Chiro Specialty Profitable?

[dfranklin]

I am fairly new to medical billing (8 months) and I have been billing for a Chiro for about 6-7 months.  I charge a percentage (from reading other posts I am inline within the 6-8%).  I just can not seem to make much money with them.  I file between 30 -50 claims per month and receive insurance payments around $3,000/month.  So do the math at say 7% I am only receiving $210.  My software (web based) about $100/mo.  Not much left for me for the work.

They handle their patient billing because they have a lot of cash patients and have special agreements/plans individually with them.  In fact, when an insurance patient has a copay or deductible or patient responsibility they make special arrangements with them for that money as well.  So I don't see any payment on the patient responsibility.  Even if I did I don't think it is all the much still.  So essentially I am just submitting claims and posting EOBs on my end and following up to make sure insurance A/R is good.

I would like to take on more chiros but I just don't know how to do it where it is profitable for me.  Even if I did it on a per claim at $5.00/claim that is only $150-$250 based on their # of claims (still not good).

Would love some help and ideas.

Thanks!

[Alice Scott]

HI,
We too bill for quite a few chiros and they can be a "pain" - no pun intended.  Chiropractors vary greatly in how many patients they see,  how they bill, and how much income they generate.  Some wish to work with self pay patients and don't want to deal with insurance.  The 30 - 50 claims a month can't take you very long to take care of.  You just need to multiply that times a few more chiropractors.  You will run into chiropractors who can generate you much more than $200 a month.  We have one single chiropractor who we bill well over $1000 every month.  We handle all his patient billing as well as the insurance billing and he runs a very efficient office.  He bills modalities and sells foot levelers.  Many of our single chiropractic offices average $300 - $400 per month income for us.  $200 is a low.

With your web based software - are you paying per provider?  This can be expensive.  We are now using a web based software with no up front costs that doesn't charge per provider.  They charge only per computer seat.  So if you use only one computer at a time the cost is $149 per month.  That's it.  You need to be aware of your costs as well as the income you generate.

Alice

[PMRNC]

My advice is that you need to step back and look at your contract. I see a few problems which COULD exist.
You say the practice is managing all patient payments?  Right there is (could be) a problem, are you tracking them? If not that means there are two sets of books for the practice... BIG NO NO!
If you are tracking them, does your contract state your % is based on the full practice revenue or is it specific in saying insurance payments only?
Right there that issue is causing you a "loss".  If the practice is NOT managing these payments together you might want to tell them it's a bad idea to have two sets of books. And if your contract is stating your collection rate is based on total practice revenue, they are in breech.

After you look at these issues and if everything is on the up/up and your just taking a loss it might be a good idea to turn the client loose. 

Also $100 a month for software.. I agree with Alice, if this is per provider, it's expensive but it's also a cost you could pass on to them, if it's not per provider than it's a loss or just the cost of doing business.

[thatcuteblonde]

You might want to find a chiropractic office that has physical therapy as well or at least modalities. 30 to 50 claims per month is extremely minimal. If you're thinking about expanding and doing this long term, you might want to consider purchasing a software program. You can get a program like Medisoft for a very reasonable rate, especially if you purchase it from E-bay or Craigslist.

[PMRNC]

I don't recommend ever purchasing a PM software off of Ebay and Craigslist, way too many bootlegs out there not to mention there are licensing fees to companies such as Medisoft. You never BUY the software, just the right/license to use it. It's true there are some vendors using Ebay but you have to really do your homework to be sure they are reputable and the copy will be licensed to you. I've seen a lot of people get stiffed buying off Ebay and Craigslist is even worse.

[Pay_My_Claims]

I don't recommend ever purchasing a PM software off of Ebay and Craigslist, way too many bootlegs out there not to mention there are licensing fees to companies such as Medisoft. You never BUY the software, just the right/license to use it. It's true there are some vendors using Ebay but you have to really do your homework to be sure they are reputable and the copy will be licensed to you. I've seen a lot of people get stiffed buying off Ebay and Craigslist is even worse.

Amen on that Linda.

[PMRNC]

I know someone who bought their PM Software there for $3100 which WOULD have been a decent bargain, she took it out of the box and the license agreement wouldn't let her go on.. she called the company and they told her she had to pay the full price since the copy she bought was not a licensed copy.. not the software company's fault because they fully disclose this fee to their customers, she couldn't get her money back either because in small print on the Ebay sellers page it said something like "Price does not include software company's licensing/registration fee"  OOPS
So she was completely out the $3100 because it was a $5000 software. A lot of people don't realize you really don't BUY the software but instead you buy the rights to use it. You don't really "own" it per' se.

[dfranklin]

Thanks for the great responses...I really appreciate everyone's help!

As for my web based software it is per provider if each provider is billing under their tax id...if they bill under the office tax id then it is considered 1 provider.  The monthly base is $75 which includes 25 claim submissions.  After the 25 it is $1.00 per claim up to 500, 500+ =.75.  The system is great though especially for newbies...it is really easy to use and has a lot of benefits. I can provide controlled access to the doctor, office staff, their CPA and any of my "future staff" to login from anyware (no additonal fees).  It is called Medrium. Have you heard of it?  What do you think about it?  The idea is to sell the provider on using this software in their office for appointments scheduling, updating info etc...

For the 2 sets of books: The provider is tracking all of their stuff in house both insurance payments and patient payments.  They don't look to me for any data. Essentially as far as they are concerned they have only 1 set of books.   They forward me the EOB's and correspondances so I can track the insurance payments so I can stay on top of them and make sure we recieve all insurance payments. 

