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RCC:
@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:

--- 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.
--- End quote ---

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.

RCC:
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

shanbull:
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.

PMRNC:

--- 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.
--- End quote ---

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.

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