Author Topic: Can you make a profit by charging 4%?  (Read 23533 times)

DMK

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Re: Can you make a profit by charging 4%?
« Reply #30 on: November 14, 2012, 10:21:34 AM »

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?

Because small practices and rural practices will NOT have to have EHR if there is financial hardship, but they will still need to bill for services.  If you are only going to focus on large practices, hospitals and clinics, YOU may not care about outsourcing or the little guy, but most of the billers on this forum are servicing small businesses as well as good size clinics.  The little guy will get fined for non-compliance just the same as the big guy, however, he'll get fined right out of business!

QueenAlicia

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Re: Can you make a profit by charging 4%?
« Reply #31 on: November 16, 2012, 02:54:35 AM »
WOW! My jaw dropped.  Billing companies MUST comply with HIPAA.  Don't comply you won't be in business long and you'll probably be in jail, lol.  I think a revisit to the OIG third party portion may be in need here  ;D

For example, if you are faxing over patient  you know that you must black out some information?  That is apart of HIPAA as well as verifying patient identity over the phone.  You can't just give out patient information without identifying who the person is. 

Outsourcing to India is another story and those HUGE companies will eventually fail because the patients will complain about their information being over there.  In addition to that the laws here in the US do not apply over there and there have been several incidents were the offshore company has threatened to sell the providers patient info if they did not pay more money. 

I would not trust ANY company that does business over there because it shows that they care about the dollar more than patient information security. 

tallmanusa

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Re: Can you make a profit by charging 4%?
« Reply #32 on: November 16, 2012, 06:45:36 AM »

There are dozens of huge companies who do this business, actually well over 80% of the business is done by a handful of companies, they ALL outsource.
One company, which is public so their records are public information; Athena Health symbol ATHN, is valued at 2.2 Billion dollars; its CEO got paid $300 million dollars (including stocks) last year, he is not in jail , he is doing fine, living in a mansion of 50 million dollars. Again all of this is public information.
By the way they charge 6.5%.

DMK

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Re: Can you make a profit by charging 4%?
« Reply #33 on: November 16, 2012, 10:37:57 AM »
Athena is probably doing everything right, but I doubt that they all are.  BTW are you working for Athena? Because it sure sounds like a sales pitch.

This forum is a great place for back and forth discussion about ALL the complexities of Medical Billing, not just a soap box for doing it ONE way. 

As a nation, we are built on a lot of small businesses.  True, there are large companies, making lots of money, but this forum is mostly about the little guy or the newbie or the person who wants the American dream of owning their own business.

There are laws in place (some good, some bad, some well intentioned but with bad consequences) that we ALL have to follow.  The big guys can pay the fines and pass the costs on to their consumers, the little guy needs to do it RIGHT the first time and all the time. 

If you don't understand this, you don't understand most of the people in this forum.

tallmanusa

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Re: Can you make a profit by charging 4%?
« Reply #34 on: November 16, 2012, 11:03:41 AM »
No, I don't work for Athena; what sales pitch,  I compete with them.
I give their example because it is a public company, I don't have accurate information about private companies.
For the record I am building a company that someday would be a public company.

Laws are the same for little guys and mega companies. I don't believe that big companies get away with it because they are big. If anything big companies draw more attention and are subject to more scrutiny than little guys.

I pointed out how big companies are doing it, I don't make any value judgement, whether it is right or wrong, I state the way it is.

PMRNC

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Re: Can you make a profit by charging 4%?
« Reply #35 on: November 18, 2012, 06:10:01 PM »
Quote
There are dozens of huge companies who do this business, actually well over 80% of the business is done by a handful of companies, they ALL outsource.
One company, which is public so their records are public information; Athena Health symbol ATHN, is valued at 2.2 Billion dollars; its CEO got paid $300 million dollars (including stocks) last year, he is not in jail , he is doing fine, living in a mansion of 50 million dollars. Again all of this is public information.
By the way they charge 6.5%.