My % is NOT based on all practice revenue.  ONLY insurance payments because they don't just take the patient responsibility at face value....they come up with individual prices for the patient.  IE They will tell a patient you will have to pay $50 /visit (just an example) plus what we receive from the insurance.  So with all these different agreements and special arrangements for the patient payments I would not be able to track them if I wanted to..


What are modalities and why would it be more beneficial to have a chiropractor that has physical therapist or at least modalities?

Thanks!

[Michele]

If the average claim charge is $50 and reimbursement is < that, then 30-50% of your fee is going to your software isn't it?  It will be hard for you to make much that way. 

I just think that charging you per claim (your software vendor) is not in your best interest. 

Curious what others think on the fees for the software.

Michele

[PMRNC]

 I have to agree with Michelle.
Since your software is based on per provider with monthly fees, you would be justified in passing on that cost to the provider, it's only when you do NOT incur charges on a per client basis that it would be considered the "price of doing business". Also those monthly fees are high.. there are free cleearinghouses and even the other ones (good ones too) that charge per claim the usual rate is $.25cents to .50cents. a $1.00 per claim (even after 25 free) is high.. too high in my opinion. It sounds like the vendor is nickle and diming you.. I've seen Medrium (not privy to their pricing structure) and I can safely say you can get the same features in a more appropriately priced software.

My % is NOT based on all practice revenue.  ONLY insurance payments because they don't just take the patient responsibility at face value....they come up with individual prices for the patient.  IE They will tell a patient you will have to pay $50 /visit (just an example) plus what we receive from the insurance.  So with all these different agreements and special arrangements for the patient payments I would not be able to track them if I wanted to..

That does not sound on the up & up to me.. sounds like they are waiving copay's, lowering patient OOP, etc. But that's another issue.  It's only natural all patients will have a different OOP, that's what adjustment codes are for. The superbills or daysheets have a spot on them to indicate the payment, it gets posted and then patient is billed balance. If there is hardship on file that has a place to be indicated in software.. I'm not seeing the logic of them doing their own patient statements UNLESS like I mentioned there is some funny stuff going on.. even then it's not in their best interest.

[dfranklin]

I think you are right...that is what they are doing (Waiving/lowering the copays and OOP).  I remembered awhile back the Doc had mentioned that why should patients with insurance have to pay more OOP then cash patients.....which is why he sets up different plans for his insurance patients.  IE patient A who has a low reimbursement from insurance would have to pay around $100 OOP for each visit so instead he says you will pay $25.00 visist plus what we collect from the insurance payments....I did not like the way he wanted to do it so in the beginning so I said Then you guys keep your own books and tracking and I will just submit the insurance claims for you and follow up on them.  I know it leaves some money on the table for me as I then can not get paid on any patient billing, but it was that or not take the account at all becuase I did not want to get tangled up in anything.

As for the software maybe I should look into others if there are other web based that are as comparable and will be less expensive and more profitable.  What ones are there?

The other reason I use the Medrium is because it is part of the package I bought with ABS and I get full support and extras such as they will provide demos to my prospects.  Medrium is really good for the newbies like me that don't have the background in medical billing.  It does the real time error checking and really makes it hard to make a mistake.  It has caught some mistakes by my Provider.  I hope to eventually be so proficient and experienced (like you guys) that I don't have to rely on software etc, but for now that is the other reason I use them.  Has anyone heard of ABS?  Their thoughts?

Thanks!

[PMRNC]

It has caught some mistakes by my Provider.  I hope to eventually be so proficient and experienced (like you guys) that I don't have to rely on software etc, but for now that is the other reason I use them.  Has anyone heard of ABS?  Their thoughts?

None I would say on a forum or put in writing but i will tell you to do a bit of research on them to see what pops up.

[thatcuteblonde]

I bought my Medisoft off Craigslist and didn't have any problems but it was brand new, unopened, etc.  but I agree, you can't just buy the first one that comes along. Programs like Medisoft aren't terribly expensive to begin with and if you're the only one using it you can get a single user version for a reasonable rate. Microwize is the company I've bought through quite a few times when I've done consulting and they were willing to beat any quote we were given by 10%. So that's something you might want to look into as there are no additional charges once you get the software.

Modalities, like stim, ultrasound, manual therapy, etc. can increase the reimbursement per claim by over 100%. I've worked for a Chiro that billed out there ex, manual therapy, nuero muscular re-ed, traction, stim, etc. and his billed amount per claim, on average was 500% more than that of a chiro I worked for who did nothing but $45 adjustments.

Alot of Chiro's discount their services, especially where out of network claims are concerned. They don't want to go in network and take the huge discount but they also don't want to hold the patient responsible for the additional fees. They see it as a win-win scenario.

[dfranklin]

If you charge the provider based on ALL of the receivables meaning cash clients in addition to the insurance, how do you handle tracking when the provider is doing plans?  I have a chiropractor who has different monthly plans that give them different things...ie maybe $150/month and you get up to 5 visits in a month or you get xyz and abc per month etc.  How can I track those payments and when a patient comes in and if they have used up their month's worth of service?

[PMRNC]

The provider can still let you know about those payments and then also you want to have the adjustment amounts to write off anyway. There are ways he can do this. A daysheet can be kept for cash patients that can show the amount paid, and amount written off/adjusted. Also if your provider gives you the payment deposits he can make a note of the adjustments there.If he's giving you the superbills the payment should be on there and then he can place a note of the adjustment there as well.