Author Topic: starting a medical billing business  (Read 22939 times)

PURPLELADY

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Re: starting a medical billing business
« Reply #45 on: March 16, 2009, 05:52:58 PM »
Thanks Michelle. You are truly a blessing!!!
We are registered with the state, waiting on the LLC to come back, have a p.o. box address, notarized our partnership agreement, financial software, fax#, computers, office supplies, etc.  We plan to file for our business license and open a business bank account next month. All we need now is the billing software, set up merchant services, ontomypc, and a business phone.  Here is the problem....it was suggested that we use a cell phone as a business phone. Then a suggestion that we get a phone installed and foward calls to the cell phone. What do you suggest?? My partner does not want people to speak to voice mail. We both work full time jobs (getting in about 6:00).  Also, do you think I should sign up with the clearinghouse and medicare/medicaid now (just to get it over with) even without the license yet?
Is there a basic contract for dr/billing service? or should I create one myself as I go along with each dr? What should be in the contract? Do you know of a brochure template I can download?

Michele

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Re: starting a medical billing business
« Reply #46 on: March 16, 2009, 07:38:44 PM »
If you are able to answer the cell phone during the day it sounds like that might be a good idea.  But if you would not be able to talk (at work) then it probably wouldn't.  I don't have a copy of any standard contract.  We designed our own.  Contracts vary greatly from very basic, to very detailed.  I would recommend that you have your lawyer review your contract before you use it.

I've always used Microsoft publisher for designing brochures.  There are a few templates available with publisher. 

Michele
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PURPLELADY

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Re: starting a medical billing business
« Reply #47 on: March 16, 2009, 09:15:24 PM »
Thanks Michelle.  Do you think I should sign up with clearinghouse/insurances even though I have no biz license or clients?  Or do I wait until I get my client.

PMRNC

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Re: starting a medical billing business
« Reply #48 on: March 17, 2009, 06:26:21 AM »
If your clearinghouse charges per transaction and doesn't have any monthly or setup fees then it wouldn't hurt to get enrolled, however it's ok just to have your enrollment papers ready for when you get your first client.

Also some things you missed in your setup.. You will want to be sure your BAA's are ready for the HITECH Act, it's an extension of HIPAA where BA's will now carry the same liabilities as CE's so current BA's will be scrambling to review their BAA's, if you do this now and get them ready you'll have one less thing to stress about next year. You also want to look into errors & omissions insurance and start getting your compliance plan ready.
Linda Walker
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PURPLELADY

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Re: starting a medical billing business
« Reply #49 on: March 17, 2009, 05:31:02 PM »
Thank you.....But I'm afraid you lost me with the BAA'S and the BA'S and the HITECH ACT. Can you break those down for me? What does the initials stand for, what is it,what is their purpose, how do I get it, etc.  Where do I begin to search for the errors and omission insurance? Any suggestions.  Is there a website I can go to for this stuff?    Thanks.

PMRNC

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Re: starting a medical billing business
« Reply #50 on: March 25, 2009, 06:03:42 AM »
I had some clients who were just so disorganized that I would have them fax deposit slips so I can match them up to the payments for the week, I had one provider who insisted on doing his banking daily so with him we actually got on track faster by matching up daily.
I know there are billing companies with lock boxes setup who collect/gather the checks and make deposits, I had a hard time selling that to a physician, plus as you grow it becomes too time consuming IMO. Doctors AND billing company both are both bound by state/federal record retention laws anyway so it just seems a bit safer to get them on a weekly schedule to fax over daysheets/superbills, etc. Busier offices might want to do it twice a week. Your contract should have this included in the provider responsibility area of the contract.
As for mistakes... if the office made ANY mistake on the superbill or daysheet, I would fax it back along with a quick form for them to complete and sign and send back. I did that to Cover my butt, doing this on the phone would be too risky, even if I documented it, it's still not proof enough they made the correction or change.

