Author Topic: * Urgent Response * First Client  (Read 4436 times)

RCC

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* Urgent Response * First Client
« on: April 25, 2014, 09:55:58 AM »
I have a possible new client. Dr of internal medicine. I will meet with him next Tuesday. New practice and all. Please tell me what it is that I need to ask of him. He says he going to be out of network, does he need to be credential for any insurances like at least Medicaid & Medicare? He says he looking into using Kareo, does that have a PM and EMR? How would you charge a new practice. I am in NY so we can't do percentage.

Thanks in advance for anyone response.

Excited and nervous. I want to do this right.  :'( ;D

Merry

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Re: * Urgent Response * First Client
« Reply #1 on: April 25, 2014, 10:49:37 AM »
Congrats.  Happy for you.  Yes,  he has to be credentialed for Medicare and Medicaid.  Why is he not joining any networks?  I certainly would ask him
because you may help him see this in a different way. Sonetimes they are misinformed.  Going to let others chime in here.  Assume you are set up with a contract,  HIPAA requirements and that he is also HIPAA compliant with Policies and Procedures etc. 
And please tell us about you.  We love it when new billers find us.  If you need additionsl resources,  please check out medicalbillingstudycourse.com where you can purchase individual courses if you need help in certain areas. 
A big welcome!!

Merry
« Last Edit: April 25, 2014, 10:51:09 AM by Merry »

RichardP

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Re: * Urgent Response * First Client
« Reply #2 on: April 25, 2014, 11:05:09 AM »
I'm going to be blunt.  Teaching you to fish, rather than just giving you a fish, and all.

You have posted here multiple times, so I assume that means you have an internet connection.  Yet you are asking us about Kareo.  Why do you not just go to Kareo's website and discover the answers for yourself?  Also, you ask about Medicare and Medicaid.  Why would the provider need to be credentialed with these if s/he is not going to see Medicare and Medicaid patients.  And if s/he is going to see these patients, why have you not told us that?

If you actually want to be responsible for the financial well-being of another (cash flow for provider), you really need to buy into the "figure it out for yourself if you can" mentality.  With the questions you are asking here, it looks like you want others to do the work for you.

For example:  go to this link and type in the terms you want to learn about in the upper right-hand corner of the page.

http://www.medicalbillinglive.com/members/index.php

If you type in "credentialing, you will get many links to posts here about that subject.  The very first link is to a post by HeidiK yesterday (4-24-14).  Her post contains the first link below.  The third entry on the "credentialing" page contains a post by Linda.  Her post contains the second link below.

http://www.mcres.com/mcrmm08.htm
http://www.caqh.org/ucd.php

I am all for helping folks learn.  I am not at all in favor of helping someone get in over their head.  If this is a provider new to private practice, they need a biller who knows what they are doing.  You are not coming across as that person.  If you are going to be useful for a new doctor, you need to have an intellectual curiousity that will drive you to find your own answers.  There are plenty of resources in the database of posts here.  It sounds like you have not yet made good use of those resources.  I've pointed you in a direction that can be very useful for you if you want it to be.

We have established quite a few providers in their own practices for the first time.  I know all that is involved in doing that when the doctor doesn't know what he needs and doesn't even know the right questions to ask.  So I know the problems that can be caused by such a doctor relying on a biller who also doesn't know what they are doing.  Hence, my bluntness here.

PMRNC

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Re: * Urgent Response * First Client
« Reply #3 on: April 25, 2014, 11:30:44 AM »
Quote
I have a possible new client. Dr of internal medicine. I will meet with him next Tuesday. New practice and all. Please tell me what it is that I need to ask of him. He says he going to be out of network, does he need to be credential for any insurances like at least Medicaid & Medicare? He says he looking into using Kareo, does that have a PM and EMR? How would you charge a new practice. I am in NY so we can't do percentage.

He doesn't NEED to be credentialed with any carrier, nor does he HAVE to be enrolled in Medicare or Medicaid. I'm assuming you have billing knowledge so you know the requirements if you plan to be non par with all carriers, Medicare, Medicaid etc? If he does plan to enroll then yes of course he will need to get enrolled with Medicare/Medicaid. If not, sounds like he'll be almost a cash based practice and your goal would probably be to help him become an all cash provider. Focus on efficiency in the office with collecting all fees up front. I have had a few clients GO cash and it's not easy, so if this is a NEW practice you want to start off on the right foot.

