Medical Billing Forum

General Category => General Questions => Topic started by: tallmanusa on November 01, 2012, 10:32:02 AM

Title: Can you make a profit by charging 4%?
Post by: tallmanusa on November 01, 2012, 10:32:02 AM
Can you make a profit by charging 4% of the net revenue?

This business is very price sensitive and doctors are always looking to cut costs. The going rate is around 6%; at 4% there would be no shortage of clients. I see some companies doing the same on Google ads. I will get nationwide clients through the same. I would charge $800 minimum.
I plan to do primarily e- claims through Kareo software, sub contract the billing/ coding to be done remotely.

Many people here are very experienced and know a lot more than me.

Thanks

Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on November 01, 2012, 05:38:23 PM
I truly don't have a professional answer to this one and I'm not sure I am comfortable giving you my personal opinion on the subj.    There was this pretty big billing company going around advertising their 4% cheap rates and cheap is how they were perceived, I don't even want to continue the story except to emphasize the word "cheap".   I also have to disagree about doctors looking to cut costs. I haven't seen a doctor try and screw me down in YEARS. I don't have not done % based billing in years. Some are shocked even when I tell them it's illegal for them to get into a % based contract in my state (NY) and once they learn that, they are fine. The other ones I simply ask them if they pay a % to their electric company , phone company, etc.    I get paid for the work I do. Simple. If I were to get a client that tells me.. Well Joe the biller down the street will do it all for 2%.. Great, call me in 6 months but expect my rate to be higher.
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on November 02, 2012, 07:06:39 AM
Linda, thanks for the reply.
You have been in business a long time, you have a client base, this is luxury a lot of us don't have.
A new company has to offer something different. If we offer the same as everybody else, we are certain to fail. If we offer the same things at the same price we have nothing to offer, except our good looks, and you know how far that gets you.

One does not have to sell on a percentage basis; one can sell for $2.99 per claim or $3.99 per claim while the going rate is $5 to $8 per claim. The percentage is the most common, and what the doctor would be already paying.

I beg to differ with you that doctors are not price sensitive; I have spent my lifetime dealing with physicians, they are the cheapest people, and now more than ever. As you know medicare is cutting their pay by 27% starting January 1, under Obamacare. Other insurances usually follow medicare, the doctors would be scrambling to save a nickel anywhere they can.

My question remains the same, can you make money by discounting the services whether by percentage or per claim basis? If I cannot I would not enter the field, I have nothing to offer; and so goes for every newcomer.

Title: Re: Can you make a profit by charging 4%?
Post by: supertaz93 on November 02, 2012, 09:34:27 AM
In business, you can price yourself out of business in either direction.  My sister-in-law was selling golden retrievers for $100 because she thought that was a fair amount.  She was getting no takers.  Come to find out, because her price was so low, people assumed something was wrong with the puppies.  She tripled her price and sold the puppies immediately. 
Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on November 02, 2012, 10:03:41 AM

Quote
In business, you can price yourself out of business in either direction.  My sister-in-law was selling golden retrievers for $100 because she thought that was a fair amount.  She was getting no takers.  Come to find out, because her price was so low, people assumed something was wrong with the puppies.  She tripled her price and sold the puppies immediately.

Excellent analogy.. When I founded PMRNC with my then partner we actually offered free memberships almost for a year.. we did ok but not great. We then began to charge a very minimal fee ( I believe we started at $19.99 for the year) and we actually got LESS business. It wasn't until later on when we raised our price and upped our services that we began seeing a real profit.   After then taking some courses on marketing and advertising I learned that was what was called "PERCEIVED VALUE".   

Quote
You have been in business a long time, you have a client base, this is luxury a lot of us don't have.
A new company has to offer something different. If we offer the same as everybody else, we are certain to fail. If we offer the same things at the same price we have nothing to offer, except our good looks, and you know how far that gets you.

No matter what you charge, if you are indeed offering what everyone else is offering that's right, you are going to have a harder time. If you have less experience, less knowledge and less to offer, that is how it goes. If I opened up a Pizza shop and have never made pizza before, whether I charge .25 cents a slice or $2.25 a slice, the pizza shop on the other side of town is going to get more business than me.  That's just a fact. People (especially doctors and other professionals) do place perceived value on something.   If I went to my lawyer and asked him to just charge me 4% he'd laugh at me and he should laugh at me.    I was new in business too. I started out with ZERO clients and never resorted to cheapening myself.  I did have one major advantage that goes to prove my theory, I was on the other side of the fence. When I was up against the 4% group physicians did indeed choose me over them when I was 3% higher just starting out.   I dont want my clients telling other physicians.. "Go use HRS, they are cheap, they only charge 2.99 a claim" I'm sorry, if that was how I had to get clients I'd find another business.  We already have an uphill battle with the offshore companies advertising .50 cents a claim!! Add this and it sours an industry.

Quote
I beg to differ with you that doctors are not price sensitive; I have spent my lifetime dealing with physicians, they are the cheapest people, and now more than ever.

Your opinion in what experiences you have had may differ, but I'm sorry I have NOT dealt with cheap physicians.  I've certainly had some tell me that other companies are offering a lower cost.. but again, their response is going to depend on  my response.   We teach people how to treat and respect us. That's a fact. Sociology 101 LOL.    I have been doing this a long time and I've seen and talked with billing companies who think like this and don't make it a year.

Quote
As you know medicare is cutting their pay by 27% starting January 1, under Obamacare. Other insurances usually follow medicare, the doctors would be scrambling to save a nickel anywhere they can.


I have no idea what your experience is in the business, however the consulting portion of my business BECAUSE of Obamacare has doubled. I have taken out 79 physicians from Medicare and/or Medicaid   De credentialing became just as much of a demand for me than credentialing :)  Carriers will not be able to "mimic" Medicare where that is concerned, that's a myth, premiums WILL rise but there will NOT be this competition among carriers that people think. I'm not happy at all About Obamacare, as a patient and as the daughter of parents on Medicare I'm so not happy with it and I'm scared for my folks because of it and my own family because I know my own Cadillac policy through my husband's days are numbered. But IF it goes through, my business will go on I will just once again diversify. Like I said.. I'm getting calls left and right about opting out of Medicare. I'm not worried about Obamacare in the least from a business stand point.

Quote
One does not have to sell on a percentage basis; one can sell for $2.99 per claim or $3.99 per claim while the going rate is $5 to $8 per claim. The percentage is the most common, and what the doctor would be already paying
.

What is "common" is not always what is right or what is successful.  It's also common that people get paid to work. Physicians are human too and they are out to make a living. Like I said.. once I ask them if any of their other service providers charge them based on a percentage of their revenue.. conversation over. They pretty much all say "I guess I didn't think of it that way".  Would a physician hire an office manager in house and pay her based on a percentage of his revenue? I think not.   And also there is the legality of such fee-splitting arrangements now in many states.  I'm in NY where it's illegal.. I could get more business than I know what to do with by letting physicians know if they are paying their billing company a %, they are risking their practices and medical license.  I think the average physician would be highly insulted to be called "cheap"    It's very simple ... I work XX hours, I get paid for those hours. They get that.  That old line "We don't get paid till you get paid" is so tired and they know it too.   

Keep ONE more thing in mind and I might not be your favorite person after this.. but I'm honest.   NETWORKING is absolutely KEY in this business.. your networking skills will not be worth anything if you outbid and undercut the "competition"   The KEY is your services, thinking outside the box and being diversified. IF you don't have the experience or knowledge you have a broader disadvantage, maybe that's negative of me to say, but again, it's honest. I didn't say IMPOSSIBLE. But look at how you would be entering into this business, best to keep your fellow billing companies as "friends" or you won't last a year.

Quote
My question remains the same, can you make money by discounting the services whether by percentage or per claim basis? If I cannot I would not enter the field, I have nothing to offer; and so goes for every newcomer.
 

I'll answer this practically, opinion aside.    YES you can make a profit that way. After you have worked 4 X as hard, have 2X as many clients and worked 3 X as many hours as the other.   

The two main ingredients in this business is NETWORKING and DIVERSITY, today's new billing company must have those two things or they will not make it.
Title: Re: Can you make a profit by charging 4%?
Post by: QueenAlicia on November 02, 2012, 02:10:25 PM
My answer is NO!  It depends on the specialty.

The going rate is not 6%, that would be based upon your region. 

Also if you are using Kareo than you must be eating those costs as they charge per provider.  If you charge 4% it screams cheap, lack of experience (which may not be the case) and that you are desperate.  Not only that, depending on the provider reimbursements you may not make anything but $1 a claim (such as MH).

Not to sound harsh but you work to hard to make pennies.  Get paid what you are worth, show the provider why you charge would you do and stop letting them nickel and dime you. You want your business to not only make money but for you to make money.  I am talking from experience.

Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on November 02, 2012, 03:48:50 PM
Thanks for the responses.
I am the organizer, I plan to subcontract almost all of the work. At the end of the day if I can get 20% net margin, I am happy. I am still doing my research and that is why I ask questions; if that is not feasible I will do something else.

Here is medical billing service that charges 4%; they say so on their website:
http://www.ebiometronics.com/

I talked to them, the owner is a doctor ( Nephrologist); they claim to have several hundred clients. They appear to be profitable. Actually I asked him. Nephrology is a high paying specialty, for him to spend most of his time in this business, he must be doing well.
They use the office ally system. Is that better than Kareo? but that is another question.

There are several other companies with the same business model; whether I can emulate them, that remains to be seen.

How do they get their business? Google Adwords. You can get a client for about $200.
Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on November 02, 2012, 09:55:20 PM
Quote
I am the organizer, I plan to subcontract almost all of the work. At the end of the day if I can get 20% net margin, I am happy. I am still doing my research and that is why I ask questions; if that is not feasible I will do something else.

What are your plans in regards to compliance. Subcontracting out the work the way you have planned is additional costs JUST in compliance assurance itself. You are going to want to have the MAX amount in E/O insurance.. right there your 4% is a no -go . I'm not trying to be harsh, just real.   I've seen and talked to many billing company owners in start-up with the same stars in their eyes.. "I'll finance it, sub out the work and cash the checks"  Compliance gets sacrificed, service is sacrificed because you have subcontractors you cannot expect to have the same level of personal service as an in house office.  To get a good picture when you are projecting costs you want to have a good compliance plan in place and obtain insurance quotes. Compliance in this business is absolutely IMPERATIVE.  Maybe your plans are to expand on to sub contractors when you have a large client base? I don't see this being done out of the gate or even for a while at same time your only charging 4%.

Quote
Quote
Here is medical billing service that charges 4%; they say so on their website:
http://www.ebiometronics.com/

I talked to them, the owner is a doctor ( Nephrologist); they claim to have several hundred clients. They appear to be profitable. Actually I asked him. Nephrology is a high paying specialty, for him to spend most of his time in this business, he must be doing well.
They use the office ally system. Is that better than Kareo? but that is another question.