Mom said.. "If everyone was jumping off the bridge, does that mean you should and that it's ok to jump off the bridge"   I'm confused and your confusing others because you come here, look for help, some of us have been doing this for decades, you want feedback and our opinions and we give them. But it does seem like you want us to tell you what you want to hear.    Did you ask Athena Health what their protocol is for patients who don't want EHR and choose to opt out? Did you ask any healthcare provider or offshore company what measures are in place for telling patients their information is being sent offshore?    Seems to me your looking only at the $$ issues and you again, just want us to tell you what you want to hear. At this point.. good luck and I hope things work out for you. Not much more we can say.
Linda Walker
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RichardP

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Re: Can you make a profit by charging 4%?
« Reply #36 on: November 19, 2012, 08:45:15 PM »
A few points that occurred to me reading through this:

1. tallmanusa does not sound to me like any doctor that I have ever talked to that has been in private practice for 30 years.  Maybe he was a corporate worker-bee doctor working for wages.

2. From my conversations with big business, it sounds like they plan to honor HIPAA mainly in the breach.  "Let them sue us" seems to be a safe proposition because a.) most patients don't know enough about what their rights are to know what a violation would be; b.) most patients have no clue what is being done with their electronic data, and so would not even know that a violation has occurred, and; c.) the agency charged with policing HIPAA violations does not have the budget to monitor the majority of violations.  They few fines they will be able to levy will just be a cost of doing business.

3. As of about three months ago, a great many users were complaining that they were having trouble getting Practice Fusion and Kareo to talk with each other in all the ways needed in order to do billing properly.

4. Practice Fusion will only display 1,000 patients at a time.  For a practice that has more than a thousand patients, cleaning up problems in the database becomes impossible.  Practice Fusion has a limited set of criterion on which to search, and the problems that don't meet those criterion are invisible to you unless you know the specific patient to search for.

5. Office Ally comes in two parts:  a.) Practice Mate, which you use as any practice management system, inputting patient demographics, insurance info, and billing codes.  You bill the HCFA stuff electronically, and the patient statements by printing them, and; b.) Office Ally.  The Office Ally side is electronic billing only.  If you have your own billing program, you can print your statements to a text file and upload that text file to the Office Ally side of "Office Ally".  They turn that text file into electronic data and send it off electronically just as if you had submitted the data through the Practice Mate side of things.  tallmanusa can accept clients who are not web-based and still do electronic billing in this way.

6.  I have a number of clients who see 20-30 patients a day, and all of them have a Physician Office Lab (POL).  Because of the Labs, we do very complicated billing, the tracking of which requires copious pop-up note-posting on the account itself, not in some contact software that has to be accessed separately.  Practice Mate in "Office Ally" does not have such note-posting ability and I think Kareo does not either, so they are useful only for very simple billing.  Kareo can handle more complexity, and has way better reports, than "Office Ally" - but is still not complex enough for my needs.

7.  Many of my clients are not Participating Providers in Medicare; more will probably be dropping out.  None plan to use EMRs.  But they still have to bill.  They use their billing software for Scheduling patients, inputting demographics and insurance info.  We put in the DX and CPT codes and print to text file, then upload to the Office Ally side of "Office Ally" for electronic billing.  Probably five of my clients bring in (not "charge", but actually bring in) more than one million dollars in income per year.  My clients do high-volume, high complexity work, which makes for complicated billing.  And we manage quite well with the set-up I just described.

8. Practice Mate in "Office Ally", Kareo, and Practice Fusion, are not complex enough to handle our billing needs with the ease that our current software does.  But then, it cost a good bit to buy.  We charge 5% plus certain minor fixed expenses, and pay some of our workers $30.00 per hour, and still turn a nice profit.  But we are in Beverly Hills.  Your mileage will vary if you are outside of a major metropolitan area.

I have no doubt forgotten some of the other points I was going to make, but hopefully this much helps someone.

tallmanusa

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Re: Can you make a profit by charging 4%?
« Reply #37 on: November 20, 2012, 08:41:51 AM »
Thanks for the comments Richard, very helpful.
I agree with you that most billing companies have many things to worry about, HIPAA is not one of them, as long as you follow some basic rules do your best to comply with them.
My impression is that the platform you use is the key to this business, you survive or perish on the system you choose. This is an IT business more than ever, or at least it has become one now.

Office Ally/ Practice mate, I did not think that it was a good enough system that I would want to offer; but it is free.

Kareo/ Practice Fusion is good enough and will do for most practices, cost $299 per month for the top platform, but not good enough for large practices.

What if you have large practices:

There are two that I investigated, I am sure there are others.

Advanced MD
Health Fusion/ Meditouch, this works with ipads as well.

The above two are more expensive than Kareo.

If you charging only 5% your profit is constrained if you offer high end platforms.

