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

Profit Margin

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sagemb:

--- Quote from: PMRNC on November 18, 2014, 08:49:45 PM ---Their PM system is THEIR's.. lock, stock and barrel, I have my own HIPAA compliant login and that's that. problem solved.

--- End quote ---

I'm glad to hear that because I've been considering the same. And I find it motivating to hear from Michele's reply also that billers aren't expected to loose their shirts over the course of business.

sagemb:

--- Quote from: kristin on November 18, 2014, 11:01:49 PM ---What concerns me though, that you asked about, is the 52 hours a week it took you to work the one account.

--- End quote ---

I think you hit the nail on the head. Major bulk of the work goes into denial handling and follow up. A lot of bad data comes from the doctors office. I basically get all the superbills for clinic patients and facesheets from his hospital runs. And the staff basically just writes the missing info including the carrier name, member id, group id, etc. Sometimes its printed, sometimes not.

Once, I get all this info, I get cracking on the demo entry and eligibility check. Now the problem with Kareo Elig Verification is that it'll do it for most of the major carriers but not the small ones, in this case, these are the 2nd major bulk. Medicare and Medicaid being the primary bulk. So almost half the bills aren't going through that process. And I find out when a load of them get mailed back for numerous incorrect data, from wrong carrier to wrong id, to wrong names.

I have had talks with the doctor about these because I can only work with the data given to me. And he understood...but just too busy to do anything about it. Now...fast forward...if I find myself in this situation over and over, I'm the type to bust my behind to double the work and go through painful elig verification in other ways, which in itself is such a time-staking work.

Michele:
Basically the problem is that the people in the doctors office are not doing their jobs, or at least not doing it well and you are paying for it. 

DMK:

--- Quote from: Michele on November 19, 2014, 01:42:43 PM ---Basically the problem is that the people in the doctors office are not doing their jobs, or at least not doing it well and you are paying for it.

--- End quote ---

It's more like he's getting a less than minimum wage employee to do the job.  The office staff should be sending you the correct, clean information so you don't have to do all the extra work to chase things down.  You can sell this point by letting them know that the faster you send the correct information, the faster they get paid.

PMRNC:
I'm going to play devils advocate here.. It's NOT your problem what their staff is doing or not doing.. however.. since you are billing on a %.. you have MADE that your problem. That's again, why I caution against % based billing. We keep seeing same problems with % billing over and over and there is no easier way to say it than to say.. WHY?? get paid for your time!! Your a professional.. your income should NOT depend on the job they are doing at the offices. I see so many billing companies struggling with this part in their business and I really believe that is why most of them close up. YOUR income should be comprised of the work you do, the time you put in and the experience you have.  You will NOT increase your profit margin as long as your profits are dependent upon the work they do at the office instead of the work YOU put int. I don't know of a nicer way to say that but I hope you get my point. You run the show.. your income should NOT be dependent on how they are doing THEIR jobs. That's not way business works, I think many times we think it does and because "everyone else" is billing a % we think we have to in order to remain competitive.. HOG wash... :)

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