Author Topic: Suggestions for Billing Software  (Read 24013 times)

henryn

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Re: Suggestions for Billing Software
« Reply #45 on: February 26, 2013, 03:59:15 AM »
Yeah i am using advanced MD software. It is great and i would like to recommend it to every one to save thier cost and time.
therapy billing software

henryn

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Re: Suggestions for Billing Software
« Reply #46 on: February 26, 2013, 04:03:56 AM »
You can take a tour to this link. They will help you in getting a reliable and robust billing software. Try it.
therapy billing software

gurumedbill

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Re: Suggestions for Billing Software
« Reply #47 on: February 26, 2013, 08:48:40 AM »
If you can get the doctor to pay or if the doctor already has it then AdvancedMD is a great option but their pricing is out of control for a billing service that is looking to grow.  Things have even gotten worse since they got bought out by ADP.  I'm not surprised because that was my same experience when I used to use Medisoft and they went from being privately held to being purchased by NDCHealth.  Those corporations just want to make as much money as possible and try to make people fee they are trapped and don't have any options.
Speaking of price increases I noticed that not longer after Kareo added their billing service they also have gotten rid of their less expensive pricing options from their website and only have the $299 a month plan listed.  Is that all they offer now or do they still offer the cheaper plans and just not show them on their website.  If you are paying $299 a month per provider for a billing service that can get pretty pricey as well.

PMRNC

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Re: Suggestions for Billing Software
« Reply #48 on: February 26, 2013, 10:22:29 AM »
The $299 is a bit pricey for the smaller billing company, however in regards to those that are growing, and keeping in mind that is for unlimited claims there are MANY providers that spend that in clearinghouse fees alone. They also give you a discount for mid-level (non physician) providers of 50% monthly taking into account the lower reimbursements. Depending on the structure of your billing company and your clients that $299 can be passed on to the provider OR you could split it.   The clients I have on Kareo pay their own fees. I do everything else. I really do not utilize ONE PM system, I go with what my client has, wants or needs. I found sticking with ONE vendor makes a provider feel like they have to switch, they are more apprehensive. I will tell you this. OF ALL THE VENDORS out there.. BY far Kareo spends the most on marketing, you will see their AD's EVERYWHERE..they know how to market, so there is a VERY good chance the doctors already have it.. like mine did.  I have not run across a physician who has not heard of Kareo.  But on the flip side, I would not use Kareo if you are new to medical billing. They are not a company that is going to hold the newbie's hand.. get your feet wet with other solutions first.   I also tell people.. you don't OWN your medical billing software, you lease or license to use it. Always keep that in mind. 
Linda Walker
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best biller

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Re: Suggestions for Billing Software
« Reply #49 on: March 21, 2013, 01:43:10 AM »
does anyone have some good suggestions beside kareo? I am looking for a good software for my just started billing service, currently i have one client and i want a web based software for a low price.

Thanks for any advice

PMRNC

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Re: Suggestions for Billing Software
« Reply #50 on: March 21, 2013, 10:32:50 AM »
Look into collaboratemd  www.colaboratemd.com   Good reputation, good pricing and I've never heard of any complaints.
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gurumedbill

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Re: Suggestions for Billing Software
« Reply #51 on: March 22, 2013, 09:45:52 AM »
I like TotalMD (www.totalmd.com).  The software is super easy to use and the pricing is the best I've seen.

desheba

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Re: Suggestions for Billing Software
« Reply #52 on: April 12, 2013, 04:37:56 PM »
The $299 is a bit pricey for the smaller billing company, however in regards to those that are growing, and keeping in mind that is for unlimited claims there are MANY providers that spend that in clearinghouse fees alone. They also give you a discount for mid-level (non physician) providers of 50% monthly taking into account the lower reimbursements. Depending on the structure of your billing company and your clients that $299 can be passed on to the provider OR you could split it.   The clients I have on Kareo pay their own fees. I do everything else. I really do not utilize ONE PM system, I go with what my client has, wants or needs. I found sticking with ONE vendor makes a provider feel like they have to switch, they are more apprehensive. I will tell you this. OF ALL THE VENDORS out there.. BY far Kareo spends the most on marketing, you will see their AD's EVERYWHERE..they know how to market, so there is a VERY good chance the doctors already have it.. like mine did.  I have not run across a physician who has not heard of Kareo.  But on the flip side, I would not use Kareo if you are new to medical billing. They are not a company that is going to hold the newbie's hand.. get your feet wet with other solutions first.   I also tell people.. you don't OWN your medical billing software, you lease or license to use it. Always keep that in mind.