I could not pay $30 per hour and be profitable. In addition the technology is so superb, why do I need such experienced biller? I plan to outsource the billing for a fraction of that cost.
I have to make a profit, otherwise I would not be doing this for long. You can charge more, which I would not, or you can skimp on the platform which is imprudent or you outsource, which I chose.
Outsourcing does not have to be offshore, it can be within the United States.

QueenAlicia

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Re: Can you make a profit by charging 4%?
« Reply #38 on: November 20, 2012, 03:57:54 PM »
AMEN CLAP CLAP CLAP!;D

Athena is probably doing everything right, but I doubt that they all are.  BTW are you working for Athena? Because it sure sounds like a sales pitch.

This forum is a great place for back and forth discussion about ALL the complexities of Medical Billing, not just a soap box for doing it ONE way. 

As a nation, we are built on a lot of small businesses.  True, there are large companies, making lots of money, but this forum is mostly about the little guy or the newbie or the person who wants the American dream of owning their own business.

There are laws in place (some good, some bad, some well intentioned but with bad consequences) that we ALL have to follow.  The big guys can pay the fines and pass the costs on to their consumers, the little guy needs to do it RIGHT the first time and all the time. 

If you don't understand this, you don't understand most of the people in this forum.

RichardP

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Re: Can you make a profit by charging 4%?
« Reply #39 on: November 21, 2012, 04:47:00 PM »
tallmanusa - more stuff to think through.  Questions are not confrontational; rather, they are meant to stimulate thought.

1.  I should have been more clear.  The "big business" I was referring to were hospitals, doctors, data aggregators (who are sucking in data from hundreds of hospitals for the purpose of data mining - without the knowledge or permission of the patient), and anybody else who will be doing something with electronic patient data.  I was not necessarily referring to billing companies - although some might fall into that category - like the larger ones who ship stuff overseas.

2.  The combination of Practice Fusion and Kareo might work for some physicians - but pay attention to the complaints on Practice Fusion's boards about Kareo and Practice Fusion having difficulty talking to each other for billing purposes.

3.  Any doctor who is already established in private practice will have his own billing setup.  Why would he need you?  You have to have an answer he will buy into if you expect to get him as a client.  That is why I mentioned the Office Ally side of "Office Ally".  It is simply a clearinghouse - like any other clearinghouse - except that it is free if Medicare claims are less than 50% of total monthly submissions, and $20 per month if Medicare claims are 50% or more.  And you can take data from any billing program that will print claims to the hard drive as a text file - which most if not all of them do - and upload that text file to Office Ally.  That would perhaps be a service to a physician who is not yet billing electronically, who wants to, but doesn't have the funds to pay for a system that bills electronically.

I would recommend the Practice Mate side of "Office Ally" only to those who must do electronic billing and don't currently have their own billing software or the means to pay a monthly fee for a cloud system (who would that be - doctors just getting established in private practice?).  It is seriously limited in terms of being able to create reports and clean up mistakes in the database.

4.  Have you figured out the answer to this question yet: Do you want to build a kingdom, or do you want to make money?  Sometimes you can make more money by being smaller than you can by being bigger.  I have a number of clients who earn (not bill) over one million dollars per year.  We collect that money with the homely system I described above - a legacy billing program that does what I need it to do for the complex billing we do, print the HCFA output to a single text file, and upload the text file to the Office Ally (clearinghouse) side of "Office Ally".  How could my clients practice better medicine, and how could I make more money, by having a shiny, new "IT solution"?  My clients and us already faced that question together and decided we are fine as we are.

5.  Doctors don't make money by working hard.  Doctors make money by being paid for the work they do.  And they get paid for the work they do ONLY by making sure ALL the work they do is billed, and billed at the appropriate level. That is the value of a biller who knows what they are doing.  Here's an example.  Ponder what I've said here as you think through what you are actually trying to do.

