Author Topic: Can you make a profit by charging 4%?  (Read 23664 times)

tallmanusa

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Re: Can you make a profit by charging 4%?
« Reply #15 on: November 09, 2012, 03:03:39 PM »
I believe compliance issue is addressed by the Kareo/ Practice Fusion software.

supertaz93

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Re: Can you make a profit by charging 4%?
« Reply #16 on: November 09, 2012, 03:12:25 PM »
There is a lot more to "compliance" than just your software. 

tallmanusa

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Re: Can you make a profit by charging 4%?
« Reply #17 on: November 09, 2012, 05:24:15 PM »
I am not sure how much HIPAA effects the medical billing companies. From what I can gather it does not, as long as your software complies with certain requirements; Kareo advertises that theirs does.
www.athenahealth.com is a public company and they claim to have over 39,000 providers they service, I believe most of their work is outsourced to India. ( By the way they charge an average of 6%). If HIPAA was such a big deal, these mega companies would not exist.
« Last Edit: November 09, 2012, 05:27:20 PM by tallmanusa »

PMRNC

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Re: Can you make a profit by charging 4%?
« Reply #18 on: November 09, 2012, 06:49:51 PM »
Quote
I am not sure how much HIPAA effects the medical billing companies. From what I can gather it does not, as long as your software complies with certain requirements; Kareo advertises that theirs does.
www.athenahealth.com is a public company and they claim to have over 39,000 providers they service, I believe most of their work is outsourced to India. ( By the way they charge an average of 6%). If HIPAA was such a big deal, these mega companies would not exist.

I think my blood pressure went up a bit here.. I mean no disrespect but this is why physicians need us. You've been misled, mis taught or received mis information. Billing companies are INDEED subject to compliance issues. You are a business associate under HIPAA however carry the same penalties, fines and liabilities as the doctor himself, in regards to fraud/abuse. Your software and software company are merely "tools".  That doesn't even scratch the surface.
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

tallmanusa

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Re: Can you make a profit by charging 4%?
« Reply #19 on: November 10, 2012, 08:34:18 AM »
Pray tell me, how do so many medium to large sized companies outsource all their work?
There is a consultant Rochelle Glassman of Phoenix Physician Services
http://www.pps247.net/index.php?option=com_content&view=article&id=13

She gives webinars for Kareo:  https://www.kareo.com/resources/webinars

Her next webinar is on November 15.
She has completely different views than yours, that it is completely doable with Kareo software.

Regarding outsourcing our only trade organization hbma.org provides guidance for outsourcing including resources; they have a compliance conference on March 15, 2013. In my conversation with them, they informed me that HIPAA does not
" materially " effect medical billers, caveat that they use a software that has built in compliance.

If you could kindly give us a link where it describes that HIPAA is onerous specifically for medical billers I would appreciate it. It may be onerous for providers just not for the billers.

I don't plan to do any business with any provider that is not on EHR and PM web base platform.
Physicians do need us, but only if we add some value to their business and increase their revenues; the first step for them to increase their revenue is not us, but to implement EHR and PM.
« Last Edit: November 10, 2012, 09:14:10 AM by tallmanusa »

PMRNC

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Re: Can you make a profit by charging 4%?
« Reply #20 on: November 10, 2012, 09:46:14 AM »
There are two MAIN facets of HIPAA compliance, one is transactions and the other is Privacy and security. Providing links would take all day. Yes among MANY other things your software must be HIPAA compliant. They all are.. old news.   In addition as a business associate of covered entities you are required to be sure your entire business and infrastructure is in compliance.. from making sure all employee's have secure login's and only given the "minimum access required".  Making sure if you have employee's working OFF site, they too are in compliance. Having a work at home biller who works at her kitchen table is NOT compliant. The laws apply to every person touching PHI. Files left on a desk, home offices with OUT private access to fax or filing cabinets that are accessible is NOT HIPAA compliant.  Since you are a physician, it actually should be easier for you to forsee these issues and put yourself into your clients shoes. Your butt is on the line EQUALLY as the providers.  HAVING E/O insurance is critical but your E/O is only going to bail you out IF you and your employee's all are in compliance.   As a billing company your job is to make sure your providers are compliant and that you and all employee's are compliant along with their operating structure. Kitchen table billers are NOT going to cut it. 

I use Kareo too and they are great... Awesome even. :)    But your only looking at it from a software stand point when there is SOOOO much more that goes into compliance than just your software.   This is why having a compliance plan is critical for any billing company.  Read more about that on the OIG's website at: https://oig.hhs.gov/fraud/docs/complianceguidance/thirdparty.pdf

Just a tip too .. UNRELATED.  Today's billing company needs to be diversified to compete. For example, it's great your doing your homework in purchasing software, but you need to be ready for the providers who have already invested a great deal of money on their own PM solutions that don't want to change, they want to work with what they have. I've seen MANY billing companies turn down clients because the client wanted to stay on their PM system, that's because they are not prepared, all the medical billing classes and educational programs, online courses do NOT tell you things like this.  My PM solution is JUST for the ones that need one or want to switch. I utilize the clients PM solutions if they want me to. I've never turned down a client because of a software issue. I don't put all my eggs in one basket.  Just a little tip :)
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

PMRNC

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Re: Can you make a profit by charging 4%?
« Reply #21 on: November 10, 2012, 09:49:05 AM »
Also from a marketing standpoint, having a compliance plan will win you clients over the ones that don't. In my experience over the last decade, I'm willing to bet only 2 in 10 billing companies actually have a compliance plan. I don't even wait for my potential clients to ask for it. I market the fact that I have one and it's open for them to review.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

tallmanusa

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Re: Can you make a profit by charging 4%?
« Reply #22 on: November 12, 2012, 10:42:56 AM »
Some very good points.
How do I develop a compliance plan?
You are correct what do I do when a provider insists on using his own software?
If he has no EHR, and does not want to use one, I would pass on him.
My price of 5% solution includes the software for PM and EHR.
If he already has EHR we would work with that.
What happens if he has PM but not web based? Some providers have spent big money on software and don't want to change, even though it may be obsolete.