Maybe I'm misreading but they claim to have their own software.. maybe they just mean they only use their systems for all clients.  I use any system the provider wants or I have Kareo if they need a PM solution. Today's billing company has to be diversified.   I've heard Office Alley is ok, but no it's not better than Kareo, I believe Office Alley is one of the free ones (could be mistaken) I've seen it and used it once but still feel 150% confident enough to say not it's not better than Kareo.

Quote
How do they get their business? Google Adwords. You can get a client for about $200.

Online marketing is hit or miss. It's essential and I've had a LOT of success with PMRNC with Google Ad words, but when you are selling service driven business, sure I will buy they might get tons of hits.. but those hits require multiple hits and then multiple contacts to turn into clients. I do website design and marketing too so I have some experience with that as well. Most of the sites I have built that get hits still require a lot of hand holding after the click through. The website is merely a means of making a first impression in this business.   I'm not saying they are not getting clients with only $200 adword campaign but I am saying I doubt it.   

Again, just my opinion.
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on November 03, 2012, 09:35:47 AM
I am a retired physician; for 30 years I had my own practice. I was on the other side of the fence, and outsourced my billing to a billing company.

I had a long conversation with the doctor owner of ebiometronics and I have another one scheduled. They have white labeled someone else's software, they can sell that to a billing company as well, and that is what he suggested.

It appeared that he is making money and lots of it, even charging 4% and he is making more money than as a kidney specialist doctor. I believe he outsources some of the work off shore.

Here is a link to another website.  http://www.mtbc.com/
They charge 5%; I am not sure if they white label someone else's software or it is there own, however it looks very comparable to Kareo/ Practice fusion combo; they are also owned by a doctor. You will see their prices under practice management icon. By the way I thought they had a nice website.

My impression is that some people are making a lot of money in this business, upwards of a million dollars a year net profit, by selling services at discounted rates.
How they are doing it, that is what I am researching.
Title: Re: Can you make a profit by charging 4%?
Post by: Michele on November 04, 2012, 05:20:36 PM
I have seen companies that charge 4% or 5% but from what I've seen you get what you pay for.  When we started we were low, because we didn't know any better.  We started in 1994 at 5% (we didn't know about the fee splitting thing).  We are very meticulous and do a very good job.  We couldn't make it at 5%.  We raised up to 6% and didn't lose a client.  I know other services that charge that low and there are two reasons.  The first, they do a shoddy job.  They can afford to take 5% because they aren't doing all the work needed.  They send the claims in and take what comes back.  No follow up, no appeals on denials, etc.  The other thing I see with 5% billing companies is that they are robbing the dr blind!  They only charge 5% because they are taking what they think they deserve.  You may think I'm crazy but this is based on facts that we have come across. 

Just a side note, there may be good services that do their work diligently for 5%, I just haven't seen them.  :)
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on November 06, 2012, 07:24:42 AM
Thanks for the responses.
I have concluded that the answer is No. Furthermore underpricing the services is not a good idea.

I plan to charge 5%, which is still lower than the market, with a $800 minimum and $500 set up fee. I plan to do business with ONLY those practices that are willing to utilize EMR, and we would do only web based e filing. Of the various programs I have evaluated Kareo/practice fusion seems to excel, there may be others. I like their top package which is $299 per provider per month; I plan to offer that with my services, the cost is on me.
I have hired two experienced billers part time, working from home, at 1% of the revenue collected by that biller. Is that a fair compensation?

I have commissioned a web designer to design a 40+ pages website; why so many pages? I want to describe in detail what a PM + EMR can do. Practice fusion has no issues in us describing as their website does.

We need brochures.

We just need clients, though I am not ready yet.

Any comments would be appreciated.

Title: Re: Can you make a profit by charging 4%?
Post by: Michele on November 07, 2012, 07:03:55 AM
40+ pages seems like a lot to me.  Did you tell them you needed 40+ pages or did they tell you?

Regarding the billers, I personally (JMO) am not for employees working from home.  I know there are some out there somewhere that are good, but to me it's an invitation to not do a good job.  Paying them based on the revenue collected will help with that because if they aren't collecting they won't get paid, but you need systems to be able to check their work.  Personally as a biller I would never agree to work for 1% of the revenue. 
Title: Re: Can you make a profit by charging 4%?
Post by: QueenAlicia on November 07, 2012, 04:57:09 PM
I would never except 1% from an employer.  That screams cheap and it doesn't sound leagal. I would want to be an hourly employee or a subcontractor.

I think that a 40 page website is too much.  You can get what you need to say in less and you will probably loose the provider or decision maker after the first few pages.

I do like the "fee schedule" that you have set up for charging percent.  I have something similar when I have a provider that is more comfortable paying a percent and the minimum adjusts with the specialty.

Good luck!  :)
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on November 07, 2012, 06:37:20 PM
Yes 40 pages looks like a lot, but to compete you need to be able to offer full services and have to explain it.
Here is a website  www.athenahealth.com ; it is more than 50 pages. We offer just about everything they offer.
They are a big time company, but clients expect the same from a smaller company, even more services.
How would you pay a subcontractor? I don't want to pay hourly.
Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on November 09, 2012, 11:25:45 AM
IF I hired employee's I wouldn't pay them a %, I would probably steer clear of fee-splitting arrangements all-together. I would probably compensate based on an average salary using their experience/references as a guide. JMHO.   Have you worked out such thins as a compliance plan (this should be critical especially if having your employee's off-site) and also E/O insurance (again, greater liability with off site employee's)   I can certainly appreciate all the "outer" workings, software, EMR, etc... but don't forget the critical elements that could make or break you from the back end.
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on November 09, 2012, 03:03:39 PM
I believe compliance issue is addressed by the Kareo/ Practice Fusion software.
Title: Re: Can you make a profit by charging 4%?
Post by: supertaz93 on November 09, 2012, 03:12:25 PM
There is a lot more to "compliance" than just your software. 
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on November 09, 2012, 05:24:15 PM
I am not sure how much HIPAA effects the medical billing companies. From what I can gather it does not, as long as your software complies with certain requirements; Kareo advertises that theirs does.
www.athenahealth.com is a public company and they claim to have over 39,000 providers they service, I believe most of their work is outsourced to India. ( By the way they charge an average of 6%). If HIPAA was such a big deal, these mega companies would not exist.
Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on November 09, 2012, 06:49:51 PM
Quote
I am not sure how much HIPAA effects the medical billing companies. From what I can gather it does not, as long as your software complies with certain requirements; Kareo advertises that theirs does.
www.athenahealth.com is a public company and they claim to have over 39,000 providers they service, I believe most of their work is outsourced to India. ( By the way they charge an average of 6%). If HIPAA was such a big deal, these mega companies would not exist.

I think my blood pressure went up a bit here.. I mean no disrespect but this is why physicians need us. You've been misled, mis taught or received mis information. Billing companies are INDEED subject to compliance issues. You are a business associate under HIPAA however carry the same penalties, fines and liabilities as the doctor himself, in regards to fraud/abuse. Your software and software company are merely "tools".  That doesn't even scratch the surface.
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on November 10, 2012, 08:34:18 AM
Pray tell me, how do so many medium to large sized companies outsource all their work?
There is a consultant Rochelle Glassman of Phoenix Physician Services
http://www.pps247.net/index.php?option=com_content&view=article&id=13

She gives webinars for Kareo:  https://www.kareo.com/resources/webinars

Her next webinar is on November 15.
She has completely different views than yours, that it is completely doable with Kareo software.

Regarding outsourcing our only trade organization hbma.org provides guidance for outsourcing including resources; they have a compliance conference on March 15, 2013. In my conversation with them, they informed me that HIPAA does not
" materially " effect medical billers, caveat that they use a software that has built in compliance.

If you could kindly give us a link where it describes that HIPAA is onerous specifically for medical billers I would appreciate it. It may be onerous for providers just not for the billers.

I don't plan to do any business with any provider that is not on EHR and PM web base platform.
Physicians do need us, but only if we add some value to their business and increase their revenues; the first step for them to increase their revenue is not us, but to implement EHR and PM.
Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on November 10, 2012, 09:46:14 AM
There are two MAIN facets of HIPAA compliance, one is transactions and the other is Privacy and security. Providing links would take all day. Yes among MANY other things your software must be HIPAA compliant. They all are.. old news.   In addition as a business associate of covered entities you are required to be sure your entire business and infrastructure is in compliance.. from making sure all employee's have secure login's and only given the "minimum access required".  Making sure if you have employee's working OFF site, they too are in compliance. Having a work at home biller who works at her kitchen table is NOT compliant. The laws apply to every person touching PHI. Files left on a desk, home offices with OUT private access to fax or filing cabinets that are accessible is NOT HIPAA compliant.  Since you are a physician, it actually should be easier for you to forsee these issues and put yourself into your clients shoes. Your butt is on the line EQUALLY as the providers.  HAVING E/O insurance is critical but your E/O is only going to bail you out IF you and your employee's all are in compliance.   As a billing company your job is to make sure your providers are compliant and that you and all employee's are compliant along with their operating structure. Kitchen table billers are NOT going to cut it. 

I use Kareo too and they are great... Awesome even. :)    But your only looking at it from a software stand point when there is SOOOO much more that goes into compliance than just your software.   This is why having a compliance plan is critical for any billing company.  Read more about that on the OIG's website at: https://oig.hhs.gov/fraud/docs/complianceguidance/thirdparty.pdf

Just a tip too .. UNRELATED.  Today's billing company needs to be diversified to compete. For example, it's great your doing your homework in purchasing software, but you need to be ready for the providers who have already invested a great deal of money on their own PM solutions that don't want to change, they want to work with what they have. I've seen MANY billing companies turn down clients because the client wanted to stay on their PM system, that's because they are not prepared, all the medical billing classes and educational programs, online courses do NOT tell you things like this.  My PM solution is JUST for the ones that need one or want to switch. I utilize the clients PM solutions if they want me to. I've never turned down a client because of a software issue. I don't put all my eggs in one basket.  Just a little tip :)
Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on November 10, 2012, 09:49:05 AM
Also from a marketing standpoint, having a compliance plan will win you clients over the ones that don't. In my experience over the last decade, I'm willing to bet only 2 in 10 billing companies actually have a compliance plan. I don't even wait for my potential clients to ask for it. I market the fact that I have one and it's open for them to review.
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on November 12, 2012, 10:42:56 AM
Some very good points.
How do I develop a compliance plan?
You are correct what do I do when a provider insists on using his own software?
If he has no EHR, and does not want to use one, I would pass on him.
My price of 5% solution includes the software for PM and EHR.
If he already has EHR we would work with that.
What happens if he has PM but not web based? Some providers have spent big money on software and don't want to change, even though it may be obsolete.
Title: Re: Can you make a profit by charging 4%?
Post by: DMK on November 12, 2012, 10:50:53 AM
Thanks Linda for putting it so succinctly.  Some billers don't think HIPAA all the way through.  Billers have more patient information than the doctors do, BECAUSE they have multiple doctors.  If it were only data crunching will Dx and CPT codes that would be one thing, but those codes get attached to PEOPLE's information (date of birth, social, name, address etc).  It's a big responsibility and not one to be taken lightly.  If someone (the owner of the billing company, or a low paid data entry person) is that flippant about someone else's personal information then they shouldn't be handling it.
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on November 12, 2012, 10:55:02 AM
I asked elsewhere, there are middle to large companies doing most of this business who outsource most of their work within USA or offshore. These companies handle 80% of all the medical billing business. How do they do compliance?
Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on November 13, 2012, 02:05:14 PM
Quote
How do I develop a compliance plan?
Take a look at the link I provided above for the OIG's compliance plan for the third party billing company.

