Medical Billing Forum

Starting a Medical Billing Business => Starting Your Own Medical Billing Business => Topic started by: williamportor on September 23, 2012, 02:16:20 PM

Title: Employees working at home
Post by: williamportor on September 23, 2012, 02:16:20 PM
Hello Everyone- My business is growing, and I'll soon be hiring my first employee. I had an idea I would like to share. I'm wondering if it's possible to hire employee's to do data entry and other aspects of the billing process, and allow them to work from their own homes as well. As the owner, one would have to set up a system to insure employees were working when they were supposed to, and producing the required amount of work each workday. If sucessful however, this would allow one to grow their company, and continue to add employees as needed without the expense of renting office space, or having their employees occupy the owners' home for hours each day. I submit my claims to a clearinghouse, and have a 96% paid record. Does this kind of business model seem possible? and if so, what kind of software and/or other techology would be required to make this kind of system a reality?  :) 
Title: Re: Employees working at home
Post by: PMRNC on September 23, 2012, 02:32:55 PM
I for one (BY MY OWN PERSONA CHOICE) won't do this. A. it's too much liability. you have to up your E/O and you take full responsibility and liability. and B. I'm just a control freak who no one in their right mind would work with me. LOL

I guess it could be done, of course you have to update compliance plans, policies procedures, E/O insurance, and BAA agreements.  You could find remote solutions such as logmein.com or if you already use a web based PM system you can talk to them about access for employee's (keeping in mind HIPAA login/remote requirements)

Not saying it can't be done. When I started I knew my goal was never to get as big as to lose control or take on too much liability.   I also hate the term data entry in regards to employee's.  No such thing, data entry is clearly downgrading the responsibility.   Just my 2 cents.
Title: Re: Employees working at home
Post by: Michele on September 24, 2012, 10:30:21 AM
I agree with Linda.  I do not allow employees to work from home.  IMO it's just never as productive.  I'm sure there is an exception to this rule but it's not worth the chances. I've heard to many horror stories from people who have done it.
Title: Re: Employees working at home
Post by: PMRNC on September 24, 2012, 10:53:00 AM
I have a good friend I met back when I started who grew her business VERY quickly.. she hired 2 in house employee's, things were great, then she had to move so the employee's worked remotely. One of them ended up stealing clients (despite a non compete which don't hold up in court) and the other one tried to claim more work than was done and stole about $10,000 from her this way.   JMHO but if I can't stand over them, I won't hire them.
Title: Re: Employees working at home
Post by: Cpatel on September 25, 2012, 01:19:40 PM
I agree with Michelle and Linda. I will never allow employee to work from home from day one.

Title: Re: Employees working at home
Post by: williamportor on October 01, 2012, 08:56:50 AM
Thank You for your input everyone. It looks like I'll be expanding my home office, to include a few employees. :)
Title: Re: Employees working at home
Post by: rdmoore2003 on October 02, 2012, 03:44:49 PM
at one point I worked from home 1 day a week.   When I did the remote into the server, it would track the time that I worked.  It was set to show exactly how long I was in each account and give the information on what i did in each account.  with a system like that, i would not have issues with employees working from home, but it would be just the 1 day a week.
Title: Re: Employees working at home
Post by: PMRNC on October 02, 2012, 04:37:39 PM
While I can see that would be a bit more comforting for certain reasons, it's not assurance of compliance issues. For example, if you have an employee working off her home computer which happens to be the kids computer or the hubby's computer or maybe they have an unlocked filing cabinet. Sounds like small things but can be big headaches. If they are your employee no matter where they work, your closet, your office, their home, you are ultimately responsible for their compliance and there's no way to assure that without taking proper steps, IMHO I would have to have someone working with me (in house) for a while before I could take those risks. Plus the added liability goes on your insurance as well. You will need to add each employee to your E/O policy in order to be covered.
Title: Re: Employees working at home
Post by: rdmoore2003 on October 03, 2012, 09:55:15 AM
I completely agree with you Linda.  I had to work for almost a year in house before I had the chance to work from home.  I had to get a new puter to do this and employer set everything on it for the home -work.   it was alot to do to be compliant, but it is not for everyone..it is so involved that i did not do it for long.  it was easier just to go into office
Title: Re: Employees working at home
Post by: Michele on October 03, 2012, 11:50:18 AM
As the owner, I work from home quite often but honestly it is a pain.  I can never quite finish anything.  I can't file or get anything filed, I can't fax or photocopy or get anything I print.  When I come in I have to go thru the work I did at home and 'finish' it.  That is another reason that I don't want my employees working from home.  It is not the most efficient.  But for me, it is a necessity.  :)
Title: Re: Employees working at home
Post by: medco on October 17, 2012, 03:08:47 PM
Hello,

