General Category > General Questions
Can you make a profit by charging 4%?
PMRNC:
There are two MAIN facets of HIPAA compliance, one is transactions and the other is Privacy and security. Providing links would take all day. Yes among MANY other things your software must be HIPAA compliant. They all are.. old news. In addition as a business associate of covered entities you are required to be sure your entire business and infrastructure is in compliance.. from making sure all employee's have secure login's and only given the "minimum access required". Making sure if you have employee's working OFF site, they too are in compliance. Having a work at home biller who works at her kitchen table is NOT compliant. The laws apply to every person touching PHI. Files left on a desk, home offices with OUT private access to fax or filing cabinets that are accessible is NOT HIPAA compliant. Since you are a physician, it actually should be easier for you to forsee these issues and put yourself into your clients shoes. Your butt is on the line EQUALLY as the providers. HAVING E/O insurance is critical but your E/O is only going to bail you out IF you and your employee's all are in compliance. As a billing company your job is to make sure your providers are compliant and that you and all employee's are compliant along with their operating structure. Kitchen table billers are NOT going to cut it.
I use Kareo too and they are great... Awesome even. :) But your only looking at it from a software stand point when there is SOOOO much more that goes into compliance than just your software. This is why having a compliance plan is critical for any billing company. Read more about that on the OIG's website at: https://oig.hhs.gov/fraud/docs/complianceguidance/thirdparty.pdf
Just a tip too .. UNRELATED. Today's billing company needs to be diversified to compete. For example, it's great your doing your homework in purchasing software, but you need to be ready for the providers who have already invested a great deal of money on their own PM solutions that don't want to change, they want to work with what they have. I've seen MANY billing companies turn down clients because the client wanted to stay on their PM system, that's because they are not prepared, all the medical billing classes and educational programs, online courses do NOT tell you things like this. My PM solution is JUST for the ones that need one or want to switch. I utilize the clients PM solutions if they want me to. I've never turned down a client because of a software issue. I don't put all my eggs in one basket. Just a little tip :)
PMRNC:
Also from a marketing standpoint, having a compliance plan will win you clients over the ones that don't. In my experience over the last decade, I'm willing to bet only 2 in 10 billing companies actually have a compliance plan. I don't even wait for my potential clients to ask for it. I market the fact that I have one and it's open for them to review.
tallmanusa:
Some very good points.
How do I develop a compliance plan?
You are correct what do I do when a provider insists on using his own software?
If he has no EHR, and does not want to use one, I would pass on him.
My price of 5% solution includes the software for PM and EHR.
If he already has EHR we would work with that.
What happens if he has PM but not web based? Some providers have spent big money on software and don't want to change, even though it may be obsolete.
DMK:
Thanks Linda for putting it so succinctly. Some billers don't think HIPAA all the way through. Billers have more patient information than the doctors do, BECAUSE they have multiple doctors. If it were only data crunching will Dx and CPT codes that would be one thing, but those codes get attached to PEOPLE's information (date of birth, social, name, address etc). It's a big responsibility and not one to be taken lightly. If someone (the owner of the billing company, or a low paid data entry person) is that flippant about someone else's personal information then they shouldn't be handling it.
tallmanusa:
I asked elsewhere, there are middle to large companies doing most of this business who outsource most of their work within USA or offshore. These companies handle 80% of all the medical billing business. How do they do compliance?
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