)?
Title: Re: Suggestions for Billing Software
Post by: Michele on October 12, 2017, 06:45:36 AM
We have not looked into it in several years, but we did an extensive search a couple years back and we were never able to locate a cloud based software that was reasonable for multiple providers.  We worked with a company trying to develop one but they didn't succeed.