Kareo has both PM and EMR, I use Kareo but I will warn you they are NOT for the new medical biller. Unless you have experience you will need more training, Kareo's support is only so-so but I think it's because many sign up with them having no experience and expect full medical billing training. They won't do it..  I love their system it's one of the best ones out there I've ever worked on. My clients on Kareo hold their own subscriptions so the cost is not built into my fees (I'm in NY also ..upstate) This helps me keep my fees competitive yet allow me to still make money. I bill a flat fee which is "based" on an hourly rate I expect with all costs added in.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

RCC

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Re: * Urgent Response * First Client
« Reply #4 on: April 25, 2014, 12:21:32 PM »
Thanks to all, I said Kareo, because the physician said thats what he wants to use. I have brought many of the books and have read them all. I was just asking as a new biller and you have to start somewhere. Everyone was a new something. Your bluntness was well taken, but you will not discourage me in asking questions. He stated that he doesn't want to work with insurance companies, he wants to do all out of network. I use office ally and I claim. This forum was for us to ask questions. I have 30 years experience in the medical field, but I only did the superbill end, I was a medical secretary. But I appreciate all the input whether you are critical or not. I rather ask, then not ask. Why should he participate in insurance, I didn't see any of your books on that.

Thanks to all, really appreciate it.

RCC

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Re: * Urgent Response * First Client
« Reply #5 on: April 25, 2014, 12:33:00 PM »
@Richard P - thanks for the links - thats why I ask questions here because most you guys are experienced and can lead someone where to get the right information, because everything on the internet is not facts.

PMRNC

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Re: * Urgent Response * First Client
« Reply #6 on: April 25, 2014, 12:38:43 PM »
Quote
Thanks to all, I said Kareo, because the physician said thats what he wants to use. I have brought many of the books and have read them all. I was just asking as a new biller and you have to start somewhere. Everyone was a new something. Your bluntness was well taken, but you will not discourage me in asking questions. He stated that he doesn't want to work with insurance companies, he wants to do all out of network. I use office ally and I claim. This forum was for us to ask questions. I have 30 years experience in the medical field, but I only did the superbill end, I was a medical secretary. But I appreciate all the input whether you are critical or not. I rather ask, then not ask. Why should he participate in insurance, I didn't see any of your books on that.

Thanks to all, really appreciate it.

Please don't take offense.. I don't think anyone's intent is to discourage. I'm a firm believer in letting the provider choose their PM system or using the one they have already implemented.. I've seen billers LOSE accounts trying to push their software or persuade the provider to switch.. it's so much neater to use what they want you to use AND let them maintain the subscription, fees, etc.. many of the outsourced billing companies trying to sell you THEIR software will disagree I'm sure.  Again,  though, as a Kareo user, I do want to make sure you understand you will have a bit of a hard time navigating at first.. it is a GREAT .. WONDERFUL PM system but NOT for someone who has NEVER used a PM system before. I don't know if you have or haven't. I'd say if you have the time to learn it.. go for it. I will say it is USER friendly but ONLY to those who have experience with other PM systems. I'm not saying you should turn this account down, I'm saying that you need to make sure you are prepared to take it on. I have to say if the provider LIKES Kareo, it tells me something.. it tells me this provider has considered in-house, has taken the time to investigate PM solutions and willing to invest in a good solid program. I have to hesitate when a provider tells me they don't care or "you pick it out".  So right there I think you have a potential for a good client there.  The bad part is that if you have never worked in a solid PM system (and I'm sorry if this offends people but Office Alley, free claims, etc etc.. is not what I would call a solid PM system) you WILL need to take extra time to learn it and that is a cost of doing business you should never pass down to your client. When I first started my first mistake was thinking I had to learn ONE practice management software (MINE) and that clients would just "flock" to it. Not true at all..though many of the business opportunities out there will have you thinking otherwise. The fact was that there are all sorts of providers out there.. some have spent THOUSAND's of dollars and then they contact a billing company who tells them they need to switch to their software.. I learned later on this was NOT the way to go. I learned this lesson when I took on a pediatric group on Medical Manager, one of the HARDEST PM systems to learn.. but by golly it worked for them and a conversion was UN-necessary and plain silly!   Maybe this is TMI but your post said they were interested in Kareo and I have to tell you that makes them a great potential first client IMHO. I just want you to know that it could also be very difficult if you have never billed with a PM system before.
« Last Edit: April 25, 2014, 12:40:34 PM by PMRNC »
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

