Author Topic: Billing Service question  (Read 2357 times)

mbloom

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Billing Service question
« on: October 12, 2013, 11:17:21 AM »
My scope of business is medical billing straightforward. I have recently encountered a client that wants me to make implement her EHR software. She acts as through its part of responsibility. I don't want to upset her because she is a good client and gives me referrals. I am curious if any of you have ever experienced this and if you did/would charge to do this aspect of it. Also, we conflicted on whether or not I receive a portion of patient payments. I dimply to have statements mailed out. Additionally, should they come to me and then I post and forward to her or vice versa. Any suggestions would be appreciated. 

RichardP

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Re: Billing Service question
« Reply #1 on: October 12, 2013, 11:53:24 AM »
1.  From the standpoint of fraud control, it is always recommended to have the bank deposit function separated from the payment posting function.  We do not ever accept anything directly from the patient.  Everything goes directly to the client - who makes copies and sends the copies to us.

2.  We make it clear to our clients that billing is a function completely separate from practice management.  We charge our clients a percentage fee for the billing function - getting their money from the payors for services they rendered to their patients.  The services we provide for our billing fee are clearly spelled out.  But our clients still ask us from time to time to do functions that are part of practice management, not billing.  We point out that they are asking us to do something that is not part of the billing function, so there will be an additional fee involved if we decided to take on the work.  They either agree to the additional payment, or they drop the request.

Note that we are staffed properly to do the billing function - enough people to do the work, and no more.  That means no one is sitting around twiddling their thumbs waiting for the clients to give us special work projects.  That means we generally do not have the time available to take on the extra practice management projects that are requested of us.

3.  Do you have the skills to implement your client's EHR software?  If yes, and you do it, does that mean she will then look to you on a continuing basis to fix any glitches that occur and to monitor software updates from the vendor and install them as they are released?  What if the computer(s) that the EHR is installed on fail?  Will she expect you to acquire new computers and install all software (including the EHR stuff) to keep her in business?  These functions are normally performed by an IT person, not a billing person.

These functions are properly considered practice management functions, not billing functions.  I would suggest that you not do any of them without pointing this out to your client and charging an extra fee to do them.  Otherwise, she will soon have you going home with her to do her dishes and vacuum her house as part of your "billing responsibilities".

PMRNC

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Re: Billing Service question
« Reply #2 on: October 12, 2013, 01:01:16 PM »
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My scope of business is medical billing straightforward. I have recently encountered a client that wants me to make implement her EHR software.


This really isn't something NORMALLY done by a billing company/biller, consultants are doing the work but they have experience in doing so. Why not recommend an EHR vendor for them to talk to, they will generally do everything from sales to implementation, testing, etc.


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She acts as through its part of responsibility. I don't want to upset her because she is a good client and gives me referrals
.

It is still business and the more you do for free, the more they expect and eventually the professional relationship will deteriorate further.


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Also, we conflicted on whether or not I receive a portion of patient payments. I dimply to have statements mailed out. Additionally, should they come to me and then I post and forward to her or vice versa. Any suggestions would be appreciated.

This is really a contract issue. What does your contract state. I've seen billers who mistakenly put in their contracts they get X% for insurance billing which leaves them out flat. I might be different in how I think of billing and full practice management. I consider full practice to be any task related to the practice receivables, from verification of benefits, straight to zero balance on the account.   That means I'm sending out billing statements, filing appeals, follow up even with patients in regards to their balances. This means I am doing the work, if I was to bill on a % (which I do NOT as I wouldn't get paid what I'm worth if I did) my contract would state X% of ALL PRACTICE REVENUE.   A few words can completely change a contract. I also consider credentialing and reviewing managed care plans and reporting to my client problem areas in those contracts.   Billing to me is just sending claims and statements and nothing more. Most companies do MUCH more than that so get paid for the work you do. This is one of the problems with % based billign. Your jumping through hoops to collect when most things that are a problem are coming from the clients end so you spend hours and hours working on something and if it's on their end you are not getting paid for your time. If you are doing a percentage than ANYTHING you touch should be collected/paid upon.    BUT.. you don't mention what your contract says about this so I don't know how your client can and should be interpreting it. If you have not protected yourself in the contract you may want to amend it as soon as possible.

