General Category > New!
* Urgent Response * First Client
RCC:
@lindawalker - Thanks so much.
Merry:
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
PMRNC:
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.
RichardP:
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:
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! :)
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