RCC

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Re: * Urgent Response * First Client
« Reply #7 on: April 25, 2014, 12:53:18 PM »
No I am glad, the gentlemen just sounded like I shouldn't take this client on. But whomever I do, will be my first client. So I am just stating that I have to start somewhere, I am just asking these questions in advance before I start so that I will not mess up his account or my reputation. So if you can direct me in the right way, I am all for it. I am a learner and quick at it, just want to make sure I am doing it properly. You know books say one thing, but hands on experience is totally the best experience. You can learn a system by reading, but doing is the best experience. Thanks.

And he knows I am new and is willing to give me this account. He is new also, just starting his practice. So I figure being that he will not have as many patients yet, this would be a good account to start with. Just want to do this right! Thanks
« Last Edit: April 25, 2014, 12:55:15 PM by RCC »

shanbull

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Re: * Urgent Response * First Client
« Reply #8 on: April 25, 2014, 12:57:29 PM »
I'm not really understanding why he thinks he would want to be out of network for every insurer. Medicare is one thing, but private plans are another. Out of network rates charge patients more money - both the coinsurance and deductible will be higher. Most people have no interest in seeing a doctor that is out of their network, especially not a primary care doctor. I certainly wouldn't. Insurance companies also discourage members from going out of network. It would be one thing if he were planning to operate on a cash only basis, there are people who wish to do that, but registering out of network could severely impact both his client population and his revenue. Since he is a new provider, he would benefit from establishing a client base. This is going to be incredibly difficult if he is out of network for everything. Another issue is that if he opts out now, there is a mandatory waiting period of years for most insurance companies before he would be eligible to be in network. So if he changed his mind after choosing to be out of network, he couldn't make the switch for a while. Dealing with insurance companies is a lot of red tape, but it could be worth it for him to be in network with at least some of the major plans in the area. Yes, he would receive less reimbursement per patient, but if he sees 10 times as many patients because he's in network, he will end up with a bigger paycheck. If he's not interested in that at all, he would probably be better off finding patients on a cash-only basis. Then he would definitely not have to deal with insurance.

How this ends up being set up will impact what you want in a PM system, so it is crucial to figure out the insurance part before you start looking at systems.
« Last Edit: April 25, 2014, 01:00:53 PM by shanbull »

PMRNC

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Re: * Urgent Response * First Client
« Reply #9 on: April 25, 2014, 01:19:12 PM »
Quote
I'm not really understanding why he thinks he would want to be out of network for every insurer. Medicare is one thing, but private plans are another. Out of network rates charge patients more money - both the coinsurance and deductible will be higher. Most people have no interest in seeing a doctor that is out of their network, especially not a primary care doctor. I certainly wouldn't. Insurance companies also discourage members from going out of network. It would be one thing if he were planning to operate on a cash only basis, there are people who wish to do that, but registering out of network could severely impact both his client population and his revenue. Since he is a new provider, he would benefit from establishing a client base. This is going to be incredibly difficult if he is out of network for everything. Another issue is that if he opts out now, there is a mandatory waiting period of years for most insurance companies before he would be eligible to be in network. So if he changed his mind after choosing to be out of network, he couldn't make the switch for a while. Dealing with insurance companies is a lot of red tape, but it could be worth it for him to be in network with at least some of the major plans in the area. Yes, he would receive less reimbursement per patient, but if he sees 10 times as many patients because he's in network, he will end up with a bigger paycheck. If he's not interested in that at all, he would probably be better off finding patients on a cash-only basis. Then he would definitely not have to deal with insurance.