Your BAA is your Business Associates Agreement which is required by HIPAA, you will want to discuss this with your attorney and make sure you research and are very clear on HIPAA regulations. The HITECH Act is going to be an extension of HIPAA next year that will bring forth the SAME liability to Business Associates as it does to Covered Entities. MOST third party billing companies are considered BA's and providers are Covered Entities, however there are some billing companies that are Covered Entities, it all depends on your setup/services. Years ago when HIPAA went into effect and I was billing, I chose to cover myself as a Covered Entity, I guess I saw this coming down the pike.

For errors & omissions you might want to research by your state. Some companies refer to E&O as ; Business liability, business malpractice and Quai Tam insurance. Coverage varies from 1 Million and up. For a 3 Million dollar policy in Upstate NY (I'm not billing, just consulting right now) I pay $866 for the year which I've heard is pretty good. In NJ and PA it was much higher, premiums will vary by state and by the services you will provide. Those coding and actually doing contract negotiations, fee schedule negotiations, etc will pay higher premiums because their liability is greater. The average policy premium for a small to mid size medical billing company providing full practice management can range from $600-$2000 a year, again it depends on your location, liability, services, and amount of coverage you choose. A good start in researching this is to call your home-owners and see if they sell that type of insurance. Just be sure you specify it's "Liability" insurance, don't get confused between that and regular business/office insurance which covers your equipment, and work area.. etc.

Linda Walker
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« Last Edit: March 25, 2009, 06:05:39 AM by PMRNC »
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

PURPLELADY

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Re: starting a medical billing business
« Reply #51 on: March 25, 2009, 09:42:32 PM »
Thanks Linda. 

     I  thought that since this is starting out as a home-based business that our LLC and homeowners insurance would be enough.  Thanks so much for the info.  I will look into it asap.

     I'm planning on purchasing the Ingenix code it fast (2008) 1-9 software for 49.95 single user and the icd-9, hcfa and cpt books.  Am I wasting my money? What reference material do I really need? If I need any. I did stipulate in my contract that diagnosis and procedure codes should be on all charge slips.

PMRNC

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Re: starting a medical billing business
« Reply #52 on: March 26, 2009, 07:28:41 AM »
You can shop for coding books, I like Ingenix, but there are also others, if you are comfortable with it stay with it, I also do keep the books handy and updated yearly. I like the binders so that I can order updates and just insert them rather than a bookshelf full of coding books. I recommend always having at LEAST the previous year and the current year because many billers can get their feet in the door by offering to clean up A/R which involves older claims. having 3 years (2 previous years and current) is Ideal.

As for your setup, the LLC is to protect your personal assets.. it's not the same as "liability" in your day-to-day work. Many billers think that just because they don't code they don't need Errors & Omissions but that's not true at all. There are many other liabilities out there, the false claims act for example doesn't just say if you submit a fraudulant claim you are libel, how it reads is that anyone who is sending claims "SHOULD" know. To give you an example, I had a client a few years back that was required by law to supervise his biofeedback techs, that meant when biofeedback was done, he had to be IN his office and available. As a billing company I knew that rule, however I was not AT the office, therefore the claims I sent where he WAS NOT in his office and I did NOT know.. were considered "errors" .. Once I found out (he went on a trip to Europe and superbills were being faxed to me by his biofeedback tech) Then it became MY liability because then I knew what was going on. I had to legally report it, stop sending claims and dismiss the client. Medicare actually paid me a whistle blowers fee (2 years later. LOL) and he was sanctioned. IF I had continued to send claims KNOWING they were fraudulent I would have been held JUST as libel as he. Going to court ONE time on federal or state charges will close your doors for business very quickly. Another example is if you are billing charges you know the provider is coding incorrectly and he/she refuses or doesn't change or document, you are again, just as responsible legally.
To go further, if you look at lawsuits involving billing schemes you will find many Office managers and in-house billers going down right along with the doctor.

I am not trying to scare you but I believe when you enter this business, there is more to know than just the fluff of how nice it is to work from home.