Quote
You are correct what do I do when a provider insists on using his own software?
With technology today there are just so many ways to access the provider's system remotely. The most reliable I have researched was using logmein.com Each of my clients has an account. For every client that I utilize THEIR PM System I have my OWN login to both the Administrator's access on the computer (windows login) and there are 2 more layers of security using LogmeIn   So long as the process you use is HIPAA compliant you are fine. Having my OWN login is also good for audit trail purposes in addition to being compliant.

Quote
If he has no EHR, and does not want to use one, I would pass on him.

Why?  I've never turned down a client for software, their business is medicine. If it's something I can't work with, I'll find a way, in this industry turning down a client is NOT a good idea.  JMHO


Quote
What happens if he has PM but not web based? Some providers have spent big money on software and don't want to change, even though it may be obsolete.

As long as their PM solution is HIPAA compliant, 5010 ready, there's no reason it can't be utilized. There are plenty of remote options like I mentioned above. The challenge is of course if your not experienced there's a learning curve of the PM software. With my experience so far, I've never found a PM system I couldn't find my way around.

Quote
I asked elsewhere, there are middle to large companies doing most of this business who outsource most of their work within USA or offshore. These companies handle 80% of all the medical billing business. How do they do compliance?

With offshore companies they are NOT required to adhere to US laws, therefore full compliance and liability falls on the provider. This is how I usually get a potential client to turn away from offshore, by simply explaining the money they are saving with the billing they will spend twice as much in their FREQUENT but NECESSARY trips to these facilities. That is the ONLY assurance of compliance you have. I'm constantly amazed at these doctors who offshore outsource and have never visited the place, and have just taken these companies at their word!! 
Title: Re: Can you make a profit by charging 4%?
Post by: rdmoore2003 on November 13, 2012, 02:25:55 PM
i need a drink after this.   hipaa should be the first thing, IMO, that a person should learn about in its entirety before even starting in any part of the medical field.  and never ever go by something you were told by another person just because they do some sort of webinars or training.    most people will tell you that psychologists cant write rx, but that is false.
Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on November 13, 2012, 06:00:07 PM
Quote
i need a drink after this.   hipaa should be the first thing, IMO, that a person should learn about in its entirety before even starting in any part of the medical field.  and never ever go by something you were told by another person just because they do some sort of webinars or training.    most people will tell you that psychologists cant write rx, but that is false.

A glass of wine to Regina from me :)       I totally agree. You have to remember you have NO way of knowing the company your speaking with IS adhering to compliance.  Something simple like an unlock able filing cabinet!  I mostly see the problems with the ones that hire outside help and don't maintain the proper insurance or check and make sure they are compliant themselves since it's their liability.   
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on November 14, 2012, 06:20:02 AM
There are dozens of companies who collectively service the vast majority of providers. I will give one example of athenahealth.com, because this is a public company symbol ATHN. What they do is public information. They claim to have 39,000 providers as clients. They outsource most of their billing. They are not the only ones, almost all companies public and private outsource their billing services, some within USA, some offshore. That is how this business is run, at that level.
And yes, they don't take anyone who does not have EHR, like most of these companies.
I am at a loss, if that is how the business is done, then where is the problem?
Title: Re: Can you make a profit by charging 4%?
Post by: rdmoore2003 on November 14, 2012, 09:27:59 AM
Linda, thanks for the wine.  :)
Title: Re: Can you make a profit by charging 4%?
Post by: DMK on November 14, 2012, 10:21:34 AM

And yes, they don't take anyone who does not have EHR, like most of these companies.
I am at a loss, if that is how the business is done, then where is the problem?

Because small practices and rural practices will NOT have to have EHR if there is financial hardship, but they will still need to bill for services.  If you are only going to focus on large practices, hospitals and clinics, YOU may not care about outsourcing or the little guy, but most of the billers on this forum are servicing small businesses as well as good size clinics.  The little guy will get fined for non-compliance just the same as the big guy, however, he'll get fined right out of business!
Title: Re: Can you make a profit by charging 4%?
Post by: QueenAlicia on November 16, 2012, 02:54:35 AM
WOW! My jaw dropped.  Billing companies MUST comply with HIPAA.  Don't comply you won't be in business long and you'll probably be in jail, lol.  I think a revisit to the OIG third party portion may be in need here  ;D

For example, if you are faxing over patient  you know that you must black out some information?  That is apart of HIPAA as well as verifying patient identity over the phone.  You can't just give out patient information without identifying who the person is. 

Outsourcing to India is another story and those HUGE companies will eventually fail because the patients will complain about their information being over there.  In addition to that the laws here in the US do not apply over there and there have been several incidents were the offshore company has threatened to sell the providers patient info if they did not pay more money. 

I would not trust ANY company that does business over there because it shows that they care about the dollar more than patient information security. 
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on November 16, 2012, 06:45:36 AM

There are dozens of huge companies who do this business, actually well over 80% of the business is done by a handful of companies, they ALL outsource.
One company, which is public so their records are public information; Athena Health symbol ATHN, is valued at 2.2 Billion dollars; its CEO got paid $300 million dollars (including stocks) last year, he is not in jail , he is doing fine, living in a mansion of 50 million dollars. Again all of this is public information.
By the way they charge 6.5%.
Title: Re: Can you make a profit by charging 4%?
Post by: DMK on November 16, 2012, 10:37:57 AM
Athena is probably doing everything right, but I doubt that they all are.  BTW are you working for Athena? Because it sure sounds like a sales pitch.

This forum is a great place for back and forth discussion about ALL the complexities of Medical Billing, not just a soap box for doing it ONE way. 

As a nation, we are built on a lot of small businesses.  True, there are large companies, making lots of money, but this forum is mostly about the little guy or the newbie or the person who wants the American dream of owning their own business.

There are laws in place (some good, some bad, some well intentioned but with bad consequences) that we ALL have to follow.  The big guys can pay the fines and pass the costs on to their consumers, the little guy needs to do it RIGHT the first time and all the time. 

If you don't understand this, you don't understand most of the people in this forum.
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on November 16, 2012, 11:03:41 AM
No, I don't work for Athena; what sales pitch,  I compete with them.
I give their example because it is a public company, I don't have accurate information about private companies.
For the record I am building a company that someday would be a public company.

Laws are the same for little guys and mega companies. I don't believe that big companies get away with it because they are big. If anything big companies draw more attention and are subject to more scrutiny than little guys.

I pointed out how big companies are doing it, I don't make any value judgement, whether it is right or wrong, I state the way it is.
Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on November 18, 2012, 06:10:01 PM
Quote
There are dozens of huge companies who do this business, actually well over 80% of the business is done by a handful of companies, they ALL outsource.
One company, which is public so their records are public information; Athena Health symbol ATHN, is valued at 2.2 Billion dollars; its CEO got paid $300 million dollars (including stocks) last year, he is not in jail , he is doing fine, living in a mansion of 50 million dollars. Again all of this is public information.
By the way they charge 6.5%.

Mom said.. "If everyone was jumping off the bridge, does that mean you should and that it's ok to jump off the bridge"   I'm confused and your confusing others because you come here, look for help, some of us have been doing this for decades, you want feedback and our opinions and we give them. But it does seem like you want us to tell you what you want to hear.    Did you ask Athena Health what their protocol is for patients who don't want EHR and choose to opt out? Did you ask any healthcare provider or offshore company what measures are in place for telling patients their information is being sent offshore?    Seems to me your looking only at the $$ issues and you again, just want us to tell you what you want to hear. At this point.. good luck and I hope things work out for you. Not much more we can say.
Title: Re: Can you make a profit by charging 4%?
Post by: RichardP on November 19, 2012, 08:45:15 PM
A few points that occurred to me reading through this:

1. tallmanusa does not sound to me like any doctor that I have ever talked to that has been in private practice for 30 years.  Maybe he was a corporate worker-bee doctor working for wages.

2. From my conversations with big business, it sounds like they plan to honor HIPAA mainly in the breach.  "Let them sue us" seems to be a safe proposition because a.) most patients don't know enough about what their rights are to know what a violation would be; b.) most patients have no clue what is being done with their electronic data, and so would not even know that a violation has occurred, and; c.) the agency charged with policing HIPAA violations does not have the budget to monitor the majority of violations.  They few fines they will be able to levy will just be a cost of doing business.

3. As of about three months ago, a great many users were complaining that they were having trouble getting Practice Fusion and Kareo to talk with each other in all the ways needed in order to do billing properly.

4. Practice Fusion will only display 1,000 patients at a time.  For a practice that has more than a thousand patients, cleaning up problems in the database becomes impossible.  Practice Fusion has a limited set of criterion on which to search, and the problems that don't meet those criterion are invisible to you unless you know the specific patient to search for.

5. Office Ally comes in two parts:  a.) Practice Mate, which you use as any practice management system, inputting patient demographics, insurance info, and billing codes.  You bill the HCFA stuff electronically, and the patient statements by printing them, and; b.) Office Ally.  The Office Ally side is electronic billing only.  If you have your own billing program, you can print your statements to a text file and upload that text file to the Office Ally side of "Office Ally".  They turn that text file into electronic data and send it off electronically just as if you had submitted the data through the Practice Mate side of things.  tallmanusa can accept clients who are not web-based and still do electronic billing in this way.

6.  I have a number of clients who see 20-30 patients a day, and all of them have a Physician Office Lab (POL).  Because of the Labs, we do very complicated billing, the tracking of which requires copious pop-up note-posting on the account itself, not in some contact software that has to be accessed separately.  Practice Mate in "Office Ally" does not have such note-posting ability and I think Kareo does not either, so they are useful only for very simple billing.  Kareo can handle more complexity, and has way better reports, than "Office Ally" - but is still not complex enough for my needs.

7.  Many of my clients are not Participating Providers in Medicare; more will probably be dropping out.  None plan to use EMRs.  But they still have to bill.  They use their billing software for Scheduling patients, inputting demographics and insurance info.  We put in the DX and CPT codes and print to text file, then upload to the Office Ally side of "Office Ally" for electronic billing.  Probably five of my clients bring in (not "charge", but actually bring in) more than one million dollars in income per year.  My clients do high-volume, high complexity work, which makes for complicated billing.  And we manage quite well with the set-up I just described.

8. Practice Mate in "Office Ally", Kareo, and Practice Fusion, are not complex enough to handle our billing needs with the ease that our current software does.  But then, it cost a good bit to buy.  We charge 5% plus certain minor fixed expenses, and pay some of our workers $30.00 per hour, and still turn a nice profit.  But we are in Beverly Hills.  Your mileage will vary if you are outside of a major metropolitan area.