I have a question...If the client has been doing fee for service and now wants to bill insurance and wants me to find the software to use, should I be researching the software for me to purchase as a billing company or for the provider to purchase and I would be the user?  I am not sure if I should incorporate the costs into my fees or if the provider is responsible? Also, if I purchased the software under the billing company, would the provider be considered a user?  if this relationship ever terminated, how would the provider get the info I have billed under my software?

In suggestions or comments are greatly appreciated

Desheba

RichardP

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Re: Suggestions for Billing Software
« Reply #53 on: April 12, 2013, 11:13:45 PM »
I've been thinking for some time about writing this.  desheba provided the opportunity / excuse.

1.  desheba - the phrase fee-for-service commonly refers to when a provider receives a fee for each service such as an office visit, test, procedure, or other health care service.  This is the most common form of payment for solo practitioners and doctor's groups.  Starting to bill Insurance Carriers does not change this.  Did you mean something different?  Like, maybe your client has been cash-only up til now, but now wants to bill Insurance Carriers?

2.  Electronic Medical Records (EMR) stores the data that a provider would normally place into a paper chart.  Practice Management (PM) software is the new name for what used to be called billing software.  In some software solutions, the EMR and PM are built together and share a common database.  In most software solutions, the EMR does not have a PM system built into it.  The EMR stores the patient's chart info in its own database.  The billing must be done out of a PM system, which has a separate database.  If the EMR and the PM won't talk to each other in electronic language (which most won't for now), demographic data and billing codes must be taken out of the EMR database and entered into the PM database before any billing can take place.  An example of this setup is Practice Fusion (EMR) and Kareo (PM) before their relationship broke up.

In the near future, CMS is going to start paying doctors less for Medicare charges if they are not using an EMR.  CMS is paying doctors up to around $50,000 over a number of years to help them pay for an EMR.  If your client has Medicare patients, is your client maybe talking about this situation and using the term "billing program" because s/he doesn't know better - when what s/he really wants is an EMR?

3.  The (old) billing software that I/we use can create multiple databases.  So we can bill in one of two ways.  We can have a separate database for each provider/doctor, and switch from one database to another when we switch work from one doctor to another.  Or, in a single database, we can have Doctor 1, Doctor 2, Doctor 3 .... Doctor n.  In that single database, we specify which doctor number we are working on, and the data input is applied to that doctor number in the database.  Given this setup, we can have as many doctors as we want when we create a separate database for each doctor.  Or - we can have multiple doctors, but only up to the limit that the program will handle, when we have multiple doctors in one database.

In practical terms, we are not limited by our old software as to the number of providers we can bill.  However, the terms of use state that the main program can only be installed on one hard drive at a time.  So, for example, I can install the software on my computer hard drive.  I can have, say, 300 providers that I bill for.  But I am limited to only one user - since only one person can sit at my computer at a time.  Or, for example, I could install the software on a server, and have multiple users dial into the server to work on billing for the 300 providers I have (in this example).

This is the common configuration for billing software / Practice Management software being licensed today.  The main part of the program, along with its Provider database, is installed on a server.  Users / billers then dial into the server from their own workstations.

4.  In today's sofware climate, both Electronic Medical Records (EMR) and Practice Management (PM) systems are offered at a price per provider and users.  A common offering would be $XX.XX for the first provider and three users.  That means the software and database is set up on a server, you can do billing for only one provider/doctor, and three billers can dial into the server from their workstations at any given time to work on that one provider's business.  You pay extra to enable more than three billers to dial into the server at the same time.  And you pay extra to add the ability to do the billing for additional providers - although the fee for these additional providers is normally less than the fee for the first provider.

