Author Topic: Can you make a profit by charging 4%?  (Read 22202 times)

tallmanusa

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Re: Can you make a profit by charging 4%?
« Reply #60 on: December 07, 2012, 06:44:32 AM »
It is quite simple, the larger companies outsource to India, where billers get paid 50 cents an hour.

You can't pay $15 per hour and compete with someone who pays 50 cents per hour. There is no evidence that what the companies get for 50 cents per hour is any worse than $15 per hour.

With regards to suits, do you have some link that larger companies get sued more often? The large companies have tough contracts which makes suing them nearly impossible.

Athena Health is a public company, and on their records I don't see any pending suit.

Richard I don't doubt that small billers could help a lot of doctors; but the doctors are not convinced. E Clinical Works has 220,000 providers, that is 15% of the total market in USA, that is just one company. Doctors are flocking to these companies.
« Last Edit: December 07, 2012, 07:29:10 AM by tallmanusa »

RichardP

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Re: Can you make a profit by charging 4%?
« Reply #61 on: December 08, 2012, 01:39:32 PM »
One can make money by starting a business - if they can attract investment money for start-up, and then later issue stock.  One can pay themselves a handsome salary out of the investor's start-up money, and also pay themselves in stock.  When the stock goes public, the entrepreneur can sell part or all of their stock and make even more money.  And then, six months after the Initial Public Offering, the company can go bankrupt because its business plan was unworkable, and it is no bother to the entrepreneur who has already gotten their money out of the start-up.  So yes tallmanusa, you can make yourself very wealthy by starting a billing company - even if you have no clue what billing is actually about.

Making money by starting a business is not the same thing as making money by doing medical billing properly.  This forum is here to answer questions from those who wish to make money from doing medical billing properly.  This is not a website designed to answer questions from those who want to learn how to start a business of the sort you wish to start.

I have posted some serious information about the actual billing part of medical billing, and you have responded to none of it other than to ignore what I said and ask why I wasn't using more sophisticated technology - even though I had already stated that we considered doing that (researched the issue) and decided it would not help us bring in any more money for the doctor than we do with our dinosaur setup.  I'm left thinking that you are not a real person; rather, your posts are being written by a computer algorithm riffing off of key words in others' posts.  Case in point:

You said above:  "There is no evidence that what the companies get for 50 cents per hour is any worse than $15 per hour."

I can't imagine a real person would write such an uninformed statement.  Particularly when I have written several times in this thread about the 50-doctor medical group that is leaving on the table about 30% of the money they should be collecting.  There was no evidence to these folks that they were leaving that money on the table - until someone who knew what they were doing took a look at what they were doing.  Their current off-site billing company, who ships the work offshore, has said nothing about this issue to them.  They just bill what they are sent, and write off whatever gets rejected by the Insurance Carriers.  We still monitor their work occassionally.  And in spite of our comments, they are still leaving about 30% on the table (that fact won't show up in anybody's statistics, so how can you research it?).  We won't take on their billing until their income exceeds their expenses - so they have no one who gives a damn to get in their faces and insist that they bill properly (since we get paid a percent, we tend to insist that our clients bill properly, because that means more money for us).

No evidence ... ???  There is, to people who know what they are looking at.

But, per my previous comment above - doctors who do simple medicine can get by with simple billling.  So for those folks, there would be no benefit to them to overpay for their billing.  For those folks, there would be no evidence that "what the companies get for 50 cents per hour is any worse than $15 per hour.

That makes the point that has been made throughout this discussion, but your comments are not informed by it:  there are many different types of medical billing, from the simple to the extremely complex.  The blanket statements you make don't account for these differences.  Medical billing never has been, and never will be, a one-size-fits-all enterprise.

That distinction extends to the type of medicine practiced also - private practice vs. institutional medicine.  In institutional medicine, the doctors use whatever technology the business office insists on.  And institutional medicine uses the large billing companies.  Those doctors are included in the numbers touted for how many doctors are using the large billing companies.  But it can hardly be said that these same doctors actually chose the large billing companies.  They didn't.  The business office did.  The choices made by doctors in private practice are quite different.  They actually make the choice personally.  When you look at statistics, it helps to break them out based on private practice versus institutional medicine.

    He who knows not, and knows not that he knows not, is a fool; avoid him.
    He who knows not, and knows that he knows not, is a student; teach him.
    He who knows, and knows not that he knows, is asleep; wake him.
    He who knows, and knows that he knows, is a wise man; follow him.