I have no doubt forgotten some of the other points I was going to make, but hopefully this much helps someone.
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on November 20, 2012, 08:41:51 AM
Thanks for the comments Richard, very helpful.
I agree with you that most billing companies have many things to worry about, HIPAA is not one of them, as long as you follow some basic rules do your best to comply with them.
My impression is that the platform you use is the key to this business, you survive or perish on the system you choose. This is an IT business more than ever, or at least it has become one now.

Office Ally/ Practice mate, I did not think that it was a good enough system that I would want to offer; but it is free.

Kareo/ Practice Fusion is good enough and will do for most practices, cost $299 per month for the top platform, but not good enough for large practices.

What if you have large practices:

There are two that I investigated, I am sure there are others.

Advanced MD
Health Fusion/ Meditouch, this works with ipads as well.

The above two are more expensive than Kareo.

If you charging only 5% your profit is constrained if you offer high end platforms.

I could not pay $30 per hour and be profitable. In addition the technology is so superb, why do I need such experienced biller? I plan to outsource the billing for a fraction of that cost.
I have to make a profit, otherwise I would not be doing this for long. You can charge more, which I would not, or you can skimp on the platform which is imprudent or you outsource, which I chose.
Outsourcing does not have to be offshore, it can be within the United States.
Title: Re: Can you make a profit by charging 4%?
Post by: QueenAlicia on November 20, 2012, 03:57:54 PM
AMEN CLAP CLAP CLAP!!  ;D

Athena is probably doing everything right, but I doubt that they all are.  BTW are you working for Athena? Because it sure sounds like a sales pitch.

This forum is a great place for back and forth discussion about ALL the complexities of Medical Billing, not just a soap box for doing it ONE way. 

As a nation, we are built on a lot of small businesses.  True, there are large companies, making lots of money, but this forum is mostly about the little guy or the newbie or the person who wants the American dream of owning their own business.

There are laws in place (some good, some bad, some well intentioned but with bad consequences) that we ALL have to follow.  The big guys can pay the fines and pass the costs on to their consumers, the little guy needs to do it RIGHT the first time and all the time. 

If you don't understand this, you don't understand most of the people in this forum.
Title: Re: Can you make a profit by charging 4%?
Post by: RichardP on November 21, 2012, 04:47:00 PM
tallmanusa - more stuff to think through.  Questions are not confrontational; rather, they are meant to stimulate thought.

1.  I should have been more clear.  The "big business" I was referring to were hospitals, doctors, data aggregators (who are sucking in data from hundreds of hospitals for the purpose of data mining - without the knowledge or permission of the patient), and anybody else who will be doing something with electronic patient data.  I was not necessarily referring to billing companies - although some might fall into that category - like the larger ones who ship stuff overseas.

2.  The combination of Practice Fusion and Kareo might work for some physicians - but pay attention to the complaints on Practice Fusion's boards about Kareo and Practice Fusion having difficulty talking to each other for billing purposes.

3.  Any doctor who is already established in private practice will have his own billing setup.  Why would he need you?  You have to have an answer he will buy into if you expect to get him as a client.  That is why I mentioned the Office Ally side of "Office Ally".  It is simply a clearinghouse - like any other clearinghouse - except that it is free if Medicare claims are less than 50% of total monthly submissions, and $20 per month if Medicare claims are 50% or more.  And you can take data from any billing program that will print claims to the hard drive as a text file - which most if not all of them do - and upload that text file to Office Ally.  That would perhaps be a service to a physician who is not yet billing electronically, who wants to, but doesn't have the funds to pay for a system that bills electronically.

I would recommend the Practice Mate side of "Office Ally" only to those who must do electronic billing and don't currently have their own billing software or the means to pay a monthly fee for a cloud system (who would that be - doctors just getting established in private practice?).  It is seriously limited in terms of being able to create reports and clean up mistakes in the database.

4.  Have you figured out the answer to this question yet: Do you want to build a kingdom, or do you want to make money?  Sometimes you can make more money by being smaller than you can by being bigger.  I have a number of clients who earn (not bill) over one million dollars per year.  We collect that money with the homely system I described above - a legacy billing program that does what I need it to do for the complex billing we do, print the HCFA output to a single text file, and upload the text file to the Office Ally (clearinghouse) side of "Office Ally".  How could my clients practice better medicine, and how could I make more money, by having a shiny, new "IT solution"?  My clients and us already faced that question together and decided we are fine as we are.

5.  Doctors don't make money by working hard.  Doctors make money by being paid for the work they do.  And they get paid for the work they do ONLY by making sure ALL the work they do is billed, and billed at the appropriate level. That is the value of a biller who knows what they are doing.  Here's an example.  Ponder what I've said here as you think through what you are actually trying to do.

We have been asked to take on a client who has established a state-of-the-art 50-doctor doctors' group with state-of-the-art equipment.  Labs, radiology, whatever-you-need, can all be done on-site.  Problem is, they are a start-up, and income does not yet exceed expense (the doctors are very well paid, which is part of the problem).  We will take them on as a client if they make it to the point that income exceeds expense (we don't fund start-ups; we also want to get paid for our work).  We consulted on the start-up, and have been monitoring the billing for them.  Their billing is currently being handled by a large billing company that sends the work offshore.  They bill what is sent to them, and nothing more (is that the kind of company you are wanting to create?).  The doctors are cracker-jack doctors who are top experts in their field.  But they don't know diddle about getting themselves paid.  As we monitor their billing, we see time and again when they don't bill for all the work they performed.  And often, what they do bill is for a lower amount than what their work qualifies for.  In short - these top-notch doctors are leaving on the table about 30% of what they could get paid.  Yet, their current billing company (who charges more than we do) is giving the doctors zero feedback about this.  And the doctors are using an electronic billing "IT-solution" that costs several hundred thousands dollars.  And yet, even using this, those doctors are leaving on the table about 30% of what they could be earning.  The current billing company is not helping them avoid this.  The expensive IT solution is not helping them avoid this.  Only billers who know what they are doing, who give a damn, and who work hands-on with each physician can help them avoid this.  And the bad part about all of this is the doctors don't even know they are leaving money on the table until it is pointed out to them.

Hopefully, this blurb will help you better understand the lack of understanding you displayed in this part of your response to me:  "I could not pay $30 per hour and be profitable. In addition the technology is so superb, why do I need such experienced biller?"

Experienced billers who know what they are doing are the only ones who will know when you are leaving money on the table.  Technology cannot help you with this.  But this is relevant only for complicated billing.  Simple billing is another matter.  But, again, if the billing is simple, why would they need you?
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on November 23, 2012, 10:04:34 AM
Thanks for a very thoughtful response.
Just a question; your doctors seem to have a substantial practice, why not use a robust PM system like Advanced MD instead of Practice Mate.
And are you familiar with Mitochon, a free EHR and PM system?

You raise a very good question; with all this technology why would a doctor need us? I have to be able to answer this question, and in some detail.

The flip side of this technology is that billers are available at very low cost; I plan to pay 1% of the collections revenue cycle managment, and I have no shortage of them in United States; no need to go off shore.
The technology did not eliminate the job of billers, but it made their jobs scarcer to find.
Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on November 23, 2012, 11:49:56 AM
Quote
The flip side of this technology is that billers are available at very low cost; I plan to pay 1% of the collections revenue cycle managment, and I have no shortage of them in United States; no need to go off shore.
The technology did not eliminate the job of billers, but it made their jobs scarcer to find.

I disagree, I do not think technology is pushing billers aside nor do I think they would be available at "low cost"  First of all.. the position of "Medical Biller" is really outdated. If you are JUST a biller, you probably have been w/out a job for a while.  WITH The exception of marketing I do not ever use the term Medical Biller to describe my self, I am a practice management administrator and consultant. I DO MUCH more than billing. And if we are going to talk about how technology has made them scarcer I would have to ask then why would a medical billing company need to hire billers than?  ::) ;D     

Only about 15% of what I do is medical billing actually. Almost everything else I do is not available with technology at all.  Today's billing company has to be a full practice company and must offer a wide variety of services. Not to mention there are quite a few other things I can still add and might add in the future.

Nope.. I pretty solidly sold that my services will still be in demand even with all the technology.   Though, I still do believe we won't see EHR as mandatory like they say.. I see so many delays coming.. it's inevitable.
Title: Re: Can you make a profit by charging 4%?
Post by: RichardP on November 28, 2012, 10:34:24 PM
It's been a busy week.  Hope all who celebrated had a happy Thanksgiving.

tallmanusa, you asked "your doctors seem to have a substantial practice, why not use a robust PM system like Advanced MD instead of Practice Mate."  Short answer: we get the job done with what we currently have, as described above.  The billing software was paid for long ago, it does what I need it to do for complicated billing (things that more "robust" software does not do),  and electronic billing through Office Ally is $20 per month only if Medicare is greater than 50% of the billing.  I would gain nothing by switching to a different system.

Only one of my clients is using EMR, and is using Practice Fusion for that (it is pretty intuitive to use).  We do the billing through my billing software as described above, which easily handles complicated billing.  We have a customized fee slip that the doc uses to mark off what he did and sends that paper to us.  The one client I have that was using the Practice Mate side of "Office Ally for billing, I have switched to my billing software and bill as described above.  The paper fee slip leaves an audit trail for us to point to in case we are ever accused of billing for charges that the doctor didn't authorize.  That protection is a valuable thing to have, and is difficult to come up with in a totally paperless practice (complicated subject not suitable for discussing here).

Other than the client using Practice Fusion, none of my clients intend to use an EMR.  They will drop out of Medicare first if push comes to shove.  My one client who uses an EMR says it has added about 1 1/2 hours to his work day just inputting all the data into the computer (others who use EMRs agree that his figure is consistent with the increased amount of time they must spend).  He is seriously considering dropping the EMR.  Seriously take some time and think this through.  This doctor is one who earns more than one million dollars per year.  Estimate what that translates into in terms of earnings per hour.  It is now costing him 1 1/2 hours of earnings, every single day, just for the "priviledge" of using an EMR (plus whatever charges there are related to using the EMR).  If he stopped using the EMR, he would re-gain that 1 1/2 hours of earnings every day.  Multiply this reality by every doctor using an EMR and you can see some implications for long-term use of EMRs.

I did not ask "with all this technology why would a doctor need us?"  I suggest you re-read both of my posts above to see what I actually said.  Which was - technology cannot give a doctor what he actually needs in order to get paid - which is, someone who knows all that he can bill for, and what the highest level he can legally bill for and still get paid is.  Remember my potential client with the 50-doctor doctors group?  They have very bright and shiny and expensive technology - and they still leave about 30% of their money lying on the table.  And they don't even know it (until we point it out to them).  What caused you to think, from that example of the doctors leaving money on the table, that I asked "with all this technology, why would a doctor need us"?  I said the exact opposite:  it is not the technology that gets a doctor paid; rather, it is the knowledge in the head of the biller.