If you don't currently have clients, you don't have to purchase your insurance until you do. To be honest I didn't purchase my E/O until I had 2 or 3 clients and generated income. Some associations will offer discounts on E/O, but be careful of them and make sure the discount is worth the membership fee. One association out there charges an arm and a leg and many sign up just to get a $100 discount on E/O but they pay over $500 to become a member. ???
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

PURPLELADY

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Re: starting a medical billing business
« Reply #53 on: March 26, 2009, 08:46:25 PM »
THANKS PMRNC!!!  YOU ARE ALLLLRIGHT!!!!

PURPLELADY

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Re: starting a medical billing business
« Reply #54 on: April 05, 2009, 01:03:43 AM »
Question.....

Can I safely assume when charging a percentage per claim that I include the copay that is paid up front at the dr office?  Also, when billing the dr monthly, am I adding all moneies collected for the month and then do the percentage of that or  am I billing a percentage for each claim. By the way, in my previous posts I stated that I was going to purchase ezclaim software for 570.00. Well, they have a software that just prints claims. I will be using that and office ally for starters(office ally charges a fee for putting claims to paper).

PMRNC

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Re: starting a medical billing business
« Reply #55 on: April 05, 2009, 11:51:30 AM »
How you charge should be spelled out completely in your contract. If you are going to charge a percentage of collections, just stating that is not enough, you would need to spell out that you willl either be charging a X% of total practice revenue (includes copay's and ALL incoming payments) or X% of insurance revenue..etc.
Typically the billing company should get a % of total practice revenue if they are doing full practice management.
My rule was. .. I touch it, I get paid.

Quote
By the way, in my previous posts I stated that I was going to purchase ezclaim software for 570.00. Well, they have a software that just prints claims. I will be using that and office ally for starters(office ally charges a fee for putting claims to paper).

You are going to find you will be VERY limited in the services you can provide clients. If you are going to use a sub-standard "print/send" claims only software, you will NOT be able to provide your clients with practice management, with claims only they really don't need a billing company since most of the work comes prior to and after the claim is submitted. If your intention is to cut costs starting out, you will find in the long run this will be a very big drawback. If you are looking to get into this business you need to have a full understanding of all services involved with full practice management. I'm afraid most of your claims only businesses are either gone or have figured out they need to do it all in order to stay competitive and in business.
DON'T Skimp on software..it's too important to your business and your clients business, and in the long run you will end up with a harder time trying to compete. Software conversions are NOT fun, and they are extremely costly. Take your time looking for the right PM Software and make sure it does all you need it to do. Going with a software that just prints/sends claims is really going to limit you where there is no need for your services.

Linda Walker
PMRNC
www.billerswebsite.com
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

PURPLELADY

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Re: starting a medical billing business
« Reply #56 on: April 06, 2009, 05:51:49 PM »
Thanks Linda.....
 
I do have a line in our agreement somewhat saying that we charge a % for any payments paid to dr as a result of our billing which includes insurances, capitation, self-pay, and co-pays (was not sure if I could include it). 
Linda, maybe I'm misunderstanding what full practice management is.  We are utilizing the full service of Office Ally and their software practice mate. I thought purchasing the "bill claim only" software would assist us.  We will offer electronic/manual billing, follow-ups, resubmissions, pt billing, pre-collections on past due balances, provide drs with reports, telephone inquiries, etc.  I thought this was enough for starters until we get our "feet on the ground". Our plan is not to always be home based.  Should we be doing much more??  I guess I'm being aware of cost just in case things dont work out. 
Linda, I greatly appreciate all your input!!  Thanks again!!

Michele

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Re: starting a medical billing business
« Reply #57 on: April 08, 2009, 12:58:44 PM »
"I do have a line in our agreement somewhat saying that we charge a % for any payments paid to dr as a result of our billing which includes insurances, capitation, self-pay, and co-pays (was not sure if I could include it)."  (from the last response to this post)

Be careful with that line.  If you are providing a full service then you will be charging your % on the entire practice revenue, not just the amounts 'as a result of your billing.'  Since you will be doing a full service you will need to track ALL patient payments including copays collected at the office by the office staff, which was not as a result of your billing.  If you are tracking it, you need to be paid, and it would be difficult to separate what you collected vs what they collected.  Like Linda said, if you touch it, get paid for it.  If you track it, you need to be paid.  With the line above you are saying you won't be paid for amounts collected in the office and that is a problem.