5 or 10 years ago I would have agreed with you completely.. but one of the first questions I always have to ask any NEW practice opening is WHY?? LOL Sorry but in today's age, that is first thing that pops into my head.. why ON earth would any doctor want to start a practice now??   With that being asked and stated one can ONLY come to the conclusion that a NEW practice is interested in two main things:  1) HELPING patients and 2) making their statement in today's economy of politics and bullcrap doctors have to deal with.  Over the past two years I've taken doctors out of Medicare, Medicaid and other payors.. DECredentialiing has become the new norm for me. New practices not wanting to PAR with carriers is really not so hard to comprehend at all. The billing company that gets that account will then become most useful in helping the practice collect up front and creating policies and procedures to help the staff DO just that. As billing companies I don't think our job anymore is to just Bill.. it's to help the practice maximize ALL sources of revenue. A practice that is NON par with all insurances should be no exception and should be encouraged. We just turn our focus to the back end and creating polices to help the practice achieve JUST that. "The customer is always right". In this case our customers are indeed our clients.. they are there to make a living. Who are we to question or discourage them from doing it the American way? <g>     

RCC.. this could be a really lucrative opportunity if you play your cards right.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

RCC

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Re: * Urgent Response * First Client
« Reply #10 on: April 25, 2014, 03:46:23 PM »
@lindawalker - Thanks so much.

Merry

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Re: * Urgent Response * First Client
« Reply #11 on: April 25, 2014, 03:59:47 PM »
I interpreted your question as to credentialing for Medicare and Medicaid as if he were interested in those carriers. If he is not interested in participating why not collect money upfront and have the patient submit the claim.  Playing devil's advocate here. 

Merry
« Last Edit: April 25, 2014, 05:59:04 PM by Merry »

PMRNC

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Re: * Urgent Response * First Client
« Reply #12 on: April 25, 2014, 05:46:04 PM »
The practices I have setup as "cash" will submit as a "courtesy" which does indeed give the patient a good incentive to pay up front. There are some carriers who are pretty good payers they have and so they will just collect the out of pocket with an AOB on file for the balance.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

RichardP

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Re: * Urgent Response * First Client
« Reply #13 on: April 26, 2014, 04:20:30 PM »
There are undoubtedly many people new to billing that read through this site.  So my response to RCC is to her as well as to all the other newbies who will see this.

1.  RCC - you claim a truth:  a person has to start somewhere.  Yes - but.  I also claimed a truth in my first post above: for a newbie, starting with a doctor who does not know what they are doing may not be the best "somewhere" for you to start.  If you start with a doctor who knows all the ropes, and just needs you to do the billing, you can learn-as-you-go from that doctor.  You cannot do that with a doctor who is just starting out in private practice.  A newbie starting out with another newbie may not lead to the best outcomes for the doctor.

2.  Following on from Point 1, I said in my first post above:  I am all for helping folks learn.  I am not at all in favor of helping someone get in over their head.  ... If you are going to be useful for a new doctor, you need to have an intellectual curiousity that will drive you to find your own answers.  I have nothing against asking questions.  But you asked questions that you could have easily found the answers to yourself - as I pointed out - by going to the Kareo website and by searching this site on the term "credentialing" and other terms (the links I gave you above were not buried in this site.  They were right at the top of the list of links that came up when I searched).  This is information that you could easily have discovered for yourself, yet you asked someone else to give it to you.  That is revealing about your attitude toward the task ahead of you.  Had you asked more complex questions that showed you had studiously queried this site and educated yourself as far as you could, my response would have been different.

My point is not to discourage you so much as it is to give you a realistic idea of what you need to be for this doctor new to private practice.  To quote myself again:  If you actually want to be responsible for the financial well-being of another ... you really need to buy into the "figure it out for yourself if you can" mentality.  If you simply want to be the passive recipient of what other people tell you, you probably will not be what a doctor new to private practice needs - unless he doesn't have many patients.  If he does have many patients, you could still be his money manager and coordinator - by contracting with an experienced biller in your area to provide the knowledge you don't have yet.  Pay that experienced biller to help you get the doctor up and running.  Managers don't usually know all the things needed to bring the project to a successful completion.  They simply manage other folks who do know all the things needed.  See yourself in that light and things take on a different look.