The structure of $XX.XX for the first provider and three users would stay the same, regardless of whether your client purchases the system or you purchase it.  The provider is the provider, and the billers are the user, regardless of who purchases the system.  If you have ten clients, it would be cheaper overall for you to purchase the system at the full price for the first provider, and then pay for each additional provider at a reduced price.  Total price to you would be less than if each of your ten providers bought the system for themselves at the full price.

5.  When pricing billing software, ask if the software can create multiple databases (new databases).  If you pay for only one provider, that might mean only one provider in a single database.  If you want more than one provider in that single database, you will have to pay an additional fee - the Doctor 1, Doctor 2, Doctor 3, Doctor n in-a-single-database thing.  If you can create multiple databases with the software, you might be able to create a database for each new provider (like my billing software can do) without having to pay the additional fee for an additional provider.

6.  If you buy the PM system, I think it is fair to charge your next client whatever amount it costs to add him as a provider to your system; and if you need to add an additional user to process his billing, he should pay for that as well.  Spread the cost of the software out over 24 months and include it as a separate charge on your invoice you give him.  (If you are using Software as a Service such as Kareo, that extra monthly fee to add him as an additional provider will never go away.)

7.  Because CMS will soon reduce payments to doctors who bill for Medicare patients but don't use an EMR, you might want to consider whether to purchase an EMR and offer that as a service to your client(s) (for the appropriate fee of course).  In using your EMR, they won't get the payment available from CMS (neither will you), but they won't get their Medicare payments dinged.

8.  You asked if this relationship ever terminated, how would the provider get the info I have billed under my software?  Let's focus on billing only first.  Your client should have all his patient demographics, insurance info, and procedures / charges - either in his paper charts, or in his EMR.  The charges (codes) in your billing software should reflect / be a duplicate of what is in your client's paper charts / EMR.  The thing you will have that your client won't is how much each patient owes him at the time your relationship ends.  Others can chime in here, but my understanding is that it is common for the biller - when the relationship ends - to bill no more insurance claims, and to continue sending patient statements for the next four months (for a fee).  At the end of the four months, you would print out an age report and give it to your ex-client.  From that point forward, it is up to your ex-client to make efforts to collect what is still due him.

If you are also providing your client with an EMR, and your relationship ends, you have a much more difficult problem to solve.  See Point 9 for a discussion.

9.  Under the paper chart system, the paper chart was the legal record.  Even if the provider used an EMR and/or billing software, the electronics were not the legal record.  What was in the paper charts was the legal record.

Consider the paperless office.  No paper charts anywhere.  Only an EMR.  All data is there.  That is now the legal record.  When the doctor is charged with billing for work that was not done, the EMR is the legal record.  When he goes to court to defend himself against charges of billing for work that was not done, he will defend himself with what is in his EMR.

  a.  What if the IT tech missed the last backup and a technical glitch or virus wipes out all the data in the EMR?  With what will the doctor defend himself against charges of billing for services not provided?  At this point, he has no paper record or electronic record available to him.  Yet the insurance carriers he billed have detailed records of the bills he submitted to them.

  b.  What if you are providing the EMR to your client for a fee, he runs a paperless office, and you and your client have a falling out?  You own the EMR.  The doctor technically owns his data that is in your EMR, but how do you get that data to him in a form that is useable?  Again, with what will the doctor defend himself against charges of billing for services not provided?  At this point, your ex-client has no paper record or electronic record available to him.  Yet the insurance carriers he billed have detailed records of the bills he submitted to them.

  c.  I have a client who is putting data into the Practice Fusion EMR.  Assume he runs a paperless office and has no paper charts as back-up.  Assume a technical glitch or virus wipes out all of the data in the EMR, or assume the company goes bankrupt and shuts off power to their servers, or assume my client and Practice Fusion have a falling out and sever their relationship.  How can my client get his data out of a system that is no longer available to him?  With what will my client defend himself against charges of billing for services not provided?  At this point, he has no paper record or electronic record available to him.  Yet the insurance carriers he billed have detailed records of the bills he submitted to them.  (In reality, my client who uses Practice Fusion is also still using paper charts.)