The technology may help figure out, on an aggregate level, which treatments lead to the best outcomes (data-mining aggregated EMR data).  But you (and we) are not concerned with that.  We are concerned with getting the doctor paid - by billing for all work done, at the highest rate that is legal.  And, as the example given in my previous post shows, the technology does not help with that.  Only the knowledge in the biller's head can help with that.  (Read that last sentence over until you get it.)  But this point is valid mostly for doctors who do complicated billing.  Doctors who do really simple billing don't need a knowledgeable biller.  But then, they don't need complicated technology either.  Which of those types of practices (complicated or simple billing) are you going to sell your services to?  Just remember that the robust IT solution is not going to help either one of those types of practices get paid.  The complicated practice does need a biller who knows what they are doing.  The simple practice doesn't.  But the simple practice doesn't need complex technology either.  So what is it that you are going to be selling if you think technology is more important in the billing process than wetware - when the technology does not actually get the doctor paid?

Note:  Assume a single procedure code with three supporting diagnoses.  I assume you know that your three supporting diagnosis codes must be appropriate to the procedure code in order for you to get paid.  But did you also know that which diagnosis code is listed first can determine how much you get paid for the procedure?  Put the right diagnosis code first and you will get paid the maximum.  Put a different one of the three diagnosis codes first, and you will get paid less than the maximum - sometimes substantially so.  If you didn't know this, you'd better hire someone who does know it.

Good luck with what you are thinking about doing.  Keep us updated.

Finally - what Linda said.
Title: Re: Can you make a profit by charging 4%?
Post by: Michele on November 29, 2012, 07:41:47 AM
Garbage in - garbage out....no matter how good the system is.  :)
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on November 29, 2012, 02:52:23 PM
Here is a link that speaks for itself. It is a thorough study.

http://www.cdc.gov/nchs/data/databriefs/db98.htm

Quote:
 "Eighty-five percent of physicians who have adopted an EHR system reported being somewhat (47%) or very (38%) satisfied with their system."

It is anticipated that vast majority of practices have already adopted EHR or in the process of doing it; (55% in 2011). It would be completed before 2015 by all physicians practicing in USA; read the whole study. That is the reality.

There are five major medical billing companies in United States, most of those in business know who they are, they do about 80% of all business in medical billing. They ALL use cutting edge technology.
If I am going to be in business and I am going to challenge them, I have to do what they do, and be better and cheaper than them.
No rocket science, ABC of business.
Of course, if I did not want to challenge them, I could get by with my pencil and paper.

When I make a statement, I give a link to a study, data, or factual basis for the statement. I would hope others would do the same.

Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on November 29, 2012, 03:54:47 PM
Quote
There are five major medical billing companies in United States, most of those in business know who they are, they do about 80% of all business in medical billing. They ALL use cutting edge technology.

That's absolutely incorrect and what are we basing the word "MAJOR" on? What study would show only 5 "major" billing companies? This is absolutely FALSE since I happen to know a hundred times that amount so I would want to know what study this is from and how they conclude those 5 companies are "major"  ??  Statistics are worth nothing.. Of course if this study took 10 companies to create that study..well then I could understand how they would come up with 5. But really that number is so incredibly low I would have to think they only accounted for 10 companies. We have a network of over 7500 billers of which more than 75% are billing companies, many of which are successful and servicing a nice market of providers. 

Title: Re: Can you make a profit by charging 4%?
Post by: supertaz93 on November 29, 2012, 04:17:23 PM
Quote
When I make a statement, I give a link to a study, data, or factual basis for the statement.

Quote
There are five major medical billing companies in United States, most of those in business know who they are, they do about 80% of all business in medical billing.

Please provide your link to this information.

Also, tallmanusa, you remind me of this person I know.  That person will ask me a question, but when I reply with an answer that is not what he wanted to hear, he goes on the defensive.  You came to this forum asking if you could make a profit while charging 4%.  You already believe the answer is yes and nothing will change your mind even though facts (experience, business 101, whatever you want to call it) have been presented to you.  When several people have given you advice about your inquiry, you became defensive. Just read back through this thread.  Several members have given you great advice.  You say you are new to the medical billing field yet you act like you know it all so I am not sure why you came to this forum.  However, I believe you are quite the opposite....clueless.  Examples of you being clueless include HIPAA, compliance, and what a medical biller does (read back through this thread and your obamacare thread) 

So why did you really come to this forum? 
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on November 29, 2012, 04:29:29 PM
http://www.moneyandbusiness.com/business/accounting-taxes/accounting/5-best-online-medical-billing-service-companies

All of the above businesses do very well, and use latest technology, that was the question.

This business is no different than many other businesses, in which a small percentage of vendors do most of the business. Nothing unusual. Surprise? They use technology to get where they are, something wrong there?

Where that figures came from? My discussions with HBMA. It has 600 members, usually those doing well.

Me, defensive? I beg your pardon.

I have learned a great deal from the discussion here and so have many other people.

In essence, this is a tough business, to be successful, and the definition may vary, you have to have cutting edge technology.

Quite obviously my definition of successful is different from many others; but there is nothing wrong in that.

If nothing else, nobody should have any illusion that somehow EHR would not be completely implemented ahead of the schedule.

Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on November 29, 2012, 04:38:45 PM
HBMA?   Ahh... ok, I'm starting to see clearer now.

As for the link you posted .. this was first paragraph:
"Below you will find a list of the five best online medical billing companies.  These companies share several common characteristics as they have years of experience, and they comply with all Health Insurance Portability and Accountability Act (HIPAA) regulations to assure that patient records are handled with privacy."

I expected to see HOW they got this information or at LEAST a hint of how they rated them.. but no.    It's no more reliable than If I posted 5 companies and said they were the best.

I'm not going to continue to be argumentative.. time is money of which I'm wasting both.    You came here with questions, but I don't know why since you have found "YOUR" answers.   Good luck to you.

Title: Re: Can you make a profit by charging 4%?
Post by: QueenAlicia on November 30, 2012, 02:18:02 PM
Practice Mate/Office Ally is free because they get paid on the back in from the insurance companies.

Thanks for the comments Richard, very helpful.
I agree with you that most billing companies have many things to worry about, HIPAA is not one of them, as long as you follow some basic rules do your best to comply with them.
My impression is that the platform you use is the key to this business, you survive or perish on the system you choose. This is an IT business more than ever, or at least it has become one now.

Office Ally/ Practice mate, I did not think that it was a good enough system that I would want to offer; but it is free.

Kareo/ Practice Fusion is good enough and will do for most practices, cost $299 per month for the top platform, but not good enough for large practices.

What if you have large practices:

There are two that I investigated, I am sure there are others.

Advanced MD
Health Fusion/ Meditouch, this works with ipads as well.

The above two are more expensive than Kareo.

If you charging only 5% your profit is constrained if you offer high end platforms.

I could not pay $30 per hour and be profitable. In addition the technology is so superb, why do I need such experienced biller? I plan to outsource the billing for a fraction of that cost.
I have to make a profit, otherwise I would not be doing this for long. You can charge more, which I would not, or you can skimp on the platform which is imprudent or you outsource, which I chose.
Outsourcing does not have to be offshore, it can be within the United States.
Title: Re: Can you make a profit by charging 4%?
Post by: QueenAlicia on November 30, 2012, 02:36:28 PM
I was thinking the same thing.  Why ask questions when you are already assuming that you know everything when clearly there is an obvious amount of ignorance for this industry.  Stop harping on EMR and learn the basics of billing first.  How can you be a competitive billing software company but not know the first thing about HIPAA?!


Quote
When I make a statement, I give a link to a study, data, or factual basis for the statement.

Quote
There are five major medical billing companies in United States, most of those in business know who they are, they do about 80% of all business in medical billing.

Please provide your link to this information.

Also, tallmanusa, you remind me of this person I know.  That person will ask me a question, but when I reply with an answer that is not what he wanted to hear, he goes on the defensive.  You came to this forum asking if you could make a profit while charging 4%.  You already believe the answer is yes and nothing will change your mind even though facts (experience, business 101, whatever you want to call it) have been presented to you.  When several people have given you advice about your inquiry, you became defensive. Just read back through this thread.  Several members have given you great advice.  You say you are new to the medical billing field yet you act like you know it all so I am not sure why you came to this forum.  However, I believe you are quite the opposite....clueless.  Examples of you being clueless include HIPAA, compliance, and what a medical biller does (read back through this thread and your obamacare thread) 

So why did you really come to this forum?
Title: Re: Can you make a profit by charging 4%?
Post by: RichardP on November 30, 2012, 07:34:18 PM
1.  tallmanusa - I went into detail just to give you some things to think about as you contemplate starting a business.  Hopefully those points will also help stimulate the thoughts of others who might pass this way.  You have seriously missed my points if a.) you still think this is about pencil and paper versus technology (it isn't), and b.) you think that better technology would help my doctors earn more money (it won't).

2.  Bottom line is, the technology does not get the doctor paid all he is due.  It is the knowledge in the biller's head that gets him paid all he is due (or not, if the biller is no good).  If you are going to charge a percentage of monies collected, you will make more money if you help the doctor make more money.  Billers who know what they are doing can help you with that.  Software cannot.  But, judging from your responses here to me and others, you don't seem to have first-hand knowledge of what you are talking about.  So I'm guessing you would not know what to look for in order to hire good billers.  So - it looks like you are simply interested in skimming whatever money you can off of the top, using technology, and nevermind helping the doctor get properly paid for all the work he does.  I have nothing against technology.  I'm just pointing out to you that the technology is not what gets the doctor paid all he should be paid.

3.  I have been exposed to a good mix of older doctors, and younger doctors just setting up practice, and doctors of any age who just "put in the hours" in some doctors' group or University hospital.  The younger doctors are gung-ho about adopting technology.  Mainly because they do not have the perspective of the older doctors.  The older doctors know how many patients they can see in a day, and generally how much money they can make off of that many patients per day.  So they can recognize the drag on their efficiency created by having to use an EMR on all patients.  As I said above, this amounts to a loss of about 1 1/2 hours per day.  The young bucks and does just starting out don't have that frame of reference.  So they have no concept of the money they are leaving on the table by using EMRs and other technology.  As the older doctors die off and more newbies come on board, doctors won't know any other way of life.  Not having a comparison, there will be no basis for cognitive dissonance.  They will never know how much money they could have made without the EMR, so they have no reason to be unhappy with the EMR.  Same thing goes for the doctor paid by the hour.  He doesn't care how many patients he sees in a day, his pay stays the same.  So why should he not be satisfied with the EMR?  It is no skin off of his nose.  These folks are probably over-represented in the survey you pointed to.

4.  You said "It is anticipated that the vast majority of practices have already adopted EMR or in the process of doing it; (55% in 2011)".  Speaking statistically, 55% is not a vast majority, as your quote claims.  But consider this also:  assume that four doctors have implemented an EMR and 100,000 doctors are "studying" the issue.  We could say about this fictional group what you quoted from your link: the vast majority of the 100,004 doctors have already adopted EMR or are in the process of doing it.  "Studying the issue" counts as being in the process of doing it.  How much information does your quoted statement give us about the true state of my fictional group of 100,004 doctors (none), even though you can argue that the statement is true?  Only four out of 100,004 doctors have actually implemented an EHR.  But by using your quote, and including those who are only studying the issue, we can make it seem like the number of implementers is much larger.

