Author Topic: Any billers here in the Seattle area??  (Read 210 times)

williamportor

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Any billers here in the Seattle area??
« on: December 14, 2017, 01:57:03 PM »
Hello,

I've just been fired by my biggest client after 3 weeks. This doesn't happen very often, but feel if I could watch a professional billing company do their job for a few hours, and be able to ask questions, I could become a better and more efficient biller. I do billing for 8 other clients, though smaller, they are all happy with my work. Every time I land a larger one however, I can't seem to live up to their expectations.

Unlike many of you I had little experience with Medical Billing when I started in this business 4 years ago, but feel I've gotten much better. I don't yet have the $$ to travel to the east coast, but if there are any of you in the Seattle area that would allow me to drop by to watch, that would be very much appreciated. It's tough to grow ones business when this happens.

kristin

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Re: Any billers here in the Seattle area??
« Reply #1 on: December 14, 2017, 03:11:25 PM »
Wish I was in Seattle, that is my favorite city!

Let me ask you this...is the issue that there just isn't enough hours in the week to keep up when you do land a larger client, and you are still working all the smaller accounts too? Meaning, is there just not enough "you" to go around? If so, have you thought of sub-contracting out some of the smaller clients to someone, or adding an employee to help? I get the feeling you aren't the issue/your skill set, so much as it is a time factor.

One of the billing companies I work for has always had one huge client, and two smaller ones. I have been the only employee, and I handle one of the smaller accounts exclusively. If I was to quit, the owner would have to hire someone else, because it is simply too much work for one person to do on their own. And that is only one huge account and two smaller ones, not eight smaller ones.

Michele

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Re: Any billers here in the Seattle area??
« Reply #2 on: December 15, 2017, 07:28:33 AM »
So sorry to hear.  That is a tough one to overcome.  We once lost a very large client VERY unexpectedly and it was a huge blow!  We too had many small and medium clients and this was our first big account.  We worked for them for over a year and did a REALLY GOOD job.  We over doubled their monthly revenue without them seeing any more patients.  That's how bad their billing was before we took over.  One day I walked in and the doctor wouldn't look me in the eye.  He said "I need to talk to you".  I was FLOORED!  But on the same note, not surprised.  The doctor's wife was also a doctor and she never liked us.  He brought us in behind her back.  And she wore the pants!  So even though we did a great job and their income was good, their patient billing was going out regular for the first time EVER and the aging report was being worked, we got fired.  Linda always says if the doctor's wife is involved, RUN!  We actually have other accounts where the doctors wife is involved and it's fine, but in this case we should have known.  Anyways back to Williamsportor, I know it's a tough blow, but learn from it.  Turn it around to make it a good thing.  If you learn the lesson that you need to learn so that the next account doesn't fire you then it will have been worth it.  Look back over the time you had the account.  What condition was it in when you took over?  Did you improve it?  What more could you have done?  What (if anything) did you do wrong?

Kristin pointed out some good things.  Did you have enough time to devote to it?  Do you know what their issues were (why they hired you) and did you make them better?

Even though you started with not much experience you have been doing this long enough that you should be confident in yourself now.  Sometimes when we lose accounts it is not our fault.  In our example above, we truly did nothing wrong (work wise) on the account.  We cleaned it up and got money coming in the way it should have been.  But we still lost the account.  And the person they replaced us with had a 40% drop the first month she took over.  They have lost money due to switching from us, but it didn't stop them.  Why? Because the reason they didn't want us in there was not because we weren't doing a good job, it was because the wife and office manager (Separate people) did not like us.  They were friends and we exposed how poorly of a job the office manager was doing.  (She still works there.  :) )  The lessen we learned was that some accounts are not right to take, no matter how much money they bring in.  And also, it does not ever pay to go around the office manager.  She will find a way to get you out.  I'm not going to publicly make accusations against her so I will just say that she should have been more than fired for the things that she did and didn't do.  But she wasn't, we were.   We had another account years later that was even larger.  After our 1 year contract was up we informed them we would not be renewing.  Some accounts are truly not worth it.  (Dr's wife was the office manager!)