I have a question about starting my own medical billing business at home. I worked for a doctor for the past 8 yrs. Is it possible to do billing from home by logging into the doctor's own computer? Or do I have to buy software? I have no idea. Please help.
Title: Re: Employees working at home
Post by: PMRNC on October 17, 2012, 03:14:15 PM
It depends on how you will be structured, are you an employee of this doctor? If so they are responsible for all costs, software, computer, etc.. That's why it's not cost efficient for a provider to hire someone as an employee to work from home, their costs are more and liability is more. 

There are several structures:   employee, sub-contractor, business     who buys what depends on that.
Title: Re: Employees working at home
Post by: rdmoore2003 on October 17, 2012, 03:40:57 PM
It depends on how you will be structured, are you an employee of this doctor? If so they are responsible for all costs, software, computer, etc.. That's why it's not cost efficient for a provider to hire someone as an employee to work from home, their costs are more and liability is more. 

Yes it is possible, but I do agree with Linda.  It is not what it seems.  I have worked from home and signed to the server at work, but when you need to make calls, do you want patients to know your home # (caller id) and its just not what its cracked up to be.
Title: Re: Employees working at home
Post by: medco on October 17, 2012, 03:50:17 PM
When I worked at the doctors office my bosses wife would go into the computer and do some work from home. Do all doctors computers have the ability to do billing? I am starting a new business. I was told I could just log into their computer and do the work. Could you tell me what would be my best avenue to travel down. Thanks
Title: Re: Employees working at home
Post by: rdmoore2003 on October 17, 2012, 03:53:19 PM
you have to get the IP address from the server.  input it into your computer and sign on.  that is how I did it.   if you are firm about doing this, I suggest that you get a new computer for just the office work. 
Title: Re: Employees working at home
Post by: medco on October 17, 2012, 04:12:51 PM
I don't have to spend $20,000 on computer software? I can just use theirs? If a doctor always used a clearinghouse does that mean the his computer isn't capable of doing his billing? Does he have to get it upgraded? Any help would be great.
Title: Re: Employees working at home
Post by: midwifebiller on October 18, 2012, 01:25:51 PM
Chiming in here. ALL of our contractors work at home. This has been a few billers, then grew to over 30 billers, AR specialists, benefits specialists, etc. Paying them per work (instead of per hour), solves the padded time card problem. Visiting their home office to check the set-up and compliance helps, too. Not everyone can work from home. We screen carefully when hiring and find out about kids at home, other family  members at home, schedules, basically as much as we legally can. If there is too much drama in her life, working at home will not work. We have had to let people go during their probation period when there was just too much drama or they couldn't stay on task. For the most part, I love having contractors with their own home offices. Instant Messaging, weekly team meetings and monthly face-to-face gatherings help hold things together and create an atmosphere of cooperation. I did have one biller come to my home office to work on the extra computer--and I didn't like it!  I guess I just like my space.
Title: Re: Employees working at home
Post by: PMRNC on October 18, 2012, 04:08:08 PM
Anyone with "access" must adhere to HIPAA regulations which do require login's to both the PM software AND that remote computer. So you can't just go sign on using doctors login. This is not just required for HIPAA but it's also a lifesaver for Audit trail. Suppose there is an audit, that person's login will be on the hook for any problems, and you can catch errors made by each person BEFORE it gets to a bad point.    For my clients I bill remotely for and logging into their system, I have not only a login for the PM software but I must first login with my OWN logmein credentials and then to their Windows, I have my own login as well.   All of that detail has to be outlined in your compliance plan.
Title: Re: Employees working at home
Post by: midwifebiller on October 18, 2012, 05:50:52 PM
We use our own web-based billing program, not the midwife's, and each person has their own login. HealthPac has good audit reports which help keep track of when people log in, how much work they get done, etc.  It *would* be a nightmare if we could not keep track of each person!
Title: Re: Employees working at home
Post by: Michele on October 19, 2012, 06:37:38 AM
Wow you are the first positive case we've heard from.  Nice to hear it can be done.  :)
Title: Re: Employees working at home
Post by: PMRNC on October 19, 2012, 01:12:34 PM
Quote
I don't have to spend $20,000 on computer software? I can just use theirs? If a doctor always used a clearinghouse does that mean the his computer isn't capable of doing his billing? Does he have to get it upgraded? Any help would be great.