There are a number of good IT writings for doctors on-line or in paper magazines.  None of these writings claim that the vast majority of doctors have adopted EMRs.  Rather, they state the opposite.  This quote from your link to the CMS article is closer to the figures I am familiar with: Among solo practitioners, 29% were adopters of EMR systems.  For this kind of discussion, I think it would be useful to distinguish between solo practitioners (who's livelihood depends upon the efficiency of their own efforts), and corporate physicians who punch a clock and use whatever technology their employer places in front of them (and who's pay is only loosely tied to their productivity).

Finally, the detail of the CMS report reveals that the statistics you quote were derived from the response of the 3,180 physicians who responded to the survey.  The initial sample size was around 10,000 physicians, and about 7,000 refused to participate.  The detail says the majority of those who refused to participate were nonadopters of the EMR technology.  So - about half of the 3,180 physicians use EMR (1,700) and slightly less than 8,300 don't (of the initial 10,000 physician sample).  That proportion (about 21% adopters) is more in keeping with the anecdotal evidence I have run across.  If you haven't read the detail of the CMS report, you should.  It is enlightening.

5.  You seem to have some seriously rose-colored glasses, or you are just tweaking the readers of this forum.  At any rate, the American way is to go for it, so go for it.  Your goal is to make a buck off of creating a business.  Which is a completely different process than making a buck off of helping the doctor get paid all he is owed.
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on December 01, 2012, 06:55:18 AM
Let us be clear, my goal at this time is to challenge the supremacy of the five best rated companies. The first step is to know my competition. I have to be better and cheaper than they are. It is not an easy task, and I certainly would not get there without a clear understanding of how they operate and what the  market is. How and whether I would achieve that, remains to be seen. I have no illusions to road to riches. It is not just money; most people who build companies do not do it for the money.

Incidentally, even if you are a one person business, you are up against the same companies. Though one person can provide personal services, these companies cannot. No doctor will ever hire you without looking around what is available. Food for thought for all those who are looking for new clients and wondering why they can't land them.

I plan to have branches all over the country, that would provide personal services, and do not plan to outsource off shore at this time. I hope to have ten branches by the end of 2013.

I posted this on another thread.

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.

They all use cutting edge technology, an integrated EHR/ PM web based platform, exactly the same thing I plan to offer. Some would not take a client who does not want the package, some will, but reluctantly. Some will work around an existing EHR - for an additional fee.
What does that tell you?

There are lot of things you can tell about them.

Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on December 01, 2012, 09:42:30 AM
Quote
What does that tell you?

I don't know what it tells everyone else but I know what I'm thinking..  I don't need to sell cutting technology because I've got something those companies that outsource overseas will never have.... PROPER education, REAL experience, and above all business ethics.

I looked at that link actually, I have heard of Two of them.. I've operated my billing company since 1997, prior to that I spent 10 years working for insurance companies. Since 2000 I've operated one of the largest online communities of medical billers. None the less, I took a gander at that list of top 5..

Allstate Billing..  Interesting, I'm from NJ (born and raised) near this one.. never heard of them.. also the Dept of Insurance/banking requires ALL third party Medical billing companies be REGISTERED with the state.. they are not there:  http://www.state.nj.us/dobi/division_insurance/managedcare/tpblist.html

Athena Health- This is the one I have heard of, possible because they are an IT company, article misleads saying they service over 30,000 clients, however their own claim to fame is: Medical providers live on athenaNet®: 38,145     They provide PM/EHR software/IT.    They also list NJ as a place of doing business AND they registered :)    Those are bad things at all.. I'm just saying this article claims they are "one of the five best online medical billing companies."   Also.. THIS is an ARTICLE.. Not a study by any stretch of the imagination. They provide NO stats on how they arrived at these companies being the BEST.

ClaimCare - not much to really say, first time I've heard of them, nice website though.

MTBC.. ahhhh that's where you got your 4%. .. Of course now they are 5%...  (yes, heard of them.. many of us billing companies now have doctors who have too <G>). Least they are registered in NJ. :)   

PGM - Hmm I'm seeing a pattern with NJ billing companies (this one too is registered)  This one vaguely sounded familiar but when I ran their name through my own database I realized it sounded familiar because I have 11 billing companies with the same name.

Not knocking them, just stating some facts and calling out this bogus article about the five best online medical billing companies. Perhaps they can write what they did because they used the word "online" maybe they typed in Online Medical Billing companies in NJ, into Google ?  My point was.... don't confuse "articles of opinion with real stats"    If I were to run a membership report from my database I would come up with my own top 5 list of companies and none would include those 5.   That wouldn't happen however unless I backed that up with HOW I arrived at that conclusion.  I can write an article right now and say "List of top 5 Soda's in the US"  .. would that make it so?       

When I started my billing company I DID ZERO research on companies you would say were my competition. I don't actually think of any company I know of as competition. I networked with several companies both locally and not locally but never did the word "competition" come into play. I didn't NEED to try and compete. Clients and potential clients get what they pay for with me and I've never haggled, over my fees. If I client told me they were looking at a company who could do all that I could do for 4%, I simply shook their hand and told them I'd welcome their call in 6 months, I've had that happen where providers were shopping billing companies and I would leave my biz card and I'd hear from them again.   I had one client that went with a company (one we may or may not have talked about <g>) and is still digging out of a legal mess and I could not help him as he was in too deep.  I have another client now who found a fairly large billing company who turned around and offshore outsourced w/out notifying them which also landed them in hot water with patients, messed up their accounts, patient complaints because they couldn't get anyone to explain in English what was going on.   Yes, I have had a great many a success in cleaning up "cheap" billing companies work.   I guess in a way you can say.. WE need more of them <g>
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on December 05, 2012, 12:38:43 PM
Market research is the first step towards developing any business. A business should have a written business plan, and I do. Competition is an important part of it. Businesses who fail to plan, plan to fail.
When Walmart comes in, smaller businesses go away; there are few and far butchers left, because they have to charge more money. But butchers can survive by performing personal services, of course at higher cost, there will always be a market for them. So goes for medical billers, but just like butchers, they would have to find someone to pay for them, not easy considering that Walmart is around the corner.

A closer look at Athena Health, revealed that they outsource their work to Channai, India, according to their website. They have close to 40,000 providers.  They charge about 6.5%.
That information is buried on their website. They have a fire wall, patients and clients cannot call India, they have to call the local offices who then handle the problems consulting the Indian office.
Lesson learned.

MTBC  has only sales office in USA. They charge 5%. I don't know how many clients they have, but they once offered to buy out all the small businesses owned by the entire membership of AHIMA, which has a membership of 53,000. I am sure not every body sold out but many must have. They have running offer to buy out any small time business that wants to sell.

The inference is clear, these businesses are behemoth, and we all know how they got there.
Title: Re: Can you make a profit by charging 4%?
Post by: best biller on December 05, 2012, 06:49:40 PM
could someone explain me?
if e clinical works offers to do the billing for just 2.9%, is there any reason for a doctor to do it with a small company for a higher rate?
Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on December 06, 2012, 09:14:06 AM
Quote
could someone explain me?
if e clinical works offers to do the billing for just 2.9%, is there any reason for a doctor to do it with a small company for a higher rate?

This is what I was afraid of.. this kind of question and discussion which I feel is a bit inappropriate.. as far as I know e clinical works is a software product/service, I sure hope it's not a billing company to which someone would come on here to price shop.   If so I'd have to say that's "CHEAP"

One more comment on this and I'm done with this discussion.   Yes maybe in many industries market research is important in a detailed way, however this industry isn't one of them.  If you decide to "compete" rather than network and you are shopping other services, do NOT be surprised if you receive a cold shoulder along the way. It's frankly TACKY IMHO.   Secondly..  I've lived by networking and NOT doing this type of "UNDERCUTTING" and for that reason alone I've received numerous referal's and have consulted with numerous billing companies as well as networked with them.    I suggest if your trying to "UNDERCUT" that you step back and then learn about "Perceived value"   

Quote
Businesses who fail to plan, plan to fail

Yes, all businesses should have a plan, but you have repeatedly looked at the "pricing" angle only.  I certainly haven't failed and I have NEVER undercut another billing company nor would I.  My services are worth more than 4% hands down and my services will OUT do the 4% market any day.  Nuff said.
Title: Re: Can you make a profit by charging 4%?
Post by: Michele on December 06, 2012, 10:21:47 AM
could someone explain me?
if e clinical works offers to do the billing for just 2.9%, is there any reason for a doctor to do it with a small company for a higher rate?

You get what you pay for.
Title: Re: Can you make a profit by charging 4%?
Post by: RichardP on December 06, 2012, 08:11:21 PM
best biller - some doctors do really complicated work, others do really simply work, and others are somewhere between those two extremes.

The doctors who do only a few things, over and over, and whose accounts receivable are also simple, could get by with a cheap billing setup such as you describe.  In such a situation, there is little chance that the doctors will be leaving money on the table through their ignorance of how to bill properly.  In this situation, the doctor is only paying for billing, and anybody can do it.

The more complex the medicine gets, the more likely it is that a doctor will leave money on the table because of incorrect billing.  The doctors who do more complex medicine, and maybe also have physician office labs (POL), pay not only for billing, but also pay for the knowledge that their biller has (if they are any good) that can help the doctors not leave money on the table through poor billing practices.  A good biller can get these doctors more money than what the biller costs them. 

I give an example on Page 3 of this thread where a group of doctors, using very sophisticated technology and software, are still leaving about 30% on the table - due to them not knowing how to bill for their services properly.  A biller who knows what s/he is doing can recoup most if not all of that 30%, which will more than pay for the 5-8 percent the biller may charge.  It is not likely that the company you mentioned would recoup any of that 30%.  Therefore, their low rate is of no benefit at all to that group of doctors.

A good biller will manage the finances of the doctor.  If the medicine is complex, the finances will be complex, and the need for financial management will be correspondingly more complex.  If the medicine is simple, the finances will be simple.  And the need for financial management will be simple or non-existant.  But consider this, based on a recent real-life encounter with the doctor's wife.  A doctor at a sizeable practice just up and quit one day.  The practice called a highly-regarded staff physician away from UCLA Medical Center.  Been a physician for a while.  First time in private practice, where his income depends on his own efforts.  Pays a reasonable fee to some off-site company to do his billing electronically.  He gets EOBs electronically.  But has never needed to look at the EOBs, since he has been a staff doctor for all of his professional life and somebody else looked at them.  He just collected his salary.  Doesn't really know how to interpret them, so has not looked at his electronic EOBs since he took over the practice.  Some of you are already asking the relevant question in your heads:  if he doesn't look at his EOBs, how can he know how much of his charges are simply being written off rather than persued?  And without knowing the answer to that question, how can he know that he is getting paid all he should be getting paid?  How can he know that his billing company is actually doing the work he is paying them for?  My wife gently pointed this out to the doctor's wife, and the doctor's wife was both flabbergasted and appalled.  That anecdote is another example of how doctors benefit from the services and knowledge of a personal biller.  If the personal biller is any good, they will force the doctor to pay attention to his finances - which is to the doctor's benefit.
Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on December 07, 2012, 06:36:30 AM
I just couldn't sleep w/out wondering something.. no matter HOW I run the numbers there's NO way I could offer (nor would I, of course) my services for 4%.. I am willing to BET that those "cheaper" servicing companies hire just the bare bones minimum of data processors and how the hell are they buying E/O insurance?   (my bet, is they are NOT) But it makes sense, when you look at all the fraud cases filed, they are all the larger billing companies. Even more suits filed by physicians suing larger billing companies. 
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on December 07, 2012, 06:44:32 AM
It is quite simple, the larger companies outsource to India, where billers get paid 50 cents an hour.