I wish we were closer too!  I don't foresee a trip to the west coast but you never know!  I have never seen Seattle.  If we are heading that way we will let you know!
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Michele

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Re: Any billers here in the Seattle area??
« Reply #3 on: December 15, 2017, 07:29:21 AM »
OH, and 3 weeks?  Seriously?  No one could know if you were doing a good job in 3 weeks.  What did they tell you as a reason?
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williamportor

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Re: Any billers here in the Seattle area??
« Reply #4 on: December 20, 2017, 10:57:12 AM »
Thank You everyone for the input. My 8 other clients (mostly Optical and Chiropractic) take about 100 / mo hours to service and bring in about $1350.00 / mo. Not a great return for my time, but it's steady. Whenever I land a larger client I have to spend at least 30-40 hrs. a week cleaning up their billing mess (not unusual when a provider switches billers) This means I spend 50-60 hrs a week working, and can't really do a good job on anything. I can get the larger clients problems fixed, but I can't get them fixed FAST ENOUGH to suit them.

I contacted several billing companies in my area, and asked to see how they do things, and they politely told me to "get lost" I'm not sure if I'm under charging my customers, or I'm just inefficient (maybe both) Please don't get me wrong, I do love this lifestyle, but $1350.00 / mo. doesn't buy much, and I'd like to move ahead. I'm still trying to figure out how a biller can produce $5000.00 - $7000.00 of billing fees, when I struggle to do over $2000.00

Michele

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Re: Any billers here in the Seattle area??
« Reply #5 on: December 20, 2017, 01:32:55 PM »
I think it is a combination of things.  But mostly I'm thinking it is the type of clients.  First I think I've asked you this in the past if you were doing this through Practice Mate?  If so, that is a big part of the problem.  We did one account that way and had to give it up.  It took 4 to 5 times longer to do anything through that system.  I know it's free but trust me, it's costing you.  If it is taking you 100 hours to bring in $1350 that's barely $13 an hour, which is not enough.  In our experience the Optical is better than the chiropractic.  No offense DCs!  I know a lot of you and you are great, but the reimbursement per visit is low.  We do have some DCs and they are ok, but not the easiest.  I know you don't see how one person can produce $5000 - $7000 but if they don't we can't survive as a business.  It's just that you haven't seen it yet.  I believe the other main issue is efficiency.  But if you are using Practice Mate then you will not be able to improve that much.  If you spend 100 hours bringing in $1350 you will not be able to increase that much without quality of work suffering. 
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williamportor

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Re: Any billers here in the Seattle area??
« Reply #6 on: December 28, 2017, 06:26:10 AM »
I think it is a combination of things.  But mostly I'm thinking it is the type of clients.  First I think I've asked you this in the past if you were doing this through Practice Mate?  If so, that is a big part of the problem.  We did one account that way and had to give it up.  It took 4 to 5 times longer to do anything through that system.  I know it's free but trust me, it's costing you.  If it is taking you 100 hours to bring in $1350 that's barely $13 an hour, which is not enough.  In our experience the Optical is better than the chiropractic.  No offense DCs!  I know a lot of you and you are great, but the reimbursement per visit is low.  We do have some DCs and they are ok, but not the easiest.  I know you don't see how one person can produce $5000 - $7000 but if they don't we can't survive as a business.  It's just that you haven't seen it yet.  I believe the other main issue is efficiency.  But if you are using Practice Mate then you will not be able to improve that much.  If you spend 100 hours bringing in $1350 you will not be able to increase that much without quality of work suffering.



OK. Practice Mate is no good. I can switch PM systems, but the 2 MD's I did billing for were using Practice Mate, it might be a bit rude to suggest they switch systems, but any suggestions as to what I should be using for my other clients? 