If you are going to operate your own business, yes you will need a practice management system. Will you be able to access a clients computer / PM software? Yes if that's what they want, and yes if you plan to make sure you are in full compliance and you have a contract you are set, however for every one client you find that wants you to use their computer/software you will find 2 that want you to take it all.. so that means if you are going into business for yourself you will need to have a PM software system of your own. As a business owner you never charge your clients costs associated with "Doing business" such as attorney fees, insurance, coding books, continued education, memberships, software, etc etc. Any cost that is utilized by the business FOR the business is Never passed on to the client. IF you plan to work as an "employee" there are several things that must be done in accordance with IRS guidelines on both the clients end and your end. The client would need to provide ALL items needed, even the computer, software, etc in order to get any type of employee deduction allowed under IRS guidelines.   To give you an example, I had a client that left his practice and instead went into book publishing, he wanted me to work for him but he was in a different state, he went to his accountant who advised him that for an employee status he was better off finding someone inhouse because I would be using all of my own computer, supplies, etc and that wouldn't qualify him for any employee deductions.   

Point is that if your going to start a business you need to prepare to pay the start up costs as you would starting any business. If you decide you are looking to be an employee, well it's not advantageous for physicians to hire "employees'' to work from home, they get better deductions and lest out of pocket costs by hiring an outside billing agency/company.    I wrote this article from my website which should give you a good idea in weighing your options between starting a business and becoming a work at home employee.   http://www.billerswebsite.com/jobvsbiz.htm   I hope that helps.
Title: Re: Employees working at home
Post by: tallmanusa on November 12, 2012, 09:54:10 AM
From what I can gather, there is a 80/20 rule in this business. (And in other businesses too). That 80% of the business is done by 20% of the companies. All of these medium to large companies outsource their work, some within USA, some off shore. Almost all pay for performance to persons who are sub contractors (not employees). Almost all use web based systems; for the most part web based system has no up front cost. Non web based systems are passe, like horses and bayonets.

The Superbill is also fading, the EHR is integrated, no Superbill is required. Good riddance.
Now how do these companies comply with HIPAA?

To find out who these companies are do a search on Google for " medical billing companies "; the top five companies do most of the business. Their websites describe that they offer web based integrated EHR.
The point is that this business has changed so much that it has not much in common with yesteryear technology. Some people still believe that you have to pay up front for software.
Even a small operator with few doctors has to compete with the major companies; if you have no cloud based system, no EHR, and no sub contractors to offer, I am not sure how far you would get.
Title: Re: Employees working at home
Post by: PMRNC on November 13, 2012, 02:21:29 PM
Quote
for the most part web based system has no up front cost. Non web based systems are passe, like horses and bayonets.

No way.. I disagree completely.. the #1 most widely sold PM system has been Medisoft for YEARS and it's still the most widely used.  Of all my clients total past/present only 3 had web based/ASP based systems.   