You can't pay $15 per hour and compete with someone who pays 50 cents per hour. There is no evidence that what the companies get for 50 cents per hour is any worse than $15 per hour.

With regards to suits, do you have some link that larger companies get sued more often? The large companies have tough contracts which makes suing them nearly impossible.

Athena Health is a public company, and on their records I don't see any pending suit.

Richard I don't doubt that small billers could help a lot of doctors; but the doctors are not convinced. E Clinical Works has 220,000 providers, that is 15% of the total market in USA, that is just one company. Doctors are flocking to these companies.
Title: Re: Can you make a profit by charging 4%?
Post by: RichardP on December 08, 2012, 01:39:32 PM
One can make money by starting a business - if they can attract investment money for start-up, and then later issue stock.  One can pay themselves a handsome salary out of the investor's start-up money, and also pay themselves in stock.  When the stock goes public, the entrepreneur can sell part or all of their stock and make even more money.  And then, six months after the Initial Public Offering, the company can go bankrupt because its business plan was unworkable, and it is no bother to the entrepreneur who has already gotten their money out of the start-up.  So yes tallmanusa, you can make yourself very wealthy by starting a billing company - even if you have no clue what billing is actually about.

Making money by starting a business is not the same thing as making money by doing medical billing properly.  This forum is here to answer questions from those who wish to make money from doing medical billing properly.  This is not a website designed to answer questions from those who want to learn how to start a business of the sort you wish to start.

I have posted some serious information about the actual billing part of medical billing, and you have responded to none of it other than to ignore what I said and ask why I wasn't using more sophisticated technology - even though I had already stated that we considered doing that (researched the issue) and decided it would not help us bring in any more money for the doctor than we do with our dinosaur setup.  I'm left thinking that you are not a real person; rather, your posts are being written by a computer algorithm riffing off of key words in others' posts.  Case in point:

You said above:  "There is no evidence that what the companies get for 50 cents per hour is any worse than $15 per hour."

I can't imagine a real person would write such an uninformed statement.  Particularly when I have written several times in this thread about the 50-doctor medical group that is leaving on the table about 30% of the money they should be collecting.  There was no evidence to these folks that they were leaving that money on the table - until someone who knew what they were doing took a look at what they were doing.  Their current off-site billing company, who ships the work offshore, has said nothing about this issue to them.  They just bill what they are sent, and write off whatever gets rejected by the Insurance Carriers.  We still monitor their work occassionally.  And in spite of our comments, they are still leaving about 30% on the table (that fact won't show up in anybody's statistics, so how can you research it?).  We won't take on their billing until their income exceeds their expenses - so they have no one who gives a damn to get in their faces and insist that they bill properly (since we get paid a percent, we tend to insist that our clients bill properly, because that means more money for us).

No evidence ... ???  There is, to people who know what they are looking at.

But, per my previous comment above - doctors who do simple medicine can get by with simple billling.  So for those folks, there would be no benefit to them to overpay for their billing.  For those folks, there would be no evidence that "what the companies get for 50 cents per hour is any worse than $15 per hour.

That makes the point that has been made throughout this discussion, but your comments are not informed by it:  there are many different types of medical billing, from the simple to the extremely complex.  The blanket statements you make don't account for these differences.  Medical billing never has been, and never will be, a one-size-fits-all enterprise.

That distinction extends to the type of medicine practiced also - private practice vs. institutional medicine.  In institutional medicine, the doctors use whatever technology the business office insists on.  And institutional medicine uses the large billing companies.  Those doctors are included in the numbers touted for how many doctors are using the large billing companies.  But it can hardly be said that these same doctors actually chose the large billing companies.  They didn't.  The business office did.  The choices made by doctors in private practice are quite different.  They actually make the choice personally.  When you look at statistics, it helps to break them out based on private practice versus institutional medicine.

    He who knows not, and knows not that he knows not, is a fool; avoid him.
    He who knows not, and knows that he knows not, is a student; teach him.
    He who knows, and knows not that he knows, is asleep; wake him.
    He who knows, and knows that he knows, is a wise man; follow him.

Attributions: Persian apothegm, Sanskrit Saying
Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on December 08, 2012, 03:42:07 PM
Nicely Said Richard.  Can't think of anything I would add :)
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on December 09, 2012, 08:16:29 AM
Richard the stanza you stated is perfectly suitable to yourself. I could not have said any better also.
You are a person who peddles junk like office ally and practice mate; you must know a lot about these systems. The fact that they are free may have something to do with that? Nah. Must be stroke of genius.

Whatever I do, I would never use that free stuff to do any billing; it is disservice to the doctor.

Now you say that the doctors are " leaving money on the table "; I never responded to this before, because it is your opinion, that the doctors are idiots and hiring big companies; another stroke of genius from someone who uses free stuff.
Let me be more specific. When you take money from the doctor, it is for something and it is not for your elaborate speaking ability. To point out, every claim that is submitted mus be electronically "scrubbed". Practice Mate does not do it. Automation is used everywhere in the society and our business is better for it.
Second thing you must provide the doctors with reports,  Practice Mate does not have any.
Then the system must call to confirm the appointments, Practice Mate does not.
I can go on and on. My website would have 40 pages of what we do and how we do it.
My point is that you are taking good money from the doctor, give him the best money can buy otherwise you are cheating the doctors.
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on December 09, 2012, 09:12:19 AM
A word about outsourcing.
I will be happy to hire American workers, but my competition hires them at 50 cents an hour, I can't pay them $15 per hour and make money.
My job is to get the doctor the best money can buy.
The person I hire in India does a better job at 50 cents an hour.
Have you ever worked with East Asians? They have better work ethics,  and better education. Those are not my words, it was said time and time again during the recent elections.
Just because they look different, is no reason to consider them " inferior ".
Prejudices like always are based upon utter ignorance. They have children to feed, just like us at 50 cents per hour.

They do have problems with English, the big companies have a solution, they use a local buffer between them and the clients.

The solution is NOT denigrating the East Asians; the solution is for the US Congress to make laws that prohibit outsourcing, but such will never pass the Republican House. So that is the reality and deal with it.
So all big companies outsource, that is the way it is, accept it or find another business.

A word to Newbies, and all those attending " schools " to learn billing and coding; market is very tough, do your due diligence before you give out your money. Sadly those people preying on uniformed newbies are preying  mostly on women with their last dimes, hoping to make a few dollars in this troubled economy, many with small children.
Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on December 09, 2012, 01:26:30 PM
Quote
Now you say that the doctors are " leaving money on the table "; I never responded to this before, because it is your opinion, that the doctors are idiots and hiring big companies; another stroke of genius from someone who uses free stuff.
Let me be more specific. When you take money from the doctor, it is for something and it is not for your elaborate speaking ability. To point out, every claim that is submitted mus be electronically "scrubbed". Practice Mate does not do it. Automation is used everywhere in the society and our business is better for it.
Second thing you must provide the doctors with reports,  Practice Mate does not have any.
Then the system must call to confirm the appointments, Practice Mate does not.
I can go on and on. My website would have 40 pages of what we do and how we do it.
My point is that you are taking good money from the doctor, give him the best money can buy otherwise you are cheating the doctors.

Wow..  I have to ask you again (which you never answered) Why the heck did you come to this forum? was it to insult? Because you certainly don't want or need our EXPERTISE.. Thankfully I'm WAY too good at what I do to be insulted.. almost..but you failed.   

I RUN one of the LARGEST communities of medical billers.. I'm not an association, don't want to be one but I do know you are flat out WRONG all the way around. By example, I know a billing company in Missouri who services 102 physician practices AND runs training center as well. Guess what she uses.. PRACTICE MATE.  Guess how many pages her website has.. 5.   I also do websites for the medical services industry.. MORE is not better. NO doctor, No office manager or staffer is going to sit and sift through 40 pages.. if you don't make your sell on the FIRST page, your done. So that is MOOT.       SOFTWARE and WEBSITES do NOT make the PRACTICE MANAGEMENT INDUSTRY.. The expertise of the practice manager does! YOU have none. YOUR method is to HOPE and pray the offshore guys you hire do their job, never mind compliance.. HEY they don't have to be compliant.. it's on your neck. 


You avoid the other questions.. WHEN you hire these OFFSHORE billers or data entry processors.. DID YOU OUTLINE THE MANY TRIPS YOU WILL NEED TO TAKE OUT THERE TO INSURE COMPLIANCE??    I and the others here already know your response.

YOU have insulted MY industry and I really think everyone here should just go on and ignore your insults.   I know I will be.
Title: Re: Can you make a profit by charging 4%?
Post by: best biller on December 09, 2012, 09:03:44 PM
Dear Tallmanusa,

 In reply #10 you mentioned "I have hired two experienced billers part time, working from home, at 1% of the revenue collected by that biller" are you interested in another experienced worker?
Title: Re: Can you make a profit by charging 4%?
Post by: Michele on December 10, 2012, 07:30:41 AM
I have owned my medical billing business for almost 20 yrs and earned a good living doing it.  The operative word is 'earned'.  I have used many clearing houses both free and paid.  I have been using Office Ally now for about 4 yrs and it is hands down better than any I have paid for over the years. 

I love my country - faults and all.  I have nothing against East Asians or there desire to feed their families.  I have an issue with work being sent somewhere that I have NO CONTROL over the quality of work.  I strongly disagree with the statement that the $.50 worker does better work.  There are "bad workers" in any country and there are good workers.  But I believe that overall the training is very lacking and the ones that do better work are strictly doing it by luck.  I want someone that I can train, hands on, continuously, since things in this industry are continuously changing.  And compliance is also a big concern, to me anyway.  The compliance issue whether you want to acknowledge it or not is a big issue.

I have sat down face to face and talked with several people interested in outsourcing the work and when I have been presented with all the facts/data, it just doesn't look like a good idea....period.  The only side that makes sense is "it costs less".  Every other area falls short. 

I also had someone try to convince me to "look over" all the work done by the off shore workers because they knew the quality would not be good. 

Each to his own - this is definitely not for me.
Title: Re: Can you make a profit by charging 4%?
Post by: RichardP on December 10, 2012, 12:01:47 PM
tallmanusa said:  You are a person who peddles junk like office ally and practice mate ...


...  " leaving money on the table "; I never responded to this before, because it is your opinion ...