We have been asked to take on a client who has established a state-of-the-art 50-doctor doctors' group with state-of-the-art equipment.  Labs, radiology, whatever-you-need, can all be done on-site.  Problem is, they are a start-up, and income does not yet exceed expense (the doctors are very well paid, which is part of the problem).  We will take them on as a client if they make it to the point that income exceeds expense (we don't fund start-ups; we also want to get paid for our work).  We consulted on the start-up, and have been monitoring the billing for them.  Their billing is currently being handled by a large billing company that sends the work offshore.  They bill what is sent to them, and nothing more (is that the kind of company you are wanting to create?).  The doctors are cracker-jack doctors who are top experts in their field.  But they don't know diddle about getting themselves paid.  As we monitor their billing, we see time and again when they don't bill for all the work they performed.  And often, what they do bill is for a lower amount than what their work qualifies for.  In short - these top-notch doctors are leaving on the table about 30% of what they could get paid.  Yet, their current billing company (who charges more than we do) is giving the doctors zero feedback about this.  And the doctors are using an electronic billing "IT-solution" that costs several hundred thousands dollars.  And yet, even using this, those doctors are leaving on the table about 30% of what they could be earning.  The current billing company is not helping them avoid this.  The expensive IT solution is not helping them avoid this.  Only billers who know what they are doing, who give a damn, and who work hands-on with each physician can help them avoid this.  And the bad part about all of this is the doctors don't even know they are leaving money on the table until it is pointed out to them.

Hopefully, this blurb will help you better understand the lack of understanding you displayed in this part of your response to me:  "I could not pay $30 per hour and be profitable. In addition the technology is so superb, why do I need such experienced biller?"

Experienced billers who know what they are doing are the only ones who will know when you are leaving money on the table.  Technology cannot help you with this.  But this is relevant only for complicated billing.  Simple billing is another matter.  But, again, if the billing is simple, why would they need you?

tallmanusa

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Re: Can you make a profit by charging 4%?
« Reply #40 on: November 23, 2012, 10:04:34 AM »
Thanks for a very thoughtful response.
Just a question; your doctors seem to have a substantial practice, why not use a robust PM system like Advanced MD instead of Practice Mate.
And are you familiar with Mitochon, a free EHR and PM system?

You raise a very good question; with all this technology why would a doctor need us? I have to be able to answer this question, and in some detail.

The flip side of this technology is that billers are available at very low cost; I plan to pay 1% of the collections revenue cycle managment, and I have no shortage of them in United States; no need to go off shore.
The technology did not eliminate the job of billers, but it made their jobs scarcer to find.

PMRNC

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Re: Can you make a profit by charging 4%?
« Reply #41 on: November 23, 2012, 11:49:56 AM »
Quote
The flip side of this technology is that billers are available at very low cost; I plan to pay 1% of the collections revenue cycle managment, and I have no shortage of them in United States; no need to go off shore.
The technology did not eliminate the job of billers, but it made their jobs scarcer to find.

I disagree, I do not think technology is pushing billers aside nor do I think they would be available at "low cost"  First of all.. the position of "Medical Biller" is really outdated. If you are JUST a biller, you probably have been w/out a job for a while.  WITH The exception of marketing I do not ever use the term Medical Biller to describe my self, I am a practice management administrator and consultant. I DO MUCH more than billing. And if we are going to talk about how technology has made them scarcer I would have to ask then why would a medical billing company need to hire billers than?  ::) ;D     

Only about 15% of what I do is medical billing actually. Almost everything else I do is not available with technology at all.  Today's billing company has to be a full practice company and must offer a wide variety of services. Not to mention there are quite a few other things I can still add and might add in the future.

Nope.. I pretty solidly sold that my services will still be in demand even with all the technology.   Though, I still do believe we won't see EHR as mandatory like they say.. I see so many delays coming.. it's inevitable.
Linda Walker
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RichardP

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Re: Can you make a profit by charging 4%?
« Reply #42 on: November 28, 2012, 10:34:24 PM »
It's been a busy week.  Hope all who celebrated had a happy Thanksgiving.

tallmanusa, you asked "your doctors seem to have a substantial practice, why not use a robust PM system like Advanced MD instead of Practice Mate."  Short answer: we get the job done with what we currently have, as described above.  The billing software was paid for long ago, it does what I need it to do for complicated billing (things that more "robust" software does not do),  and electronic billing through Office Ally is $20 per month only if Medicare is greater than 50% of the billing.  I would gain nothing by switching to a different system.

Only one of my clients is using EMR, and is using Practice Fusion for that (it is pretty intuitive to use).  We do the billing through my billing software as described above, which easily handles complicated billing.  We have a customized fee slip that the doc uses to mark off what he did and sends that paper to us.  The one client I have that was using the Practice Mate side of "Office Ally for billing, I have switched to my billing software and bill as described above.  The paper fee slip leaves an audit trail for us to point to in case we are ever accused of billing for charges that the doctor didn't authorize.  That protection is a valuable thing to have, and is difficult to come up with in a totally paperless practice (complicated subject not suitable for discussing here).