Quote
The Superbill is also fading, the EHR is integrated, no Superbill is required. Good riddance.
Now how do these companies comply with HIPAA?

Ask them how EHR is working out in NY/NJ with the after affects of Hurricane Sandy..  It is my prediction this is going to be postponed, NOT for just that reason but for reasons having to do with Cyber Terrorism. It's already happened in small chunks and the middle east is only getting more tech savy on us. Plus you will have patients who exercise their right to "opt out".   Paper is not going away. I have many clients who don't want to lose some of the paper systems in place, they don't trust EHR's. MANY providers are even waiting until absolutely necessary.. most of their fears are based on the exact situation they are facing in the hospitals after the hurricane in NY/NJ, EHR was completely DOWN the entire hospital's came to a very scary stop. Also the government's track record with implementation of these types of things always includes a few years in postponements, they still have NOT ironed out the kinks in security.     As for compliance, again. The software companies make their solutions compliant, it's up to each provider to IMPLEMENT HIPAA security.   

Quote
To find out who these companies are do a search on Google for " medical billing companies "; the top five companies do most of the business. Their websites describe that they offer web based integrated EHR.

No disrespect as i know your new, but I think you are putting way too much thought into EHR and forgoing all of the other "more" important aspects of having a billing/practice management company.   I've already contracted with a few companies to network with and give referral's (affiliate) because I don't plan to get involved in the EHR stuff at all. I'll let them handle that part :)

Quote
The point is that this business has changed so much that it has not much in common with yesteryear technology. Some people still believe that you have to pay up front for software.
Even a small operator with few doctors has to compete with the major companies; if you have no cloud based system, no EHR, and no sub contractors to offer, I am not sure how far you would get.

Again, I have to disagree, even with those solutions the MAJORITY of practices still do not fully trust internet. It's not the technology, it's the security that is the issue. I have talked to many clients with hangups on this issue and rather than try to talk them into something they are NOT ready for, I work with them, they retain the right to the same control, that's actually the number one marketing drawback in our industry, doctors are hesitant because they don't want to lose control. Why should I force technology when I can be an extension and ease them slowly.  I've seen too many billing companies lose potential clients because the client wanted to retain some control or use their software, etc.   
Title: Re: Employees working at home
Post by: DMK on November 14, 2012, 10:52:00 AM
Linda, you're my hero!
Title: Re: Employees working at home
Post by: PMRNC on November 14, 2012, 11:02:12 AM
I aint giving up my source documents that Cover my ass.. HELL NO! :)
Title: Re: Employees working at home
Post by: DMK on November 14, 2012, 12:34:44 PM
And Sandy was a bit of a litmus test for EHR wasn't it?  Can you imagine if you were in the hospital at the time, on a complicated set of medications and "poof" no one could find any information on you?  Scary.
Title: Re: Employees working at home
Post by: PMRNC on November 14, 2012, 03:34:52 PM
Very scary indeed. They are still in a PICKLE over this.. the power going out was one thing.. having your entire infrastructure go down when you rely only on that.. YOU got problems. I'll take any and all bets from those that think we will see MANDATORY EHR :) :) :)  You will lose :)
Title: Re: Employees working at home
Post by: QueenAlicia on November 15, 2012, 03:20:33 PM
A small company with no subcontractors can get pretty far. I AM a small company with 1 subcontractor that will be providing services for the new department that I am offering.  It can be done and I have seen growth over this year so I  disagree.  Many members from this own site have reached out to me for advice because they have seen me start from NOTHING!  Do not under estimate the small company's because they don't remain small forever.

I think that some people should be in this business as a business not as a biller but the actual owner for awhile so that they can be able to give valid observations.  Many practices are now just jumping on board for EHR, many haven't attested yet. 

The web based system that I am leaning towards getting to invest for clients that don't have their own or don't care what system I use has a down payment and is an industry leader.
Title: Re: Employees working at home
Post by: tallmanusa on November 15, 2012, 04:58:58 PM
What web based system is that?
Title: Re: Employees working at home
Post by: QueenAlicia on November 15, 2012, 09:39:12 PM
NueMD.  Also if you want to get specialty specific Bright tree, Office mate and a few others require a down payment.