Attributions: Persian apothegm, Sanskrit Saying
« Last Edit: December 08, 2012, 02:19:12 PM by RichardP »

PMRNC

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Re: Can you make a profit by charging 4%?
« Reply #62 on: December 08, 2012, 03:42:07 PM »
Nicely Said Richard.  Can't think of anything I would add :)
Linda Walker
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tallmanusa

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Re: Can you make a profit by charging 4%?
« Reply #63 on: December 09, 2012, 08:16:29 AM »
Richard the stanza you stated is perfectly suitable to yourself. I could not have said any better also.
You are a person who peddles junk like office ally and practice mate; you must know a lot about these systems. The fact that they are free may have something to do with that? Nah. Must be stroke of genius.

Whatever I do, I would never use that free stuff to do any billing; it is disservice to the doctor.

Now you say that the doctors are " leaving money on the table "; I never responded to this before, because it is your opinion, that the doctors are idiots and hiring big companies; another stroke of genius from someone who uses free stuff.
Let me be more specific. When you take money from the doctor, it is for something and it is not for your elaborate speaking ability. To point out, every claim that is submitted mus be electronically "scrubbed". Practice Mate does not do it. Automation is used everywhere in the society and our business is better for it.
Second thing you must provide the doctors with reports,  Practice Mate does not have any.
Then the system must call to confirm the appointments, Practice Mate does not.
I can go on and on. My website would have 40 pages of what we do and how we do it.
My point is that you are taking good money from the doctor, give him the best money can buy otherwise you are cheating the doctors.
« Last Edit: December 09, 2012, 08:59:14 AM by tallmanusa »

tallmanusa

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Re: Can you make a profit by charging 4%?
« Reply #64 on: December 09, 2012, 09:12:19 AM »
A word about outsourcing.
I will be happy to hire American workers, but my competition hires them at 50 cents an hour, I can't pay them $15 per hour and make money.
My job is to get the doctor the best money can buy.
The person I hire in India does a better job at 50 cents an hour.
Have you ever worked with East Asians? They have better work ethics,  and better education. Those are not my words, it was said time and time again during the recent elections.
Just because they look different, is no reason to consider them " inferior ".
Prejudices like always are based upon utter ignorance. They have children to feed, just like us at 50 cents per hour.

They do have problems with English, the big companies have a solution, they use a local buffer between them and the clients.

The solution is NOT denigrating the East Asians; the solution is for the US Congress to make laws that prohibit outsourcing, but such will never pass the Republican House. So that is the reality and deal with it.
So all big companies outsource, that is the way it is, accept it or find another business.

A word to Newbies, and all those attending " schools " to learn billing and coding; market is very tough, do your due diligence before you give out your money. Sadly those people preying on uniformed newbies are preying  mostly on women with their last dimes, hoping to make a few dollars in this troubled economy, many with small children.
« Last Edit: December 09, 2012, 09:16:00 AM by tallmanusa »

PMRNC

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Re: Can you make a profit by charging 4%?
« Reply #65 on: December 09, 2012, 01:26:30 PM »
Quote
Now you say that the doctors are " leaving money on the table "; I never responded to this before, because it is your opinion, that the doctors are idiots and hiring big companies; another stroke of genius from someone who uses free stuff.
Let me be more specific. When you take money from the doctor, it is for something and it is not for your elaborate speaking ability. To point out, every claim that is submitted mus be electronically "scrubbed". Practice Mate does not do it. Automation is used everywhere in the society and our business is better for it.
Second thing you must provide the doctors with reports,  Practice Mate does not have any.
Then the system must call to confirm the appointments, Practice Mate does not.
I can go on and on. My website would have 40 pages of what we do and how we do it.
My point is that you are taking good money from the doctor, give him the best money can buy otherwise you are cheating the doctors.

Wow..  I have to ask you again (which you never answered) Why the heck did you come to this forum? was it to insult? Because you certainly don't want or need our EXPERTISE.. Thankfully I'm WAY too good at what I do to be insulted.. almost..but you failed.   

I RUN one of the LARGEST communities of medical billers.. I'm not an association, don't want to be one but I do know you are flat out WRONG all the way around. By example, I know a billing company in Missouri who services 102 physician practices AND runs training center as well. Guess what she uses.. PRACTICE MATE.  Guess how many pages her website has.. 5.   I also do websites for the medical services industry.. MORE is not better. NO doctor, No office manager or staffer is going to sit and sift through 40 pages.. if you don't make your sell on the FIRST page, your done. So that is MOOT.       SOFTWARE and WEBSITES do NOT make the PRACTICE MANAGEMENT INDUSTRY.. The expertise of the practice manager does! YOU have none. YOUR method is to HOPE and pray the offshore guys you hire do their job, never mind compliance.. HEY they don't have to be compliant.. it's on your neck. 