I don't take on billing only because if you think about it that means practice is keeping two sets of books and that just sets up all kinds of flags. I touch it, I get paid.
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

RichardP

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Re: Billing Service question
« Reply #3 on: October 12, 2013, 08:36:29 PM »
... the billing function - getting their money from the payors for services they rendered to their patients.

In my definition of "billing", payors = insurance carriers and patients who owe money.  Our job as billers is to collect all monies due (from whomever), for services rendered.  That includes working accounts receivable and making phone calls to the patients.  But our contract limits the phone calls to 2, and statements to 4 (unless the patient is making payments).  At the end of four months, we give client a list of who owes and has paid nothing.  They either get written off or sent to collections.  If client wants patient to receive more than 2 calls, our contract says that client's staff does the calling, not us.  It is our clients' responsibility to provide us with all materials we need in order to get all monies due them.  In some cases where clients don't have billing software of their own, we allow them to use ours, but they pay their share of the service contract charges from the vendor.

We define practice management as anything that analyzes the function of the workflow, to include data-mining the database.  Practice management would also include the installation of systems, machines, and software to improve the function of the workflow.

Obviously, there are some grey areas where it is not clear whether to lable the activity as a billing activity or a practice management one.  We are flexible on that, but only up to a point, in order to help service our clients' needs.  As stated, when a client desires a service that is clearly not related directly to billing, we will accomodate the client, as time allows, and for an additional fee.

RichardP

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Re: Billing Service question
« Reply #4 on: October 12, 2013, 08:45:32 PM »
I don't take on billing only because if you think about it that means practice is keeping two sets of books and that just sets up all kinds of flags. I touch it, I get paid.

I don't understand the two sets of books part of that statement.

We submit our invoice for how much is due for the previous month's billing.  If we have done any separate work, for a separate charge, we submit a different invoice for that work (simply because the work can sometimes span several months).  We get two checks from the client, both written from the same business checkbook.  Or, if the work is completed within the month, that "practice management" charge goes on the same invoice with the billing charges, but it is broken out and identified as a separate charge.  In this scenario, we get one check for the total amount, from the client's business checkbook.  I don't know how either of these scenarios calls for two sets of books.

PMRNC

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Re: Billing Service question
« Reply #5 on: October 13, 2013, 03:42:09 PM »
Two sets of books is an Auditors wet dream.

IF you are a billing company and let's say your going to do a % of collections of insurance payments only and the practice will keep their patient payments (I've seen it done!) .. With you not Tracking patient payments, the practice is.. therefore 2 sets of books.

Another scenario:  Billing company hired to do Medicare billing only.   2 sets of books. Billing company tracking claims only of Medicare, practice doing rest.

Ask anyone who does audit's..this is their dream come true.. practice with two sets of books.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

samronald

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Re: Billing Service question
« Reply #6 on: November 04, 2013, 06:24:47 AM »
Initial applications of EHR were not very effective and many practitioners have merely adopted them to adhere to official norms. Therefore, no meaningful use of EHR has been evident in healthcare industry and medical billing productivity as well as efficiency has remained low.

RichardP

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Re: Billing Service question
« Reply #7 on: November 04, 2013, 11:57:13 AM »
Therefore ... medical billing productivity as well as efficiency has remained low.

Medical billing is actually done through stand-alone billing software, or Practice Management software.  EHRs are not used for medical billing - and so would not affect the productivity or efficiency of billing.

PMRNC

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Re: Billing Service question
« Reply #8 on: November 04, 2013, 03:56:01 PM »
He/She was just trying to sell their offshore viewpoints.
Linda Walker
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RichardP

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Re: Billing Service question
« Reply #9 on: November 04, 2013, 08:03:54 PM »
Yup.  My response was for the sake of the newbies reading here that don't know the truth yet.