Medical Billing Forum

General Category => General Questions => Topic started by: Crush3174 on June 07, 2015, 06:08:14 PM

Title: Client Request
Post by: Crush3174 on June 07, 2015, 06:08:14 PM
I have a client who sent me an email asking if I could send a copy of all communications I do with an insurance company on their behalf to them. My clients are dental providers and I bill their medical claims because the offices are not set up to bill medical and their staff is not trained to do this. I bill on my own software. I can understand if they want a copy of the claim we submit but to send them a copy of every telephone status we document or every email communication seems very labor intensive. Is this normal for a billing company to provide this?
Title: Re: Client Request
Post by: PMRNC on June 08, 2015, 09:02:23 AM
Do you have a business associates agreement with them?
Do you have a contract for your billing services?

I know when I do verification's or followup I do have a tickler system and the provider does receive a report of these. For benefit verification I fax over the entire sheet. The physicians records should contain everything you have plus the medical record. It sounds like they just want to have an audit trail for their own records which is completely understandable. If it's something you don't generally provide, you might want to check your contract and decide if billing them additional costs would be beneficial. I'm assuming you do reports for them? Perhaps if monthly you added another report you could do so based on notes/tickler if your PM system allows? 
Title: Re: Client Request
Post by: Crush3174 on June 09, 2015, 10:13:47 AM
Thanks for the advise. Yes, I do have an agreement/contract with them but reports are not mentioned. I submit very few claims for each client that I usually update them via email (auth approved, claim paid, we will appeal, etc). For this client, I guess I can ask him what he specifically wants and then maybe charge him by the hour and send info after treatment is finished. 

Maybe someone can help me with this  - I run a very small home based billing service. It is primarily me and 2 other part time people. What standard monthly/quarterly reports would you suggest I run for clients? I may have to create an excel spreadsheet since my PM system does not generate custom reports. It exports info into excel. I use Practice Mate/Office Ally.

Title: Re: Client Request
Post by: PMRNC on June 09, 2015, 10:32:52 AM
It depends on your contract. I do full practice management which means they GET full monthly financial/statistical practice reports. They get claims submission report, A/R, follow-up, pending claims report, etc. If you are only doing claim submission, who is doing the rest of the work? If a client is requesting info from you that you only provide claim submissions for, there could be a huge problem as someone is needed to be doing the books  :o  I don't do claims only, have not in many years because of that. All or nothing, because I find practices that think they don't need to do anything but submit claims, OR I get one that has too many hands in the cookie jar. Never a nice medium.   

I suggest reviewing contract. If you are doing full practice management you will need a PM system that is capable of giving the client the reports needed to maintain practice financial health.. that's their bread/butter and it should be automatically included with services.  If you are doing claims only, be aware that if they are not maintaining full practice data, that could come back and bite you both in the rear end.

Title: Re: Client Request
Post by: Crush3174 on June 09, 2015, 11:54:53 AM
I only do a small piece of their billing. The bulk of what they do is done in-house. In many cases, they collect upfront from the patient and I am billing for patient reimbursement. Almost all of my clients are out of network providers.

We do the insurance verification, pre-determination of medical necessity/prior auth (a very labor intensive process), submit claims and do claim follow up/appeals. I'm not sure if you consider that just submitting a claim.

Because this is so specialized, I find it hard to fit into the regular medical billing company model. My client list is growing because of "word of mouth" and some of my new clients have left the bigger billing companies because their claims were not getting worked and they were charging a lot more than I do (which I should really rethink).

I was hoping to get some feedback regarding what standard reports any client would find useful and I can see if I can incorporate that into what I'm currently doing.

Thank you.
Title: Re: Client Request
Post by: PMRNC on June 09, 2015, 02:46:09 PM
Standard practice management reports are monthly:
 A/R by days
Billed claims
pending claims

I also do quarterly and bi-annual reports with meetings for all clients. We go over contracts with providers, address problems, claims, denials, appeals, etc.

Your contract is vital in what you do next. IF you are providing full practice management you should be responsible for reporting. I would say based on what your doing that it is a form of full practice. When I get a client that wants "pick and choose" services.. I'm very mindful in explaining to them the legalities of making sure that all functions are being taken care of. For example, if I get a client that only wants me to provide insurance billing and they claim they are going to do all patient billing.. nope, I'm not contracting with them. Reason is that there is too much margin of error for fraud/abuse.. two sets of books = PROBLEMS.   I WILL do a claims only solution BUT only if I know that they are keeping the other end ..meaning they have all source documents, system in place, etc.. but with your client ASKING for this information scares me because that means.. someone .. somewhere dropped ball and something is not being covered. That to me means that you might want to review your contract and provider and billing company responsibilities and clarify with the provider who is doing what.

Title: Re: Client Request
Post by: Crush3174 on June 09, 2015, 05:45:36 PM
Thank you! That is the direction I needed. I appreciate your help and experience!