With these three scenarios as a starting point, I'm sure you can think up your own situations where a provider will be screwed if he has all patient information in an EMR that he can no longer access, with no paper backup anywhere.  We have several former clients who have put themselves in this position, and that is why we let them go as clients.  How can we defend ourselves against charges such as billing for services not rendered if the data in the client's EMR becomes unavailable for whatever reason, and the client has no paper backup?

If a client insists on having an EMR, I emphasize that he should own it outright and have it installed on his own servers - for the reasons just discussed.  I cannot in good conscience recommend that any provider put his client's data into an EMR provided by an SaaS company such as Practice Fusion, and rid himself of all paper charts.  As fragile as electronic bits and bytes are, and as succeptible to bankruptcy and other mishaps as companies are, putting all patient data at the mercy of others just makes no sense to me.

On the other hand, there are always backups.  And we know that backups are always performed.  And we know that backups never fail.  Not.

You might also read the last paragraph of the post at this link:

http://www.medicalbillinglive.com/members/index.php?topic=7254.msg22376#msg22376
« Last Edit: April 12, 2013, 11:33:35 PM by RichardP »

tallmanusa

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Re: Suggestions for Billing Software
« Reply #54 on: April 13, 2013, 02:18:48 PM »
Richard, thanks for a well thought out posting.
However Practice fusion is used by 150,000 providers, that is just one EHR system, most providers using EHR  that I have seen have no paper records.
PF integrates now with Nuesoft and CollaborateMD. You are correct that an integrated system is preferable.
The prices are falling, they are about half now what they were as little as three months ago; and they would drop more.
Your caveats are well taken, but people have made hundreds of millions of dollars in this business (Jonathan Bush of Athena Health is one), I assume they were not so afraid of " what if? ". The current system is Godsend for savvy business people.

PMRNC

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Re: Suggestions for Billing Software
« Reply #55 on: April 13, 2013, 03:42:11 PM »
Quote
If a client insists on having an EMR, I emphasize that he should own it outright and have it installed on his own servers - for the reasons just discussed.  I cannot in good conscience recommend that any provider put his client's data into an EMR provided by an SaaS company such as Practice Fusion, and rid himself of all paper charts.  As fragile as electronic bits and bytes are, and as succeptible to bankruptcy and other mishaps as companies are, putting all patient data at the mercy of others just makes no sense to me.

Richard, I def agree with you on this one! Even with PM system, I have my clients sign all the agreements with them directly.
Linda Walker
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RichardP

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Re: Suggestions for Billing Software
« Reply #56 on: April 13, 2013, 06:58:22 PM »
PF integrates now with Nuesoft and CollaborateMD. You are correct that an integrated system is preferable.

This is just a technical point, but it is important.  An integrated system is preferable over a non-integrated system.  But integrated means only that the systems can accurately pass data back and forth amongst themselves.  At least in this thread, the point I was making was single database, not integrated.  EMRs and PMs that share a single database are preferred over an EMR and a PM system that each has its own database.  Unfortunately, not many single-database EMR/PM systems exist yet.  Practice Fusion and Kareo each had their own databases, but were supposedly integrated.  A great many posts on the internet testified to the many ways in which that integration failed.  Had Practice Fusion and Kareo shared a single database, those problems would have been non-existant.  Practice Fusion and its new partners may do a better job of integrating their data-sharing functions, but I believe they will still each have separate databases, not a common database that Practice Fusion and its partner can each access.

Quote
... people have made hundreds of millions of dollars in this business ... , I assume they were not so afraid of " what if? ".

That quote is looking from the perspective of the businessperson making money by leasing the system to providers.  What is at risk for the businessperson if their provider client is charged with submitting claims for work that was not done and the data in the EMR is not available for the provider to use to defend himself?  The total risk is to the provider, not the businessperson.  So why is it relevant to us what the businessperson thinks?

Quote
The current system is Godsend for savvy business people.

