Medical Billling

[whopper]

---

Members do not see this ad.

Question: Who here has a private practice or works in private practice that uses a billing company that's national?
I'm going to move my private practice, go to a new billing provider that charges 7%, but a colleague of mine told me a specific national provider charges $300 total month. (I'm not mentioning the name only to avoid SDN violations).

Anyone here uses any billing providers that are national where they've had a good experience.

 

[TexasPhysician]

I wouldn’t trust a billing company that charges $300. What likely happens is that a computer automatically bills for you. Anything denied is ignored. You lose money.

Most companies that I’ve seen charge 5-8%

 

[Sushirolls]

I wouldn’t trust a billing company that charges $300. What likely happens is that a computer automatically bills for you. Anything denied is ignored. You lose money.

Most companies that I’ve seen charge 5-8%

This, so this! ^^^^^

I used to use a company that was ~state regional but did have national level clients, and I was on hook for minimum $500/month. Too many things were dropped, not fully followed up on, and I and my staff ultimately had to do it. Best thing I ever did was switch over to using the integrated biling with Luminello. They integrated with a third party company called ApexEDI. Very easy to submit and the billing per month is a fraction. I only wish I did it much sooner.

You could possibly look into ApexEDI or other similar clearing house billing submission entities yourself, if your EMR/note setup doesn't have the ability to seamless data submit.

7% is basically so bad. Such a bad deal. You get finder under 5% and even 3-5% if you have enough volume. But again, best thing I did was drop 3rd party billers.

 

[whopper]

Tx physician-That's what I was thinking and when the colleague that said it's only $300/month I was shocked!

The practice I'm in existed for years and the head doctor (who has a strong academic rep but decided to go into private practice), enticed doctors to join him by handling the things that most doctors don't want to touch with a 10-foot pole. That is staffing, billing, handling the physical office stuff like managing clean up, maintenance, phone bills, utilities etc and just charged us by the month plus medical billing expenses.

He's getting older and now wants to do a half full-time practice and gave us advance warning to handle the business stuff ourselves. So I picked up a potential billing provider with a very strong rep and then lo and behold my colleague tells me she found a provider who only charges $300 month and that's it total? WTF? Is this too good to be true? She admits she doesn't know if the new provider will be any good.

Also add to the obvious factor that a reason why billing providers charge a % is cause they got to fight to make the insurance company pay the provider. They have a cash-based incentive to do their job and do it well. There's no incentive when it's a flat $300 fee.

Sushirolls 5% or less? Wow.

 

[Sushirolls]

That's what I was thinking and frankly the colleague that said it's only $300/month total doesn't really know how to run the business end of things.

The practice I'm in existed for years and the head doctor (who has a strong academic rep but decided to go into private practice), enticed doctors to join him by handling the things that most doctors don't want to touch with a 10-foot pole. That is staffing, billing, handling the physical office stuff like managing clean up, maintenance, phone bills, utilities etc and just charged us by the month plus medical billing expenses.

He's getting older and now wants to do a half full-time practice and gave us advance warning to handle the business stuff ourselves. So I picked up a potential billing provider with a very strong rep and then lo and behold my colleague tells me she found a provider who only charges $300 month and that's it total? WTF? Is this too good to be true? This is also a doctor that completely admits she's clueless on anything that is not clinical practice.

Also add to the obvious factor that a reason why billing providers charge a % is cause they got to fight to make the insurance company pay the provider. They have a cash-based incentive to do their job and do it well. There's on incentive when it's a flat $300 fee.

Psychiatry has such a small, simple billing code depth, there really are no 'fights' with insurance. You quickly learn which will cover 99417 or the smoking cessation codes or even 96127. After that, it's not that complex and there shouldn't be denials. The real issues are coverage, patients insurance lapsed or changed and you didn't catch it. Or you the doc put a random Dx code like insomnia first by accident and not GAD and this grumpy insurance company denies becauses it wasn't an F code diagnosis...

Really truly simple stuff, and if you only have a few insurance, not hard at all.

 

[Sushirolls]

*ApexEDI if I remember correctly was sold to UHC group, or Optum. Then a notice came out that they were now using Change Healthcare for their ERA enrollments.

Change Healthcare was the company that various insurance companies outsourced their threatening audit letters to, and who would do the chart audits. Last year I believe Change Healthcare was purchased by UHC Group / optum...

I could be wrong on some of these details, but UHC is getting bigger, and bigger.

 

[PsyDr]

I have an assistant that creates and submits all my bills. I’d estimate that that portion of her job is $300/month.

 

[TexasPhysician]

I have an assistant that creates and submits all my bills. I’d estimate that that portion of her job is $300/month.

How many patients and codes does a psychologist bill per day on average?

 

[PsyDr]

How many patients and codes does a psychologist bill per day on average?

clinical neuropsychology? Average per week? Average for me? Let’s say 8 patients on intake, with one unit of interview per patient. 5-10 units of technician time per patient. 2-5 units of reports writing per patient. Lowball, that’s 64 patient codes per week. Higher numbers exceed 90+, without trouble on audit.

if you have a specialized practice, it’s a lot more. We have 15 minute CPT codes, too.

My gal Friday would take a stack of notes, ensure they met the CPT code requirements, and enter everything into the billing software. Took her less than half a day, after she gained skill mastery, and quit making fun of me.

 

[TexasPhysician]

clinical neuropsychology? Average per week? Average for me? Let’s say 8 patients on intake, with one unit of interview per patient. 5-10 units of technician time per patient. 2-5 units of reports writing per patient. Lowball, that’s 64 patient codes per week. Higher numbers exceed 90+, without trouble on audit.

if you have a specialized practice, it’s a lot more. We have 15 minute CPT codes, too.

My gal Friday would take a stack of notes, ensure they met the CPT code requirements, and enter everything into the billing software. Took her less than half a day, after she gained skill mastery, and quit making fun of me.

Depending on the psychiatrist, it wouldn’t be unusual to see 60+ billing codes per day. This is typical E&M, add on counseling, interactive complexity, smoking cessation, drug screens, extended time codes, etc. Some companies will deny all uses of certain codes or only pay 1 of 3 the first pass. Then there are re-submissions. This is all pre-audit that needs to be checked. Some companies are getting tricky and “accidentally” reimbursing a lower amount for the same code on same plans. Without knowing eyes on the money, insurance companies have many ways to avoid paying us. $300 for a biller per month is $75/week. That is $15/day. $15 is not getting trained eyes on 60+ codes, resubmissions, etc. in my experience. That said, I’ve seen a single psychiatrist utilize 2 full-time in house billers. That seems excessive.

 

[robellis]

Depending on the psychiatrist, it wouldn’t be unusual to see 60+ billing codes per day. This is typical E&M, add on counseling, interactive complexity, smoking cessation, drug screens, extended time codes, etc. Some companies will deny all uses of certain codes or only pay 1 of 3 the first pass. Then there are re-submissions. This is all pre-audit that needs to be checked. Some companies are getting tricky and “accidentally” reimbursing a lower amount for the same code on same plans. Without knowing eyes on the money, insurance companies have many ways to avoid paying us. $300 for a biller per month is $75/week. That is $15/day. $15 is not getting trained eyes on 60+ codes, resubmissions, etc. in my experience. That said, I’ve seen a single psychiatrist utilize 2 full-time in house billers. That seems excessive.

They’re such scammers it’s disgusting