Practice fusion users, what about billing

[inspire004]

What do you do for billing. Learnt from Mille that PF is getting partnered with 3 billing companies. Which of the 3 has the best track record. I am a lean start up. Do I need a separate biller. ADP AdvancedMD, CollaborateMD and NueMD

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[Pain Applicant1]

Iffff........ I was able to do one thing over again when starting up I would have done my own billing. I'm doing it now, I'm learning it and now training my staff to do it. It's taking me a few months but I'm getting it done. Soon, my staff will do all of it.

If you don't do it yourself, you won't learn it. If you won't learn it, it will be easy for billers to take advantage you and take advantage of you they will.

 

[Pacman27]

Suggestions on how to learn. I have gone to the ASIPP course and feel comfortable lining up CPT codes with ICD codes, most modifiers, reviewing LCD's, what to include in notes for E and M visits.

But my problem is where to start. How to go about getting Pre Auths, to chase down unpaid claims, etc

Any thoughs would be appericiated

 

[Pain Applicant1]

Just start doing it, when things get rejected and denied find out why and never let that particular mistake happen again. Call the insurance company to find out why your claims are unpaid. It's just a game. Look on insurance cards for the numbers for pre auth.

It's not difficult, just tedious.

 

[Pacman27]

I am so excited, can't wait

Apperciate the advice

 

[inspire004]

Thanks pain app, so you donot use a biller and from PF you directly send the claims. And mange all the denials, rejections and reapplications. Some billing companies have a flat monthly fee.
They are costing about 100- 200/ mth and they are saying they got 99% claims acceptance.
I am working on work flow optimization too for each patient who walks in. What tasks, who does and how many office staff personal and what skill set to look when I recruit them at what cost.
Since most of the tasks are automatic and ehr based. With PF, I am still simulating what my front dest and ma need to do for NP,FU, PR and phone correspondences.

 

[Pain Applicant1]

Is unlikely a billing company would charge you $100-200/month and if they do you should stay clear of them. What you're likely referring to is a billing software. You'll still have to do the work.

Do yourself a favor, sacrifice a few months of your life and learn everything about billing. It can be boring and tedious but you will reap tremendous experience and knowledge. Learning billing allows you to put your finger on the pulse of the practice. Either do that or hire a company to take care of everything, such as Athena. I think they would be the only ones that I would trust at this point although I've never used them so I can't speak from experience.

I can't tell you how pissed off I am with billers. I'm spending months cleaning up their mess, not to mention the thousands upon thousands of dollars that I'll never collect. I accept this as a business loss and an education. If this happened to me I know it's happening to others as most doctors know very little about the billing process.

Put yourself in a biller's shoes. If they get paid 5% of what you collect, do you really think they're going to fight for a $100 charge. Probably not. If you multiple that by twenty charges that's $2000 for you but only $100 for them. Billers even have a saying, they go after the "low hanging fruit."

 

[inspire004]

I am having similar issues with our biller, she actually teaches at a collage. They are very good at hiding stuff and no one care about the unknown. After you make the super bill, what do you do.

I am looking into collaberativeMD. See if you come up with some questions and if it could with stand real time issues with practice

 

[Pain Applicant1]

The superbill is just a cheat sheet for you. You typically need to take the information from it and put it into a HCFA form which you then submit to the payers. The software allows you to transfer information from the superbill into the HCFA form easily, or so they say.

 

[mille125]

Iffff........ I was able to do one thing over again when starting up I would have done my own billing. I'm doing it now, I'm learning it and now training my staff to do it. It's taking me a few months but I'm getting it done. Soon, my staff will do all of it.

If you don't do it yourself, you won't learn it. If you won't learn it, it will be easy for billers to take advantage you and take advantage of you they will.

I don't know if I agree with you on this. In my opinion you would really need to know and trust your billing person before you would delegate this important task. How much can you really know a person who your just hired? Even if you have a good knowledge of billing (which is a good suggestion) you cannot do it all. The amount of oversight that you will need to provide as a brand new practice will vastly utilize your time which you cant get back. If you have figured that out and can still have a family, then kudos to you. I think that in most startups, billing in house has much more risk than reward. After a few years when you get to know your staff, it may be a different story. Having a bad or lazy or incompetent in-house biller is one of the few things that will shut down your practice.

 

[mille125]

I am having similar issues with our biller, she actually teaches at a collage. They are very good at hiding stuff and no one care about the unknown. After you make the super bill, what do you do.

I am looking into collaberativeMD. See if you come up with some questions and if it could with stand real time issues with practice

collaborative is a good program...you would be happy with it.

 

[mille125]

Thanks pain app, so you donot use a biller and from PF you directly send the claims. And mange all the denials, rejections and reapplications. Some billing companies have a flat monthly fee.
They are costing about 100- 200/ mth and they are saying they got 99% claims acceptance.
I am working on work flow optimization too for each patient who walks in. What tasks, who does and how many office staff personal and what skill set to look when I recruit them at what cost.
Since most of the tasks are automatic and ehr based. With PF, I am still simulating what my front dest and ma need to do for NP,FU, PR and phone correspondences.

usual fee is 5-7%...I agree with pain applicant. Run at 100-200/month.