There is no denying that this is true.  And it will continue to be a Godsend until the moment it stops working.

What got me to thinking about what I wrote in my previous post above was physically standing one day by one of our ex-clients who had scanned all of his charts into his brand-new EMR and sent the charts out to storage.  I can still see him standing in the examining room, laptop in hand, as he began the polite banter that takes place before examining the elderly man.  His words were directed at the patient, but his eyes were scanning the screen on his laptop, as he began to familiarize himself with the patient's history.  Suddenly, his internet connection went down, and his screen went blank.  Patient in front of him, patient history at his fingertips for a quick review before questioning the patient, and then suddenly it wasn't.  Doctor had nothing in the office he could turn to to review the patient's history.  The doctor was dead in the water.  He had to cancel patients for the rest of the day.  Fortunately for the doctor, his internet connection was restored in time for the next business day.

In addition to my personal experience, I have read stories where there was a dispute over dollars owed to the software vendors by the providers.  Providers believed they didn't owe certain charges, vendors believed they did, and promptly blocked access to the providers' EMRs until payment was made.

Both of my examples here prove the concept of a provider being held hostage by those providing the computer technology.  In a paperless office, no access to the EMR is serious busines.  That reality needs to be accounted for before an office goes paperless, no matter how much of a Godsend the technology might be.
« Last Edit: April 13, 2013, 07:02:00 PM by RichardP »

tallmanusa

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Re: Suggestions for Billing Software
« Reply #57 on: April 13, 2013, 11:49:43 PM »
Richard you write well.
There are EHR and PM that work on single data base.
At least three come to mind; MD Online, Mastermind MD, and Total MD,( in a few weeks). All of these are relatively inexpensive, about $150 per month for both.

It is my impression that in our business there is tremendous demand, the demand outstrips the supply of RCM companies. It is no accident that Athena Health has 30% annual growth rate. That being said the doctors are not going to hand over their livelihood to someone working out of their suitcases. The doctors are looking for full services, including credentialing, coding advice, meaningful use help, HIPAA compliance etc.  Every time we have been contacted, it is because the doctor needed help with something other than just billing.
« Last Edit: April 13, 2013, 11:57:05 PM by tallmanusa »

RichardP

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Re: Suggestions for Billing Software
« Reply #58 on: April 14, 2013, 01:50:55 AM »
Thank you for your kind words.  Office Ally and Practice Mate, the EMR and PM systems offered by Office Ally also work off a single database.

DMK

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Re: Suggestions for Billing Software
« Reply #59 on: April 15, 2013, 11:05:44 AM »
"What got me to thinking about what I wrote in my previous post above was physically standing one day by one of our ex-clients who had scanned all of his charts into his brand-new EMR and sent the charts out to storage.  I can still see him standing in the examining room, laptop in hand, as he began the polite banter that takes place before examining the elderly man.  His words were directed at the patient, but his eyes were scanning the screen on his laptop, as he began to familiarize himself with the patient's history.  Suddenly, his internet connection went down, and his screen went blank.  Patient in front of him, patient history at his fingertips for a quick review before questioning the patient, and then suddenly it wasn't.  Doctor had nothing in the office he could turn to to review the patient's history.  The doctor was dead in the water.  He had to cancel patients for the rest of the day.  Fortunately for the doctor, his internet connection was restored in time for the next business day."


Awesome Richard!  This is one of the most salient points made on threads regarding EHR software.  This is the nightmare that most, if not all, providers have often.  And for several reasons.  Patients HATE when the doctor is looking at the screen and not them, and the information they have on screen is only as good as the data entry was.  I've worked both ways, and have stayed with paper.  I know we'll have to eventually start to put all the info into an EHR program, but I will retain the paper backup.

I will grant you that files can get misplaced, studies not filed correctly, and there have been disasters that have wiped out both physical and electronic files.  When someone can figure out how to plan for ALL contingencies we'll all be better off.  But for now, we do the best we can with what we have, and roll with what happens!  I will say that the younger people coming into this field NEED to know how to do things manually as well as electronically and to understand WHY they need to know how to do things both ways!