I am responding to these two statements before reading further.  If I run across other things requiring a response when I continue reading, I will respond below.

When you read my comments earlier in this thread, and in other threads on this board, you will see that I make two points about the Company called "Office Ally":  1.) one of my clients was using the Practice Mate part of "Office Ally".  I took him off of that and put him on my system, because Practice Mate is severely limited in what it can do - and does not meet my needs, and 2.) the Office Ally part of "Office Ally" is simply a clearinghouse.  It does what other clearinghouses do, and does contain the same scrubber that many other clearinghouses use.  It is free to use ($20 per month if Medicare is > 50% for that month), and gets the doctor paid as easily and as quickly as the expensive ones do.

Please note that the Practice Mate part of "Office Ally" is simply a data warehouse.  When you submit that data for billing, it is routed through the clearinghouse part of "Office Ally", the part they call Office Ally (very confusing name configuration).  And, as stated, the clearinghouse called Office Ally does have a scrubber.  So your statment every claim that is submitted mus be electronically "scrubbed". Practice Mate does not do it is technically correct.  Practice Mate does not have a scrubber because it is simply a data warehouse.  But your statement is factually incorrect, because those using Practice Mate for billing do have their data passed through the scrubber that Office Ally (the clearinghouse) uses.

Finally, you said: you must provide the doctors with reports,  Practice Mate does not have any.
Practice Mate has tons of reports.  I've used Practice Mate in real-life situations.  I know what reports they have.  Practice Mate is fine for practices that do simple billing.  The number of doctors using it, and the insurance carriers that recommend it, support that point.

In terms of "leaving money on the table" - that is not my opinion.  Again, my wording above was specific about this.  Those who know billing understand what my example was about when I said (paraphrasing) "a good biller knows that when you do A, you must also have done B.  When you bill only for A and not also for B, you are leaving money on the table.  Also, a good biller knows that the amount of money the insurance carriers sometimes pay on a charge varies, depending on the order in which you have placed the diagnosis codes.  Placing a diagnosis code in the number one spot can sometimes get you paid more money than if that diagnosis code was in the number two spot."  And then there is the issue of knowing that the doctor has actually done work for which he has not billed at all (this is something that a biller cannot know unless s/he actually has face time with the doctor).

Those are just three of the issues I am constantly putting in front of my current clients (after 10 years of me doing that, they still don't remember some things) that affect how much money they get paid for the work they do.  When auditing the work of any doctor, those are three of the more obvious, but by no means only, issues that will tell you whether they could be collecting more money from the insurance carriers.  It is not opinion, because I have seen the increase in insurance payments from more correct billing first hand.  However, you did raise a point that I will acknowledge - if you don't know from first-hand experience that what I said is true, you were wise to not comment on it.

tallmanusa said:  you are taking good money from the doctor, give him the best money can buy, otherwise you are cheating the doctors.  That statement is general to the point of being useless.  What the biller owes the doctor is to get him paid the most he is entitled to for all the work he does.  As I have stated above, this is not a one-size-fits-all endeavor.  Of course, any worker/contractor owes their best to the client/owner of the business (which is all your statement says).  That is without question.   The larger question you leave unaddressed is this:  what is the best that money can buy?  The answer to that question will vary, depending on the complexity of the medicine that the doctor practices.  Where the doctor practices simple medicine, and whose billing needs are simple, off-shore billing might be the best bang for the buck (assuming compliance issues are properly addressed).  Where the doctor practices complex medicine, and whose billing needs are complex, a local biller who has face-time with the doctor might be the best bang for the buck.  The best bang for the buck is going to vary, depending on the type of medicine practiced.  The best that money can buy is going to vary, depending on the doctors needs; there is not a pre-determined answer that will be suitable for everyone.  In ignoring this truth, you are speaking platitudes to those who have been in the trenches.  More proof that you are an algorithm responding to key words in posts rather than an actual person with real-life experience.

Finally, since my last post above, I have read a statistic that, in something like the last ten years or so, the number of doctors in private practice in the United States has gone from 80% of the total down to 30% of the total.  The others could not afford to stay in private practice and so have joined with doctor groups or hospitals - those institutions most likely to be using the large billing companies that tallmanusa refers to.  That statistic does have implications for those billers who target doctors in private practice.
Title: Re: Can you make a profit by charging 4%?
Post by: QueenAlicia on December 11, 2012, 04:30:48 PM
Don't do it best biller, don't.  If you can't tell by this whole conversation I will say it now, your asking for TROUBLE!  Please just, smh, just don't, lol.

Dear Tallmanusa,

 In reply #10 you mentioned "I have hired two experienced billers part time, working from home, at 1% of the revenue collected by that biller" are you interested in another experienced worker?
Title: Re: Can you make a profit by charging 4%?
Post by: QueenAlicia on December 11, 2012, 04:33:19 PM
Quote
Now you say that the doctors are " leaving money on the table "; I never responded to this before, because it is your opinion, that the doctors are idiots and hiring big companies; another stroke of genius from someone who uses free stuff.
Let me be more specific. When you take money from the doctor, it is for something and it is not for your elaborate speaking ability. To point out, every claim that is submitted mus be electronically "scrubbed". Practice Mate does not do it. Automation is used everywhere in the society and our business is better for it.
Second thing you must provide the doctors with reports,  Practice Mate does not have any.
Then the system must call to confirm the appointments, Practice Mate does not.
I can go on and on. My website would have 40 pages of what we do and how we do it.
My point is that you are taking good money from the doctor, give him the best money can buy otherwise you are cheating the doctors.

Wow..  I have to ask you again (which you never answered) Why the heck did you come to this forum? was it to insult? Because you certainly don't want or need our EXPERTISE.. Thankfully I'm WAY too good at what I do to be insulted.. almost..but you failed.   

I RUN one of the LARGEST communities of medical billers.. I'm not an association, don't want to be one but I do know you are flat out WRONG all the way around. By example, I know a billing company in Missouri who services 102 physician practices AND runs training center as well. Guess what she uses.. PRACTICE MATE.  Guess how many pages her website has.. 5.   I also do websites for the medical services industry.. MORE is not better. NO doctor, No office manager or staffer is going to sit and sift through 40 pages.. if you don't make your sell on the FIRST page, your done. So that is MOOT.       SOFTWARE and WEBSITES do NOT make the PRACTICE MANAGEMENT INDUSTRY.. The expertise of the practice manager does! YOU have none. YOUR method is to HOPE and pray the offshore guys you hire do their job, never mind compliance.. HEY they don't have to be compliant.. it's on your neck. 


You avoid the other questions.. WHEN you hire these OFFSHORE billers or data entry processors.. DID YOU OUTLINE THE MANY TRIPS YOU WILL NEED TO TAKE OUT THERE TO INSURE COMPLIANCE??    I and the others here already know your response.

YOU have insulted MY industry and I really think everyone here should just go on and ignore your insults.   I know I will be.

LOL!!  ::)

Ignorance is bliss because apparently there has been no research on Practice Mate. You can run reports, perform EHR, schedule patients, etc.  I had a provider with 2 locations use Practice Mate.  I don't know why I continue to read and entertain this foolishness.

How are you going to create a software program when you don't the first thing about billing or HIPAA compliance.
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on December 12, 2012, 04:19:48 PM
The clearinghouse part (OA) is pretty good for a free clearinghouse.  It is even better than some of the paid clearinghouses.  As for Practice Mate, it is TERRIBLE.  I am constantly amazed at what people will put themselves through for something free.  It is like the people that stand in line for an hour for a free hamburger or something like that, when the hamburger only costs $5 and the person makes for than three times that amount per hour at the there job.  Waiting in line for an hour for a free $5 hamburger makes no sense when you could work that same hour and make $20.  JMO.  I'll get off my soapbox now.

Posted from another thread, without any comments.
Title: Re: Can you make a profit by charging 4%?
Post by: PMRNC on December 13, 2012, 08:33:38 AM
Quote
The clearinghouse part (OA) is pretty good for a free clearinghouse.  It is even better than some of the paid clearinghouses.  As for Practice Mate, it is TERRIBLE

I happen to agree with you, same goes for "cheap".. amazes me how many start off with one software and think upgrading in the future is the better deal, it's not.. it's actually a pain in the rear end and costly. (TIME and data conversion fees)   But.. let me tell you something else.. until you have met your goal of becoming a huge fortune 500 company.. I suggest you ditch the idea that software is the be all and end all and I'll tell you why.  7 out of 10 doctors you speak with (I'm shooting low with that statistic) will want to use THEIR software.  I was on another forum run by one of the associations recently and ran across a post from a biller who had a potential client who wanted her to work on their system, she was fairly new to the business and asked what should she do? The advice she got from the person who's group that was and who I've known for a long time in this business really threw me for a loop.. she said.. "Oh well you try to educate the doctor on all the benefits and then sometimes you just can't and you have to walk away" Paraphrasing but you get the idea..   Wow.. WHY?   In today's economy you don't turn away a client because they don't want to make the very large commitment of going over to YOUR software!!  And you should see all the doctors who have invested years ago in Medical Manager (very costly and cumbersome program, but VERY efficient and solid) and if your a billing company and your pitching your software with your services, your going to be turning away, again, 7 of 10 clients!  WHY??   This is why today's medical billing company needs to be diversified and yes this is going to make the new medical billers job much harder because when they are learning, most likely it's off of one system. Experienced billing companies with experienced billers will get the clients first in those situations because they can work on pretty much any system. I hate Practice Mate but one of my clients used it for a while so I had no choice. And Medisoft.. Ugh how I hate that software but I have quite a few clients who run it still. My job is NO different with those clients than it is with the ones I have on my PM solution.  And with the clients I have for consulting I have to work on VARIOUS software's to pull reports I need.  It still amazes me that even after 25 years in the business every now and again I will run into a software I've never seen.. but because I'm experienced I can navigate any software really.

So my best advice is to stop putting so much focus on the software.. YES your company should have a company wide solution.. but if your going to make it in this market you have to be ready to work on the worse software's. Physicians especially who have invested in a system (good or bad) most likely won't want to make a switch at least right away. And many of them want time before they give up the total control.   I think you also mentioned you won't work with provider who isn't using EHR? Good luck with that.. if the other companies told you they weren't I wouldn't believe them (when you are "shopping" your competition, I can't imagine why you think you'll get the facts???   anyway.. since I've got all my clients OFF Medicare/Medicaid now.. they don't have to use EHR.. they are quite relieved. Also there are practices who can and will pay the penalties rather than implement the EHR.. their reasons vary really and I don't ever tell my providers they HAVE to do something they don't have to do. 
Title: Re: Can you make a profit by charging 4%?
Post by: tallmanusa on December 13, 2012, 10:34:53 AM
Thanks Linda for the advice, very helpful.
Title: Re: Can you make a profit by charging 4%?
Post by: michelledurner on April 14, 2013, 11:43:14 AM
I agree with  PMRNC
Quote
YES you can make a profit that way. After you have worked 4 X as hard, have 2X as many clients and worked 3 X as many hours as the other.