Author Topic: Take pity on the newbie and help answer some questions! Thanks!  (Read 2044 times)


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Take pity on the newbie and help answer some questions! Thanks!
« on: October 28, 2008, 11:51:51 PM »
I've been busy searching and reading as many billing forums as I can find and I still have some questions I'm hoping one of you more experienced business owners out there can answer.  I've done medical and dental billing as an employee for many,many years and am now on the brink of starting my own business.  I have what may be some really silly questions, but they need to be asked!   

1.  As a billing company, when you call and insurance carrier to check on the status of an outstanding claim - how do you identify yourself? As the billing company or that you are calling on behalf of dr. so-and-so?

2.  Does anyone have any opinion on billing via the physicians software directly - as in using VPN to access their computers directly?

3.  I have a physician who may start using me initially just to help with older, outstanding claims.  Here's the scenario I'm facing:  He has his own software and will hand the majority of his own billing.  He hands me, say 20 claims a month that he can't get paid. I use his software (via VPN) to access the patient information, rebill the claim, etc.  So, at the end of the month, the total report will show all payments received and there is no way to break down the payments for just the claims I've gotten paid.  Therefore, I need to find a way to invoice and track my payments separately. Does anyone have any opinion on what kind of invoicing/accounting software would be best for this?

whew - hope that was clear enough.  That's enough questions for the moment - I'm sure I'll have more in the days and months to come!  I have to say to all of you already established in this business - Way to go!  There's SO much more to starting up this type of business than I thought when I started this!  Thanks so much for any help you can provide!



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Re: Take pity on the newbie and help answer some questions! Thanks!
« Reply #1 on: October 29, 2008, 10:54:04 AM »
Welcome to the forum!

As for your questions:

1.  When we call insurance carriers, we identify ourselves as 'calling from Dr. Soandso's office'.  It is too complicated and confusing to say that we are a billing service and blah, blah, blah.  If we are asked directly if we are in the office, or if we are a billing service we always answer honestly.  We are not trying to hide anything, it's just too complicated to explain for every single phone call.

2.   We have a few providers that we access their software to obtain the info we need to bill, but we always use our software to bill.  It would be too difficult to learn a new software for each dr.  We are used to ours, we know ours, we have our electronic systems in place, etc.  So it wouldn't really be feasible for us.  However, if you are just starting out, and that is an option that will save you from having to purchase software immediately, it may work for you.

3.   When you are doing strictly 'clean up' work it is harder to make money.  Your regular fees aren't really enough.  For example, he's giving you the problem claims so there is a possibility (higher than normal) that the claims might not all get paid.  Your risk is higher than if you were billing everything.  Also, like you said, it will be difficult to track.  You might want to consider charging a different way on those claims.  Either a higher fee, or a per claim, or hourly.  In any case, I'm not sure what to recommend for tracking other than a manual system, which is not ideal.   :(

Hope that helps you out.  Good luck in getting started.

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Re: Take pity on the newbie and help answer some questions! Thanks!
« Reply #2 on: October 29, 2008, 02:08:47 PM »

Like Michelle said, this is the hardest work. This is the kind I am doing right now. I receive the rejections and EOBs through the mail or fax. I have forms that I use to track all the calls I make until I get the payments. You sometimes have to call many times before something gets done by the insurances.(follow-up, follow-up!! very time consuming). Other times, I have to correct and resubmit and follow up. The appeals are rare (so far). It takes me time but at the end I get the provider paid . My salary is based on the percentage of what I collect. I work from home..

When the provider receives the payments, ask him to send you the EOBs. Yes, the only way to track this is to do it manually.


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Re: Take pity on the newbie and help answer some questions! Thanks!
« Reply #3 on: January 20, 2009, 12:26:08 PM »
Keep a copy of every claim you process. Most Insurance companies have online claims submissions as well as status. Log every client you process, contact the insurance company or look online for payment dates and amounts and log that. Nobody can keep me from my MONEY!!!