I've had 2 doctor (MD) clients, both fired me within 90 days, their reasons were 1. Too many billing errors (they wouldn't specify what kind) and 2. I didn't get their receivables down fast enough. The thing is, when I took over, they dumped a small mountain of old claims on me, by the time I had submitted all the old and new claims (usually 1-3 weeks) their receivables were larger because I didn't have time to get their EOB's, posted much less research and fix the denied claims. Once the claim submission was finished and I started addressing the posting (complete with the dizzying array of websites simply to get the EOB info.) and fixing the denied claims, I got the news my services were substandard, and I was shown the door. After these 2 enriching experiences, I've become a bit hesitant about MD billing. So, other than dispensing with Practice Mate, what could I have done better?

P.S. I never intended to become a D.C. billing guy, but The reason I have so many D.C.'s is because they are mostly who I seem to sign up, MD's clients are really tough to find, nor do I seem to live up to their expectations.
   
« Last Edit: December 28, 2017, 06:33:10 AM by williamportor »

Michele

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Re: Any billers here in the Seattle area??
« Reply #7 on: December 28, 2017, 12:00:54 PM »
The DCs can be a great learning experience for you so it's not that they aren't good.

As far as the MDs it is unfortunate that you lost them so quickly.  I am going to try to answer without harping on PM.  In our system when we start a new provider the set up of the system takes about 15 minutes.  Then the initial claims take a bit longer than normal because we have to input some additional information such as insurance, CPT, ICD, etc.  But still we are able (1 person) to get claims input and submitted within the first day.  Usually can do about 15-20 claims an hour for the first day, then up to 30 - 45 claims an hour after most of the set up is established.  If we take on a client with a backlog of claims we tell them we will do our best to get all claims out quickly but it is going to take us a bit to catch things up.  That way they know what to expect.  However, we do try to get claims in and submitted the first day so that they money starts flowing quickly.  We submit the claims as we get them input, we don't wait for all claims to be entered before sending.  But we also enroll to receive ERAs so that payments can be autoposted.  This is a huge time saver and allows for payments to be input when received and  quickly.  The providers need to be able to see that the money is coming.

I would not shy away from MDs but I would make sure that you are ready for the next one.  Have a system that allows you to have as much as possible automated, like posting payments.  Input needs to be able to be done quickly, smoothly, and efficiently.  If you are wasting all of your time on things that can be done quicker you won't have time to do the things that will matter and that are important.  You might want to consider finding someone who is looking for extra work, or part time work that could help you out in the beginning to get things rolling.  Maybe a stay at home mom who has time while kids are in school?  Or a retired person looking for something to do but doesn't need anything permanent?  Having extra help getting things started might have saved you.

We've never told a provider that they have to switch systems.  We have told two providers in 25 years that we could not renew our contract because of the system they used.  One was PM, and they chose to leave.  The other immediately offered to switch to keep us.  She knew her system was bad and was more than willing to switch.  So you can't really insist that they switch.  However, for new clients who do not have a system of their own, I would highly recommend using another system so that you can see the differences.  It's hard for you to understand or even see until you've experienced using a system that is more efficient.  Maybe you can try some demos of other systems?
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PMRNC

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Re: Any billers here in the Seattle area??
« Reply #8 on: December 28, 2017, 03:08:16 PM »
I might be in for a spanking on this but the only thing I ever learned from chiropractors was how they seemed to love to get over on the system. No offense to those who do work with them, I just refuse to. I used to process claims for insurance companies and MUCH of our founded fraud cases involved chriopractors, not as much as lab's but pretty dang close.

