Starting a Medical Billing Business > Starting Your Own Medical Billing Business

Finally! Signed my first client!! Two questions..

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I officially have my first client!! After 10 years of billing in an office I will be branching out and starting my own billing service! Yay!!

My client is a mental health provider and I will be billing for his services and his wifeís services. The client prefers that I use their EHR system that has full billing capabilities and a clearinghouse (Navicure) built-in. I will access their system remotely. Iím so excited but have a few questions...

1) My new client is currently using a billing service who uses her own PM system. The client sends his current billing service a super bill and she bills the charges appropriately. My questions is the transition for my new clients patient accounts. I will be using the clients EHR but currently no charges have been documented in their EHR because this has all been handled by the billing service through her PM billing system. Her term date will be 12/31/2017. I will begin 1/1/2018 (new year, new beginnings) say she bills a charge for 12/20/2017 and payment comes in after the fact. What type of reconciliation is done? Is there a proper transition process? Any information would be beyond helpful! The client is asking for advice to make a smooth transition and I honestly am a little lost myself. I suggested that the client request aging reports (insurance and patient)  from their current billing service but they are looking for more of a step by step process. Iíve had the conversation about followup on services prior to my effective date with an additional service agreement but they are more concerned with the reconciliation of payment after the fact. How can I reconcile services when I donít have the charges to begin with? I havenít handled a transition before especially not one where the services were not in the EHR system I will be stepping into.

2) The Client has asked that all payments comes directly to my business address and that I handle making the deposits into their business account.. Is this normal? What areas do I need to updated the billing address for? Statements...ERA enrollments...835/CMS1500 billing address...anything Iíve missed?

Thank you experts!! You are always so help and I donít want to mess things up with my first official client!!

Cheers to the New Year!!

The provider is the only one who should be obtaining info from the old billing company to send you as that is the contractual relationship. Same goes for charges, she'll have to rectify those OR have you work on the backlog while she obtains the info needed for those charges. This is one of those areas you will need to stand firm with and stay out of any and all contractual obligations the prior service has with the client. You could gently tell her she should have an attorney review her contract with the prior billing company to see what her options are.

As for payments and such going to you, no that really isn't advisable and actually Medicare would have a problem with that unless you'll be having a lockbox setup. I would advise the provider she's going from hot to hotter and would put herself right back into the pickle she's in now. This provider sounds like she needs a lot of hand holding and doesn't want much control over her billing and that could be why she is in the situation she is in. If she sends things to you, it's her legal obligation to keep her own source documents, payments should go to them with you posting them and then yes, you can reconcile with their deposits. You will still need to update her 855 to designate you as the billing company though.

Congratulations!!!    8)

Ditto with Linda on the current biller.  You should not have any direct contact.  THey need to look at their contract with that biller.  Usually the contract states that they will be responsible for all claims submitted.  So you would only be concerned with claims 1/1/18 and on.  However, we all know that's not always how it works out.

Where do the payments currently go?  To the current biller?  Medicare should be set up for EFT so you just need to do the ERA paperwork to get the ERAs delivered to you.  As for the other carriers you need to see if they are also getting EFT or if they still get paper checks and where they are currently going.  We do have a couple providers who insist that their mail/checks come to us.  We deposit the checks into their bank account (we have no access to the account) or send the checks to them to deposit, depending on what they want.   If the checks are currently going to their address I would suggest leaving it that way and just picking up the mail from them.  They may just not want to be bothered with going to the bank (can you imagine!).  It is a bit of a pain to change addresses so personally if they are getting the mail I would leave it that way.  We have a provider who has everything delivered to a PO Box, he picks it up and drops everything off to us, unopened.  We have another who gave us the PO Box key and wants us to pick up and then we give him all checks.  Providers are a funny breed.  They all have different situations.  We will receive the mail, deposit the checks if desired, but we never have access to the account.

This is a good reason why I do NOT hold PM system contracts, licenses or software fees. I let the client hold them all. Then there is less of a problem in the long run. I know in this case it can't be avoided..but it can in the future by letting the client have full license, costs and access.   

Thank you! You guys are so great and I truly appreciate your support.

I will definitely have no contact with the current biller and I have made that very clear. It is such a complicated situation to step into because the provider has no access to the current billing services PM system. My focus and energy will be focused on 1/1/18 forward. Would it be unreasonable to do a balance forward in the providers EHR system, the one I will be working out of, to reconcile payment prior 1/1/18? The balance forward would be based on the detailed aging reports for insurance and patient. I'm fairly certain their current biller will not be handling anything after the date 12/31/2017.

The providers payments currently go to the current billing services address. Complicated right? The provider, thankfully, see's only private insurance/cash pay patients. The provider has stated they current receive EFT but I am sure the current billing service receives a few payer payments via check and of course all patient payments. Patient payments is easy I will just update the statement pay to address but it becomes more complicated with insurances.

I love that! Providers are a funny breed! You hit the nail on the head there!! I am happy to accommodate their needs especially since they are my first client. I will use this as a learning experience but do not want to turn down this offer because I might prefer payments to go to them, etc. I just want the transition to go smoothly for them and ME  :).


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