 

[inspire004]

Athena has collector coordinator communicator for 5-7% , why do i choose just a billing company for 5-7%, BTW ehr and pm part of collaborative doesn't have track record . Athena has a good reputation but a bit expensive

 

[Pain Applicant1]

I don't know if I agree with you on this. In my opinion you would really need to know and trust your billing person before you would delegate this important task. How much can you really know a person who your just hired? Even if you have a good knowledge of billing (which is a good suggestion) you cannot do it all. The amount of oversight that you will need to provide as a brand new practice will vastly utilize your time which you cant get back. If you have figured that out and can still have a family, then kudos to you. I think that in most startups, billing in house has much more risk than reward. After a few years when you get to know your staff, it may be a different story. Having a bad or lazy or incompetent in-house biller is one of the few things that will shut down your practice.

I agree, you can't do it alone. However, I do recommend doing just that at the beginning. You need to know billing or you won't collect what's owed to you and most docs know zilch when it comes to this. The only way to learn it and know it cold is to do it. It's time consuming and pain. However, it'll be well worth it for the long run from a business sense. Now that I have billing down I'm transferring the work to my trusted MA who is loyal beyond belief. She's doing the work and I'm just reviewing reports but now I understand what the reports signify. It's not that time consuming anymore but did cost me a lot of time at the beginning. My collection rate has come up since I've taken it over so financially it was a good move. The OP will just have to determine how much sacrifice he's willing to make with regards to this.

 

[mille125]

I agree, you can't do it alone. However, I do recommend doing just that at the beginning. You need to know billing or you won't collect what's owed to you and most docs know zilch when it comes to this. The only way to learn it and know it cold is to do it. It's time consuming and pain. However, it'll be well worth it for the long run from a business sense. Now that I have billing down I'm transferring the work to my trusted MA who is loyal beyond belief. She's doing the work and I'm just reviewing reports but now I understand what the reports signify. It's not that time consuming anymore but did cost me a lot of time at the beginning. My collection rate has come up since I've taken it over so financially it was a good move. The OP will just have to determine how much sacrifice he's willing to make with regards to this.

Keep an eye on that MA. Do some mock audits of her work. I would have described my previous biller in the same way a few years back. She burned me to the tone of 20-30K or so in unbilled and expired claims. Watch her closely.

 

[inspire004]

So from super bill you/ ma manually polls data to Hcfa and send the claim. If there are issues with that claim. I am assuming you will need to troubleshoot.

Do you think all of this is electronic and how much is paper based, like put a stamp and send some additional documentation.

Do you check for current eligibility before you schedule a procedure. Some softwares check it in real time so that there is no hold, once the claim is out .

 

[Pain Applicant1]

Keep an eye on that MA. Do some mock audits of her work. I would have described my previous biller in the same way a few years back. She burned me to the tone of 20-30K or so in unbilled and expired claims. Watch her closely.

I think I can see this happening. Not because of lack of work ethic but just because billing can become overwhelming. I'm really thinking about switching to Athena and just letting them take care of everything.

So from super bill you/ ma manually polls data to Hcfa and send the claim. If there are issues with that claim. I am assuming you will need to troubleshoot.

Do you think all of this is electronic and how much is paper based, like put a stamp and send some additional documentation.

Do you check for current eligibility before you schedule a procedure. Some softwares check it in real time so that there is no hold, once the claim is out .

Do not do anything manually, that will take you forever and there will be no way you can sit there and do it. I don't mean this in a critical way but from the questions you're asking you should really take a course on billing. You weren't even sure what a superbill was and that is just the very, very, very tip top of the iceberg. I'm telling you from experience, do not start your own practice without having a solid foundation in billing. A bad billing experience will bring you down fast and it can be complicated and frustrating. Spend the money on a course and yes, check eligibility on everyone, at least at the beginning until you understand which payers don't require it.

 

[Pain Applicant1]

collaborative is a good program...you would be happy with it.

Are you really happy with it? I think I want to change my current software system because my staff has to enter information twice since it's not integrated with my EHR and PM software. Is it user friendly and easy to run reports? Is the claim scrubber really effective? Has your denial rate gone down?

I might switch to collaborative, still thinking about this one.

 

[mille125]

Are you really happy with it? I think I want to change my current software system because my staff has to enter information twice since it's not integrated with my EHR and PM software. Is it user friendly and easy to run reports? Is the claim scrubber really effective? Has your denial rate gone down?

I might switch to collaborative, still thinking about this one.

Do a demo on both. Athena is slightly more user friendly but it is also more expensive.

 

[inspire004]

I think its worth paying for athena and not reinvent the wheel again.

 

[inspire004]

So I did demos with collmd and athena. They try to pool as much data from super bill. But it both u still need a person to send claims. Sometime they can be submitted in batches. We all have to start some place. What billing courses are you recommending with your extensive experience

 

[Pain Applicant1]

So I did demos with collmd and athena. They try to pool as much data from super bill. But it both u still need a person to send claims. Sometime they can be submitted in batches. We all have to start some place. What billing courses are you recommending with your extensive experience

I can't help you with that one, I didn't take a course. I started reading up on billing/coding during residency and tried as hard as possible to learn everything about it. When I had a question I would just call the billers affiliated with the hospital where I was working. I also pushed my residency director to have the billers give us lectures, etc. I still stay in touch with some of them. Even with that, sending claims, posting claims, and following up denials took me some time to learn. It will always be an evolution in process as the payers can constantly modify their requirements in order to get paid.