Those that don't require a huge payment every month such as $499 a month per provider.  The only one that can compete with everything at a lower price is Kareo.  You can research others such as Total MD, Advanced MD, Omni MD, Care Cloud.

Like I said I started from nothing, spent money investing in things that I wish I didn't, so taking the time to invest in software has been a long process for me.

From the website to pricing it has been a long process for me but my business has grown and prospered. 
Title: Re: Employees working at home
Post by: PMRNC on November 29, 2012, 04:21:20 PM
I am also going to intervene with another observation., it may not be received well but I assure you I have only the best intentions in mind.   Our network has over 7500 billers, more than half are billing companies.  The ones I have actually WITNESSED failures all seem to have a common denominator.. an owner who has NO experience, no education and just wants to hire, cut payroll and make bank.   I see it over and over and over again. Some I have even taken on as mentorees for their "sub contractors" or "employee's.    I can HONESTLY say since we've been doing this since 2000 I know of only ONE company who's owner has NEVER been hands on and has succeeded.. yes there are always exceptions to the rule.  BUT... one of reasons he succeeded.. was because his WIFE was the brains/experience behind the business.    Now I just want to make another observation but I do NOT want to be misunderstood as being sexist.. this is strictly from experience only and what i have seen over the years doing this....It is mostly the "men" who believe they can put together a billing company, hire sub contractors or employee's.. do payroll and rake in the profits.  I think the reason this is, is because let's face it.. men still believe they are the "providers" and I really am NOT saying this as a stereotype, I promise it's based on what I've SEEN over the years and witnessed first hand. They normally do NOT work.   If you want a billing company, and you want it to be successful, competitive and compliant... YOU must be hands on or you will fail.   That is fact.   If you really want to own ANY business where you don't want to do the work, learn the industry, I think your better off with an MLM or other business opportunity.. THIS is not the business to play with. 
Title: Re: Employees working at home
Post by: tallmanusa on November 29, 2012, 04:57:33 PM
http://www.moneyandbusiness.com/business/accounting-taxes/accounting/5-best-online-medical-billing-service-companies 

I gave this link before.

One is a public company and records are freely available. Four are private but still we can tell plenty about them from information available.

Here is what I found.

1. The founders are not involved in the day to day business.  I cannot tell if they ever were, my impression is that they  were never involved in the operation. They are ALL men.
2. The founders are doctors or MBA or IT people.
3. At least two companies were IT companies before they got involved in Medical billing. One company has a logo that says " An IT company ".
4. They all outsource their work, they will tell you if you call them, I did. They freely admit that they outsource off shore. Two say that they " outsource locally ". One company stated that they had 1500 billers working at their location in Islamabad, Pakistan and another 2000 billers at another location in Kashmir. The addresses of these locations are available.
5. They operate through a network of sales people (not billers); I did not think that the salesmen were particularly well informed about medical billing. The salesmen freely admit that they are salesmen not billers.

There are lot of things you can tell about them.
Title: Re: Employees working at home
Post by: PMRNC on November 29, 2012, 06:44:36 PM
Quote
1. The founders are not involved in the day to day business.  I cannot tell if they ever were, my impression is that they  were never involved in the operation. They are ALL men.
2. The founders are doctors or MBA or IT people.
3. At least two companies were IT companies before they got involved in Medical billing. One company has a logo that says " An IT company ".
4. They all outsource their work, they will tell you if you call them, I did. They freely admit that they outsource off shore. Two say that they " outsource locally ". One company stated that they had 1500 billers working at their location in Islamabad, Pakistan and another 2000 billers at another location in Kashmir. The addresses of these locations are available.
5. They operate through a network of sales people (not billers); I did not think that the salesmen were particularly well informed about medical billing. The salesmen freely admit that they are salesmen not billers.

This is what I was talking about..this is what gives our business the rep it has.