Also, regarding the software thing, Linda is correct (again!).  It is too important to start out in a Yugo and then try to move up to a Cadillac.  You don't want to limit yourself in your capabilities, especially in the beginning.  You want to do an amazing job so that you get more clinics by referral.  Saves on the need to market.  There is a new technology available called SAAS which is allowing companies to offer a Great PM system at a VERY reasonable price.  Many of the web based softwares are too expensive for billing services because they charge per doc/practice and they have a set up fee for every new provider.  We have found one that charges per seat instead of per provider and the monthly fee for billing services is only $149 per month.  They are comparable to the PM system by Ingenix, and AdvancedMD but at much lower cost.  Most people don't think it's possible, but the SAAS allows them to offer the same features at a lower cost.

Whatever way you decide to go, just make sure you don't skimp on what you can do.

Michele
« Last Edit: April 08, 2009, 01:00:27 PM by Michele »
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PURPLELADY

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Re: starting a medical billing business
« Reply #58 on: April 08, 2009, 05:59:34 PM »
I'm getting confused here guys.....
Are you suggesting I not go with Office Ally and their web-based practice management system (practice mate) for free?  They also provide the reports needed for the docs. Again, I thought I could purchase the "print send" (145.00) to do my own claims opposed to paying office ally to do it.  So, do I purchase a "full" billing software along with using office ally? Or do I just can the whole thing and start over? I'm bout to loose my mind!!! (smile) I guess I'm being too cost efficient considering there is very limited funds.  
Michelle, I do see what you're saying about the line in my contract.  I will review and correct my 2-page contract it since I'm doing just billing claims, follow-up, patient billing, and collections.
I tell you.....just when I thought I was getting close to starting!!! Where is the simplicity? (smile) I'm so glad I talk to you guys first.  Thank You so much.

Alice Scott

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Re: starting a medical billing business
« Reply #59 on: April 09, 2009, 05:55:16 AM »
Alice here.  ;)
I had to comment on this one as I have been researching software for the last six months.  Michele and I became aware that the web based software had much more to offer than a server based one like the Lytec we have been using for the last 15 years.  When I saw what the web based ones can do I really got excited.  I see where it can cut down our data entry time by possibly as much as 50%.  That is HUGE!!!  I set up demos of all the web based programs I could but found them to be way too expensive for us to switch.  It would have been five figures to get started.  Then I found a new company using SaaS (which I had to look up on Wikipedia to understand).  Saas is new and enables this company to offer the same advantages as the large web based companies for a monthly fee of $99 for a doctors office and $149 for a medical billing service.  They don't have a set up fee and they don't charge extra for more than one doctor.  For only $149 a month a medical billing service can have web based software.  The software is in Beta version now, but I have tried it out and it is amazing.  They will soon be accepting early adoptors and will have it fully available sometime in June.  The company is called Xena and I think it's going to turn the world of web based software upside down.  The last demo I did with one web based company had a minimum cost of $3000 per month plus a huge start up based on the number of doctors we bill for.  I've checked and rechecked and Xena is $149 per month!!- no surprises. 

I'm a little afraid of trusting our business to a limited free program which is trying to get you to upgrade to the paid version.  I wanted all the benefits that the web based programs will offer.  Xena offers the full practice management system with the clearing house, reports, and everything else you need plus some stuff you never thought of.

We had an opportunity to go to the HIMSS conference in Chicago this week and it was obvious that server based software is antique.  Anyone starting this business needs to use a web based software and now there is an affordable one.  Anyone still using a server based software needs to look at the advantages of a web based one.  I wrote an article about some of the advantages for anyone interested.   http://www.solutions-medical-billing.com/webbasedmedicalbillingsoftware.html  You are welcome to call our office and ask Michele or me for more information. (1-800-490-4299 Eastern time)

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