3.  Kareo is a Practice Management (billing) package.  Late in the game, they have added an Electronic Medical Records (EMR) part to it.  If doctor is establishing an all-cash practice, he does not need the complex billing capabilites that Kareo has.  Office Ally is more than sufficient.  On the other hand, if he wants Kareo because he wants an EMR solution, there are undoubtedly better EMR solutions out there - including Practice Fusion, which is free.

4.  If Linda helps you establish a best-practices all-cash office with her advice, why do you even need a medical billing package?  We have clients who track their all-cash patients with Quickbooks or Excel spreadsheets.  It seems that your doctor new to private practice needs someone to explain this to him.  If you can't, hire someone to do it for you.  Your job is to help the doctor get up to speed as efficiently and as effectively as possible.  You don't have to have all the answers.  You just need to contract with, and manage, the work of those who do.

5.  Folks who have insurance know that a participating provider cannot charge them more than the "allowed amount" that their insurance carrier specifies.  But, from our experience, most folks who have insurance don't realize that a non-par provider is not constrained in any way by the "allowed amount" figure.  So - you either have to explain this to them before they see the doctor (this "work" should factor into the fee you charge), or they find out after the service is performed and they are asked to pay for it.  When the actual cost of service is explained before-hand, most prospective patients say "never mind", and seek out an in-network doctor.  When they learn about the actual cost of service after the service has been performed, many folks never return to that provider again, and in fact may not pay the provider any more than what their insurance "allowed amount" would be (in their estimation).  For our clients, who are using this as a tool to reduce the size of their practices, this is a useful thing to do.  For a doctor just starting out, who is trying to build a practice, this will probably result in no practice being built - as prospective patients seek out an in-network provider.  Unless the provider prices his services comparable to what the carriers' "allowed amount" is.  But if he is going to do that, why be cash only / non-par?

6.  For our clients who are cash only, many patients walk away because they can't figure out how to file a claim with their health insurance carrier.  They find a provider who is in network and who will file the insurance for them.  Some of our cash-only clients, who are not trying to reduce the size of their practices, have us bill on the patients' behalf, and simply include our fee in what they charge the patient.  The patients are much happier with this, and are much more inclined to pay the doctor up front - since they have hope that the carrier will actually get billed and that the carrier will pay them, the patient.

I am no doubt leaving out some other important stuff, but this is probably enough for now.

HeidiK

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Re: * Urgent Response * First Client
« Reply #14 on: April 26, 2014, 07:46:13 PM »
Richard,

I loved the honesty and truth you put into your post!  One thing I've noticed since joining this board is how lucky newbies are to have a forum where questions can be asked - and answers are actually given!  No run-around or vagueness, just valuable, detailed information with genuine offers to come back and ask more.

You pointed out many ideas and ways newbies can "learn the ropes" and I agree how "intellectual curiosity" is a requirement for anyone choosing this profession.  I also believe there is an understanding of the huge responsibility medical billers/coders/collection specialists etc. have to do the best job they possibly can.  Whether you work in an office or as an outside billing service, without proper and accurate payments none of us would have a job. 

Getting a client or a job is difficult, especially with our economy and the many challenges providers face with lower and lower reimbursement.  Unfortunately, many don't realize the difficulties in actually doing this job and may get into a situation where they realize their limits far too late.  As you explained, there are many experienced billers and coders available for support and assistance in those cases. and I know that many of the people who post answers and advice on this forum offer that exact type of service, myself included! 

I also really liked that you pointed out how easy it is to search the index here for information.  I spent HOURS reading through many past posts when I first became a member - I learned so much about specialty-specific billing issues, hints and tips for filing claims, interpretations of difficult rules and regs etc.  Having this forum, the resources medicalbillinglive.com offers along with the Medical Billing Study Course really gives the amazing potential to become an expert for those willing to work at it!

Kudos to Michelle, Alice, moderators and everyone else who has taken the valuable time to engage with others and develop such a strong network of professionals!  :)
Heidi Kollmorgen, CCS-P
AHIMA Approved ICD-10 Trainer
hdmedicalcoding.com