You avoid the other questions.. WHEN you hire these OFFSHORE billers or data entry processors.. DID YOU OUTLINE THE MANY TRIPS YOU WILL NEED TO TAKE OUT THERE TO INSURE COMPLIANCE??    I and the others here already know your response.

YOU have insulted MY industry and I really think everyone here should just go on and ignore your insults.   I know I will be.
Linda Walker
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best biller

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Re: Can you make a profit by charging 4%?
« Reply #66 on: December 09, 2012, 09:03:44 PM »
Dear Tallmanusa,

 In reply #10 you mentioned "I have hired two experienced billers part time, working from home, at 1% of the revenue collected by that biller" are you interested in another experienced worker?

Michele

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Re: Can you make a profit by charging 4%?
« Reply #67 on: December 10, 2012, 07:30:41 AM »
I have owned my medical billing business for almost 20 yrs and earned a good living doing it.  The operative word is 'earned'.  I have used many clearing houses both free and paid.  I have been using Office Ally now for about 4 yrs and it is hands down better than any I have paid for over the years. 

I love my country - faults and all.  I have nothing against East Asians or there desire to feed their families.  I have an issue with work being sent somewhere that I have NO CONTROL over the quality of work.  I strongly disagree with the statement that the $.50 worker does better work.  There are "bad workers" in any country and there are good workers.  But I believe that overall the training is very lacking and the ones that do better work are strictly doing it by luck.  I want someone that I can train, hands on, continuously, since things in this industry are continuously changing.  And compliance is also a big concern, to me anyway.  The compliance issue whether you want to acknowledge it or not is a big issue.

I have sat down face to face and talked with several people interested in outsourcing the work and when I have been presented with all the facts/data, it just doesn't look like a good idea....period.  The only side that makes sense is "it costs less".  Every other area falls short. 

I also had someone try to convince me to "look over" all the work done by the off shore workers because they knew the quality would not be good. 

Each to his own - this is definitely not for me.
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RichardP

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Re: Can you make a profit by charging 4%?
« Reply #68 on: December 10, 2012, 12:01:47 PM »
tallmanusa said:  You are a person who peddles junk like office ally and practice mate ...


...  " leaving money on the table "; I never responded to this before, because it is your opinion ...


I am responding to these two statements before reading further.  If I run across other things requiring a response when I continue reading, I will respond below.

When you read my comments earlier in this thread, and in other threads on this board, you will see that I make two points about the Company called "Office Ally":  1.) one of my clients was using the Practice Mate part of "Office Ally".  I took him off of that and put him on my system, because Practice Mate is severely limited in what it can do - and does not meet my needs, and 2.) the Office Ally part of "Office Ally" is simply a clearinghouse.  It does what other clearinghouses do, and does contain the same scrubber that many other clearinghouses use.  It is free to use ($20 per month if Medicare is > 50% for that month), and gets the doctor paid as easily and as quickly as the expensive ones do.

Please note that the Practice Mate part of "Office Ally" is simply a data warehouse.  When you submit that data for billing, it is routed through the clearinghouse part of "Office Ally", the part they call Office Ally (very confusing name configuration).  And, as stated, the clearinghouse called Office Ally does have a scrubber.  So your statment every claim that is submitted mus be electronically "scrubbed". Practice Mate does not do it is technically correct.  Practice Mate does not have a scrubber because it is simply a data warehouse.  But your statement is factually incorrect, because those using Practice Mate for billing do have their data passed through the scrubber that Office Ally (the clearinghouse) uses.

Finally, you said: you must provide the doctors with reports,  Practice Mate does not have any.
Practice Mate has tons of reports.  I've used Practice Mate in real-life situations.  I know what reports they have.  Practice Mate is fine for practices that do simple billing.  The number of doctors using it, and the insurance carriers that recommend it, support that point.

In terms of "leaving money on the table" - that is not my opinion.  Again, my wording above was specific about this.  Those who know billing understand what my example was about when I said (paraphrasing) "a good biller knows that when you do A, you must also have done B.  When you bill only for A and not also for B, you are leaving money on the table.  Also, a good biller knows that the amount of money the insurance carriers sometimes pay on a charge varies, depending on the order in which you have placed the diagnosis codes.  Placing a diagnosis code in the number one spot can sometimes get you paid more money than if that diagnosis code was in the number two spot."  And then there is the issue of knowing that the doctor has actually done work for which he has not billed at all (this is something that a biller cannot know unless s/he actually has face time with the doctor).