I like all the tips you got from everyone. I think it just sounds like you are overwhelmed, forgive me if i missed it but did you mention any staff to help? What I know you are thinking is "well I barely make enough now to pay myself, why would I hire employee's?"  Well the old addage is true, to make money you have to spend it. That means you might lose the first year or two but once you have hit a certain point in your workload by yourself you have to ask yourself "Where do I want to be in twe years?" I say two years because today the life of a small business startup is much shorter than it was a decade ago. When I started my business I wasn't worried about that at the time because I had two clients before I even decided to go into business, but what I didn't bank on was growing as fast as I did and like you became overwhelmed. So I had to stop and ask myself that question, where did I want to be in a few years?" Well I knew one thing was for sure. I did NOT want to hire employee's and while I know some billing companies will hire remote, that was NEVER an option I would have gone nor would go to now at all. Too much liability, and if you don't have the proper insurance it can be a real nightmare. Many think you get to just decide if they are an independent contractor or just an employee but it doesn't work that way, it depends on how they do the work for you and who's supplying ALL of the things needed to do that job, and the good ol IRS.

My point is that you see yourself growing with MORE clients and more relevant clients to bring in a nice income, than you need to plan that now and it means spending the money (office space, marketing, etc.) If you know that is what you want, maybe look into a business loan or line of credit to start out. IF you are like me you might just want to bring in a decent salary or supplement another form of income. I had made the decision to not grow larger than what I could handle BY myself for that reason. I had many reasons for wanting to stay small at that time and now with two other businesses I run I'm happier keeping it small. If I need to supplement, I market my consulting services which IMHO brings in a LOT more revenue than billing and in a shorter time frame! I also like doing the consulting as it gets me doing other things besides the same ol humdrum and I get bored very easy. Of course that's just how I do it and you might be different. You just first have to first find out where you want to go and how fast you want to get there. :)
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williamportor

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Re: Any billers here in the Seattle area??
« Reply #9 on: January 01, 2018, 09:07:59 AM »
The DCs can be a great learning experience for you so it's not that they aren't good.

As far as the MDs it is unfortunate that you lost them so quickly.  I am going to try to answer without harping on PM.  In our system when we start a new provider the set up of the system takes about 15 minutes.  Then the initial claims take a bit longer than normal because we have to input some additional information such as insurance, CPT, ICD, etc.  But still we are able (1 person) to get claims input and submitted within the first day.  Usually can do about 15-20 claims an hour for the first day, then up to 30 - 45 claims an hour after most of the set up is established.  If we take on a client with a backlog of claims we tell them we will do our best to get all claims out quickly but it is going to take us a bit to catch things up.  That way they know what to expect.  However, we do try to get claims in and submitted the first day so that they money starts flowing quickly.  We submit the claims as we get them input, we don't wait for all claims to be entered before sending.  But we also enroll to receive ERAs so that payments can be autoposted.  This is a huge time saver and allows for payments to be input when received and  quickly.  The providers need to be able to see that the money is coming.

I would not shy away from MDs but I would make sure that you are ready for the next one.  Have a system that allows you to have as much as possible automated, like posting payments.  Input needs to be able to be done quickly, smoothly, and efficiently.  If you are wasting all of your time on things that can be done quicker you won't have time to do the things that will matter and that are important.  You might want to consider finding someone who is looking for extra work, or part time work that could help you out in the beginning to get things rolling.  Maybe a stay at home mom who has time while kids are in school?  Or a retired person looking for something to do but doesn't need anything permanent?  Having extra help getting things started might have saved you.

We've never told a provider that they have to switch systems.  We have told two providers in 25 years that we could not renew our contract because of the system they used.  One was PM, and they chose to leave.  The other immediately offered to switch to keep us.  She knew her system was bad and was more than willing to switch.  So you can't really insist that they switch.  However, for new clients who do not have a system of their own, I would highly recommend using another system so that you can see the differences.  It's hard for you to understand or even see until you've experienced using a system that is more efficient.  Maybe you can try some demos of other systems?

Michele and PMRNC - Thank You both for the response. Lot's of things to go over here. Much appreciated!!