Other than the client using Practice Fusion, none of my clients intend to use an EMR.  They will drop out of Medicare first if push comes to shove.  My one client who uses an EMR says it has added about 1 1/2 hours to his work day just inputting all the data into the computer (others who use EMRs agree that his figure is consistent with the increased amount of time they must spend).  He is seriously considering dropping the EMR.  Seriously take some time and think this through.  This doctor is one who earns more than one million dollars per year.  Estimate what that translates into in terms of earnings per hour.  It is now costing him 1 1/2 hours of earnings, every single day, just for the "priviledge" of using an EMR (plus whatever charges there are related to using the EMR).  If he stopped using the EMR, he would re-gain that 1 1/2 hours of earnings every day.  Multiply this reality by every doctor using an EMR and you can see some implications for long-term use of EMRs.

I did not ask "with all this technology why would a doctor need us?"  I suggest you re-read both of my posts above to see what I actually said.  Which was - technology cannot give a doctor what he actually needs in order to get paid - which is, someone who knows all that he can bill for, and what the highest level he can legally bill for and still get paid is.  Remember my potential client with the 50-doctor doctors group?  They have very bright and shiny and expensive technology - and they still leave about 30% of their money lying on the table.  And they don't even know it (until we point it out to them).  What caused you to think, from that example of the doctors leaving money on the table, that I asked "with all this technology, why would a doctor need us"?  I said the exact opposite:  it is not the technology that gets a doctor paid; rather, it is the knowledge in the head of the biller.

The technology may help figure out, on an aggregate level, which treatments lead to the best outcomes (data-mining aggregated EMR data).  But you (and we) are not concerned with that.  We are concerned with getting the doctor paid - by billing for all work done, at the highest rate that is legal.  And, as the example given in my previous post shows, the technology does not help with that.  Only the knowledge in the biller's head can help with that.  (Read that last sentence over until you get it.)  But this point is valid mostly for doctors who do complicated billing.  Doctors who do really simple billing don't need a knowledgeable biller.  But then, they don't need complicated technology either.  Which of those types of practices (complicated or simple billing) are you going to sell your services to?  Just remember that the robust IT solution is not going to help either one of those types of practices get paid.  The complicated practice does need a biller who knows what they are doing.  The simple practice doesn't.  But the simple practice doesn't need complex technology either.  So what is it that you are going to be selling if you think technology is more important in the billing process than wetware - when the technology does not actually get the doctor paid?

Note:  Assume a single procedure code with three supporting diagnoses.  I assume you know that your three supporting diagnosis codes must be appropriate to the procedure code in order for you to get paid.  But did you also know that which diagnosis code is listed first can determine how much you get paid for the procedure?  Put the right diagnosis code first and you will get paid the maximum.  Put a different one of the three diagnosis codes first, and you will get paid less than the maximum - sometimes substantially so.  If you didn't know this, you'd better hire someone who does know it.

Good luck with what you are thinking about doing.  Keep us updated.

Finally - what Linda said.
« Last Edit: November 29, 2012, 12:19:06 AM by RichardP »

Michele

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Re: Can you make a profit by charging 4%?
« Reply #43 on: November 29, 2012, 07:41:47 AM »
Garbage in - garbage out....no matter how good the system is.  :)
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tallmanusa

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Re: Can you make a profit by charging 4%?
« Reply #44 on: November 29, 2012, 02:52:23 PM »
Here is a link that speaks for itself. It is a thorough study.

http://www.cdc.gov/nchs/data/databriefs/db98.htm

Quote:
 "Eighty-five percent of physicians who have adopted an EHR system reported being somewhat (47%) or very (38%) satisfied with their system."

It is anticipated that vast majority of practices have already adopted EHR or in the process of doing it; (55% in 2011). It would be completed before 2015 by all physicians practicing in USA; read the whole study. That is the reality.

There are five major medical billing companies in United States, most of those in business know who they are, they do about 80% of all business in medical billing. They ALL use cutting edge technology.
If I am going to be in business and I am going to challenge them, I have to do what they do, and be better and cheaper than them.
No rocket science, ABC of business.
Of course, if I did not want to challenge them, I could get by with my pencil and paper.

When I make a statement, I give a link to a study, data, or factual basis for the statement. I would hope others would do the same.