Those are just three of the issues I am constantly putting in front of my current clients (after 10 years of me doing that, they still don't remember some things) that affect how much money they get paid for the work they do.  When auditing the work of any doctor, those are three of the more obvious, but by no means only, issues that will tell you whether they could be collecting more money from the insurance carriers.  It is not opinion, because I have seen the increase in insurance payments from more correct billing first hand.  However, you did raise a point that I will acknowledge - if you don't know from first-hand experience that what I said is true, you were wise to not comment on it.

tallmanusa said:  you are taking good money from the doctor, give him the best money can buy, otherwise you are cheating the doctors.  That statement is general to the point of being useless.  What the biller owes the doctor is to get him paid the most he is entitled to for all the work he does.  As I have stated above, this is not a one-size-fits-all endeavor.  Of course, any worker/contractor owes their best to the client/owner of the business (which is all your statement says).  That is without question.   The larger question you leave unaddressed is this:  what is the best that money can buy?  The answer to that question will vary, depending on the complexity of the medicine that the doctor practices.  Where the doctor practices simple medicine, and whose billing needs are simple, off-shore billing might be the best bang for the buck (assuming compliance issues are properly addressed).  Where the doctor practices complex medicine, and whose billing needs are complex, a local biller who has face-time with the doctor might be the best bang for the buck.  The best bang for the buck is going to vary, depending on the type of medicine practiced.  The best that money can buy is going to vary, depending on the doctors needs; there is not a pre-determined answer that will be suitable for everyone.  In ignoring this truth, you are speaking platitudes to those who have been in the trenches.  More proof that you are an algorithm responding to key words in posts rather than an actual person with real-life experience.

Finally, since my last post above, I have read a statistic that, in something like the last ten years or so, the number of doctors in private practice in the United States has gone from 80% of the total down to 30% of the total.  The others could not afford to stay in private practice and so have joined with doctor groups or hospitals - those institutions most likely to be using the large billing companies that tallmanusa refers to.  That statistic does have implications for those billers who target doctors in private practice.
« Last Edit: December 10, 2012, 01:46:36 PM by RichardP »

QueenAlicia

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Re: Can you make a profit by charging 4%?
« Reply #69 on: December 11, 2012, 04:30:48 PM »
Don't do it best biller, don't.  If you can't tell by this whole conversation I will say it now, your asking for TROUBLE!  Please just, smh, just don't, lol.

Dear Tallmanusa,

 In reply #10 you mentioned "I have hired two experienced billers part time, working from home, at 1% of the revenue collected by that biller" are you interested in another experienced worker?

QueenAlicia

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Re: Can you make a profit by charging 4%?
« Reply #70 on: December 11, 2012, 04:33:19 PM »
Quote
Now you say that the doctors are " leaving money on the table "; I never responded to this before, because it is your opinion, that the doctors are idiots and hiring big companies; another stroke of genius from someone who uses free stuff.
Let me be more specific. When you take money from the doctor, it is for something and it is not for your elaborate speaking ability. To point out, every claim that is submitted mus be electronically "scrubbed". Practice Mate does not do it. Automation is used everywhere in the society and our business is better for it.
Second thing you must provide the doctors with reports,  Practice Mate does not have any.
Then the system must call to confirm the appointments, Practice Mate does not.
I can go on and on. My website would have 40 pages of what we do and how we do it.
My point is that you are taking good money from the doctor, give him the best money can buy otherwise you are cheating the doctors.

Wow..  I have to ask you again (which you never answered) Why the heck did you come to this forum? was it to insult? Because you certainly don't want or need our EXPERTISE.. Thankfully I'm WAY too good at what I do to be insulted.. almost..but you failed.   

I RUN one of the LARGEST communities of medical billers.. I'm not an association, don't want to be one but I do know you are flat out WRONG all the way around. By example, I know a billing company in Missouri who services 102 physician practices AND runs training center as well. Guess what she uses.. PRACTICE MATE.  Guess how many pages her website has.. 5.   I also do websites for the medical services industry.. MORE is not better. NO doctor, No office manager or staffer is going to sit and sift through 40 pages.. if you don't make your sell on the FIRST page, your done. So that is MOOT.       SOFTWARE and WEBSITES do NOT make the PRACTICE MANAGEMENT INDUSTRY.. The expertise of the practice manager does! YOU have none. YOUR method is to HOPE and pray the offshore guys you hire do their job, never mind compliance.. HEY they don't have to be compliant.. it's on your neck. 


You avoid the other questions.. WHEN you hire these OFFSHORE billers or data entry processors.. DID YOU OUTLINE THE MANY TRIPS YOU WILL NEED TO TAKE OUT THERE TO INSURE COMPLIANCE??    I and the others here already know your response.

