Medical Billing Forum

Starting a Medical Billing Business => Starting Your Own Medical Billing Business => Topic started by: mbloom on August 26, 2013, 06:41:28 PM

Title: Biller or Billing Business
Post by: mbloom on August 26, 2013, 06:41:28 PM
With all the HiPPA restraints, policies and rules, is there a real benefit to setting up as a  business to offer your billing service versus just selling yourself as an independent biller that will work off site? TO still set your own pay, flat monthly rate or percentage, work for yourself, set your own hours and all?? THen you avoid having to notify Medicare or possibly breach a clause in the Business Associate Agreement and all....any thoughts, just curious??
Title: Re: Biller or Billing Business
Post by: PMRNC on August 28, 2013, 11:06:43 AM
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With all the HiPPA restraints, policies and rules, is there a real benefit to setting up as a  business to offer your billing service versus just selling yourself as an independent biller that will work off site?

There is a very big difference in this. If you go as an employee or independent billing agent you do NOT get to avoid HIPAA responsibilities. Your liability is the same. IF you are an "employee" of a provider and working remotely you can work under their umbrella but you will be a part of the covered entity. So basically you don't avoid HIPAA at all in any case. Even in-house billers must adhere to all HIPAA restraints, policies and procedures.  I can tell you that selling yourself as a business vs. employee is a better route. The idea of outsourcing is to save the provider time/money, he saves NO money by hiring independent contractor or employee, there are certain aspects of IRS law that have to be adhered to by both parties. As a business you can save them both money and time.  I wrote a good article on the differences :
http://www.billerswebsite.com/jobvsbiz.htm

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TO still set your own pay, flat monthly rate or percentage, work for yourself, set your own hours and all??

How you should price your services depends on too many variables, are you in a state where providers are not allowed to enter into fee splitting or revenue sharing arrangements (% based contracts), what is your experience, what type of provider, specialty, volume, etc etc etc  This is all a part of general business setup. I charge a flat fee with sliding scale which allows me to get paid for my TIME at same time considering costs and savings for the provider. Win win situation.   

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THen you avoid having to notify Medicare or possibly breach a clause in the Business Associate Agreement and all....any thoughts, just curious??

Again, breach notification is part of HITECH/HIPAA and whether you are an employee, independent contractor or business you will need to be fully compliant and trained regarding HIPAA/HITECH.. the difference would be HOW you would be classified which depends on how you decide to go.

People think a biller in the office is off the hook if she does something wrong, fraudulent or even knows something funny is going on, and that is not true. If you read cases about physician fraud you will notice a lot of office managers and billers go right down with them. Fraud and abuse is classified not only by what is being done but on the basis that a biller SHOULD know. If any fraud/abuse is going on and the biller knows about it, they are JUST as libel.
Title: Re: Biller or Billing Business
Post by: Merry on August 28, 2013, 05:32:56 PM
Thanks Linda. You said it better than I could have said it and you saved me time so I can look at the other posts. :)
Title: Re: Biller or Billing Business
Post by: mbloom on August 28, 2013, 07:04:12 PM
Thanks Linda! @Merry...was there a reason you had to take time to write out " so you can look at other posts" I am sorry if this post annoyed/bothered you - its an open forum - I was approached this way by a physician - and I brought it to my peers for feedback. If I am totally off base, forgive me for the prior statements. I should just simple say I found it rude AND offensive.

Again, thanks Linda! You are always so helpful. And just to clarify, I didn't mean to avoid HIPPA requirements- that to everyone's benefit. While I am a biller, I am also a patient of several physicians. I just meant a different standard. The physician that approached me spoke of "just being under his umbrella" and I wanted to make sure I wasn't missing something.

Thanks!!!
Title: Re: Biller or Billing Business
Post by: PMRNC on August 29, 2013, 10:58:08 AM
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The physician that approached me spoke of "just being under his umbrella" and I wanted to make sure I wasn't missing something.

You want to be careful with what structure he wants from you. Remote location/employee, Independent contractor or business owner. You will also want to make sure you check IRS guidelines for both your sake. For example, if you are an employee OR in many cases an independent contractor IRS guidelines lets the physician supply/write off all equipment, none of it should be yours at all, if they are you have to make sure leasing agreements in accordance with IRS guidelines to qualify you as an IC are in place. I also would be careful of motives.. If he wants you to work as "employee" or "IC"  what is he getting out of the deal, he's certainly not saving ANY money, in fact it's going to cost him the same if not more with equipment, books, software licenses, etc than hiring IN-house. He will need to supply you with EVERYTHING you need to perform billing or whatever services you are performing and those materials cannot be used in other practices, they would all belong to him.  That's why I prefer the business model setup, he saves money, reduces his liability/insurance and you are paid for your time and expertise. You would then be responsible for maintaining HIPAA and any other regulation compliance structure in your office. If he hires you as employee or IC, your facility/home office still must be completely compliant,only difference is he has to provide all of that and again, that's costly for a physician when they can hire someone in-house or a business much cheaper and more cost efficient already setup.

Title: Re: Biller or Billing Business
Post by: Merry on August 29, 2013, 08:13:11 PM
Mbloom..Oh my gosh..no.....I was just saying that Linda did such a good job..that I couldn't have done better and she beat me to it so I could look at the other posts and see what others were saying and try to help them. I am so very sorry that you got the impression that I minded your question. I am here for one reason. For this wonderful community of billers. And just because I have been in this business for about 50 years, I still learn every single day, frequently from people on this board.

So, I apologize if my post was misunderstood. If you knew me, you would know that is so not me. But thank you for posting about it because I will be more careful as to how I respond.