Yes you will ultimately have to send claims but that shouldn't be too time consuming. If it is, you can always have a paper superbill, circle which codes you want, and hand it off to an employee to enter.

Just please make sure you know your billing, you don't want to learn the hard way, as I did, and it cost me substantial money which I will never collect. Probably upwards of several 10s of thousands.

 

[inspire004]

I think they have good material and course

 

[mille125]

So I did demos with collmd and athena. They try to pool as much data from super bill. But it both u still need a person to send claims. Sometime they can be submitted in batches. We all have to start some place. What billing courses are you recommending with your extensive experience

Pay a billing expert to sit at your practice one on one. Will cost you about $3000 but definitely worth it. I did it when I first started. Expert sat with biller all day long.

 

[bronchospasm]

I am starting my new practice next week. I thought about doing the billing in house and went to the asipp and SPPM courses but in the end decided that I would rather get a biller to do it right from the start. My emr has a pm and billing module. I can look at each claim, the status etc.

My wife is a CPA and over the next 6 months to a year, she is going to train to do the billing etc. I do not see myself getting rid of the biller, but, she will go through each and every claim and make sure everything is in order.

I really wanted to go with Athena, but you still have to have someone who follows up on denials etc. and the cost Of getting a biller and Emr was the same as that of Athena ~ 5.5%. Also with Athena, if you are not happy, for some reason, then, you can not use just their emr ..... It's all or nothing...If you leave, the all you have is data on a disc... For some reason, that really bothered me.

So I borrowed a biller from my friend who has been practicing pain for 5years and was happy with his biller. my billers fees are reasonable and he does the preauthorizations as well so that ther is no issue with the claim submission. He also follows up on the denials and has acess to the entire Emr. Since he does the preauthorizations, I do not have delegate it to an MA reducing some work from the clinical staff.

So as of right now, my office staff will do the patient registration, insurance eligibility, demographics, room the patients, vitals, pmh, psh, medications, allergies, prior labs, rad,MRI etc. prior to me seeing the pt. I will go over the data, do the history and physical exam, assessment and plan and code for the E&M visit and once the encounter is closed, it is sent to the biller, who reviews it and submits it the same day.

Hopefully, this works.

Will appreciate any words of wisdom from others.

 

[inspire004]

Thanks please check your pm, I am looking for a good biller

 

[inspire004]

I got lot of offers with billers, I was not going to go with % collection

 

[Pain Applicant1]

Trust no biller, go with Athena. I hate advocating for a corporation.

The strongest function Athena offers is the ability to go after denied claims. Their software is constantly updated so fewer and fewer claims will be denied during the initial rounds.

Better yet, stick your wife in your practice now. It shouldn't take her six months to be trained.

 

[joshmir]

Are you sure Athena does not follow up on denials? It sounds like Pain Applicant 1 was saying they do...

 

[bronchospasm]

No they don't... It bounces back to the designated person in your office that is responsible for making sure that all corrections are made before submitting it.

There is a person in the next office who does just that... Resubmitting claims for Athena...

 

[inspire004]

It's only a software, it can do lot better than most systems out there but it needs human to put and f/u data. I learnt a MA can hadle it , dont need certified biller. Some one needs to put the hand on the pulse to check numbers. on deductions adjust balances and f/u on missed payments. Although communicator can help but again you needs designated person to check and update. Most of them swear on the 1st pass rate of a claim and avoid rejections. I still havnt fond a good system that does every thing. Excepting a billing company.

 

[Pain Applicant1]

No they don't... It bounces back to the designated person in your office that is responsible for making sure that all corrections are made before submitting it.

There is a person in the next office who does just that... Resubmitting claims for Athena...

I see what you're saying. That's true but Athena constantly updates their system so once the claims are accepted by their system they shouldn't be rejected. That's the strongest part of their program. A lot of things are taken care of in real time also. I really hate advocating for this company.

I still vote for doing it yourself. Get your wife or a trusted employee in there.

 

[romanticscience]

If doing your own billing, is software (eg, NueMD) necessary? My practice will be low-volume (psychotherapy) and I'll only be accepting two insurances. Could I just use Quickbooks and file the claims with each through their web-portal?

 

[Pain Applicant1]

If doing your own billing, is software (eg, NueMD) necessary? My practice will be low-volume (psychotherapy) and I'll only be accepting two insurances. Could I just use Quickbooks and file the claims with each through their web-portal?

I don't think too many payers let you submit claims through their web-portals but if so go at it. Two payers should be relatively easy to manage, especially for a low volume practice. However, most payers require you submit through a clearinghouse. You might find office ally helpful. You can use it as your billing system and best of all it's free! I hate quickbooks. and don't see how it can easily be used for medical billing.