DMK

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Re: Can you make a profit by charging 4%?
« Reply #23 on: November 12, 2012, 10:50:53 AM »
Thanks Linda for putting it so succinctly.  Some billers don't think HIPAA all the way through.  Billers have more patient information than the doctors do, BECAUSE they have multiple doctors.  If it were only data crunching will Dx and CPT codes that would be one thing, but those codes get attached to PEOPLE's information (date of birth, social, name, address etc).  It's a big responsibility and not one to be taken lightly.  If someone (the owner of the billing company, or a low paid data entry person) is that flippant about someone else's personal information then they shouldn't be handling it.

tallmanusa

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Re: Can you make a profit by charging 4%?
« Reply #24 on: November 12, 2012, 10:55:02 AM »
I asked elsewhere, there are middle to large companies doing most of this business who outsource most of their work within USA or offshore. These companies handle 80% of all the medical billing business. How do they do compliance?

PMRNC

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Re: Can you make a profit by charging 4%?
« Reply #25 on: November 13, 2012, 02:05:14 PM »
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How do I develop a compliance plan?
Take a look at the link I provided above for the OIG's compliance plan for the third party billing company.

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You are correct what do I do when a provider insists on using his own software?
With technology today there are just so many ways to access the provider's system remotely. The most reliable I have researched was using logmein.com Each of my clients has an account. For every client that I utilize THEIR PM System I have my OWN login to both the Administrator's access on the computer (windows login) and there are 2 more layers of security using LogmeIn   So long as the process you use is HIPAA compliant you are fine. Having my OWN login is also good for audit trail purposes in addition to being compliant.

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If he has no EHR, and does not want to use one, I would pass on him.

Why?  I've never turned down a client for software, their business is medicine. If it's something I can't work with, I'll find a way, in this industry turning down a client is NOT a good idea.  JMHO


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What happens if he has PM but not web based? Some providers have spent big money on software and don't want to change, even though it may be obsolete.

As long as their PM solution is HIPAA compliant, 5010 ready, there's no reason it can't be utilized. There are plenty of remote options like I mentioned above. The challenge is of course if your not experienced there's a learning curve of the PM software. With my experience so far, I've never found a PM system I couldn't find my way around.

Quote
I asked elsewhere, there are middle to large companies doing most of this business who outsource most of their work within USA or offshore. These companies handle 80% of all the medical billing business. How do they do compliance?

With offshore companies they are NOT required to adhere to US laws, therefore full compliance and liability falls on the provider. This is how I usually get a potential client to turn away from offshore, by simply explaining the money they are saving with the billing they will spend twice as much in their FREQUENT but NECESSARY trips to these facilities. That is the ONLY assurance of compliance you have. I'm constantly amazed at these doctors who offshore outsource and have never visited the place, and have just taken these companies at their word!! 
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

rdmoore2003

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Re: Can you make a profit by charging 4%?
« Reply #26 on: November 13, 2012, 02:25:55 PM »
i need a drink after this.   hipaa should be the first thing, IMO, that a person should learn about in its entirety before even starting in any part of the medical field.  and never ever go by something you were told by another person just because they do some sort of webinars or training.    most people will tell you that psychologists cant write rx, but that is false.
Regina

PMRNC

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Re: Can you make a profit by charging 4%?
« Reply #27 on: November 13, 2012, 06:00:07 PM »
Quote
i need a drink after this.   hipaa should be the first thing, IMO, that a person should learn about in its entirety before even starting in any part of the medical field.  and never ever go by something you were told by another person just because they do some sort of webinars or training.    most people will tell you that psychologists cant write rx, but that is false.

A glass of wine to Regina from me :)       I totally agree. You have to remember you have NO way of knowing the company your speaking with IS adhering to compliance.  Something simple like an unlock able filing cabinet!  I mostly see the problems with the ones that hire outside help and don't maintain the proper insurance or check and make sure they are compliant themselves since it's their liability.   
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

tallmanusa

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Re: Can you make a profit by charging 4%?
« Reply #28 on: November 14, 2012, 06:20:02 AM »
There are dozens of companies who collectively service the vast majority of providers. I will give one example of athenahealth.com, because this is a public company symbol ATHN. What they do is public information. They claim to have 39,000 providers as clients. They outsource most of their billing. They are not the only ones, almost all companies public and private outsource their billing services, some within USA, some offshore. That is how this business is run, at that level.
And yes, they don't take anyone who does not have EHR, like most of these companies.
I am at a loss, if that is how the business is done, then where is the problem?

rdmoore2003

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Re: Can you make a profit by charging 4%?
« Reply #29 on: November 14, 2012, 09:27:59 AM »
Linda, thanks for the wine.  :)
Regina