YOU have insulted MY industry and I really think everyone here should just go on and ignore your insults.   I know I will be.

LOL!!  ::)

Ignorance is bliss because apparently there has been no research on Practice Mate. You can run reports, perform EHR, schedule patients, etc.  I had a provider with 2 locations use Practice Mate.  I don't know why I continue to read and entertain this foolishness.

How are you going to create a software program when you don't the first thing about billing or HIPAA compliance.

tallmanusa

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Re: Can you make a profit by charging 4%?
« Reply #71 on: December 12, 2012, 04:19:48 PM »
The clearinghouse part (OA) is pretty good for a free clearinghouse.  It is even better than some of the paid clearinghouses.  As for Practice Mate, it is TERRIBLE.  I am constantly amazed at what people will put themselves through for something free.  It is like the people that stand in line for an hour for a free hamburger or something like that, when the hamburger only costs $5 and the person makes for than three times that amount per hour at the there job.  Waiting in line for an hour for a free $5 hamburger makes no sense when you could work that same hour and make $20.  JMO.  I'll get off my soapbox now.

Posted from another thread, without any comments.

PMRNC

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Re: Can you make a profit by charging 4%?
« Reply #72 on: December 13, 2012, 08:33:38 AM »
Quote
The clearinghouse part (OA) is pretty good for a free clearinghouse.  It is even better than some of the paid clearinghouses.  As for Practice Mate, it is TERRIBLE

I happen to agree with you, same goes for "cheap".. amazes me how many start off with one software and think upgrading in the future is the better deal, it's not.. it's actually a pain in the rear end and costly. (TIME and data conversion fees)   But.. let me tell you something else.. until you have met your goal of becoming a huge fortune 500 company.. I suggest you ditch the idea that software is the be all and end all and I'll tell you why.  7 out of 10 doctors you speak with (I'm shooting low with that statistic) will want to use THEIR software.  I was on another forum run by one of the associations recently and ran across a post from a biller who had a potential client who wanted her to work on their system, she was fairly new to the business and asked what should she do? The advice she got from the person who's group that was and who I've known for a long time in this business really threw me for a loop.. she said.. "Oh well you try to educate the doctor on all the benefits and then sometimes you just can't and you have to walk away" Paraphrasing but you get the idea..   Wow.. WHY?   In today's economy you don't turn away a client because they don't want to make the very large commitment of going over to YOUR software!!  And you should see all the doctors who have invested years ago in Medical Manager (very costly and cumbersome program, but VERY efficient and solid) and if your a billing company and your pitching your software with your services, your going to be turning away, again, 7 of 10 clients!  WHY??   This is why today's medical billing company needs to be diversified and yes this is going to make the new medical billers job much harder because when they are learning, most likely it's off of one system. Experienced billing companies with experienced billers will get the clients first in those situations because they can work on pretty much any system. I hate Practice Mate but one of my clients used it for a while so I had no choice. And Medisoft.. Ugh how I hate that software but I have quite a few clients who run it still. My job is NO different with those clients than it is with the ones I have on my PM solution.  And with the clients I have for consulting I have to work on VARIOUS software's to pull reports I need.  It still amazes me that even after 25 years in the business every now and again I will run into a software I've never seen.. but because I'm experienced I can navigate any software really.

So my best advice is to stop putting so much focus on the software.. YES your company should have a company wide solution.. but if your going to make it in this market you have to be ready to work on the worse software's. Physicians especially who have invested in a system (good or bad) most likely won't want to make a switch at least right away. And many of them want time before they give up the total control.   I think you also mentioned you won't work with provider who isn't using EHR? Good luck with that.. if the other companies told you they weren't I wouldn't believe them (when you are "shopping" your competition, I can't imagine why you think you'll get the facts???   anyway.. since I've got all my clients OFF Medicare/Medicaid now.. they don't have to use EHR.. they are quite relieved. Also there are practices who can and will pay the penalties rather than implement the EHR.. their reasons vary really and I don't ever tell my providers they HAVE to do something they don't have to do. 
Linda Walker
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www.billerswebsite.com

tallmanusa

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Re: Can you make a profit by charging 4%?
« Reply #73 on: December 13, 2012, 10:34:53 AM »
Thanks Linda for the advice, very helpful.

michelledurner

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Re: Can you make a profit by charging 4%?
« Reply #74 on: April 14, 2013, 11:43:14 AM »
I agree with  PMRNC
Quote
YES you can make a profit that way. After you have worked 4 X as hard, have 2X as many clients and worked 3 X as many hours as the other.