Pain Billing Question

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15+ Year Member
Dec 12, 2005
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I was interested in what billing companies some of the pain doctors are using in their practices, specifically in terms of percentages, EMR compatibilities, and things to be aware of. Also, what is the threshold to consider internal billing. Thanks. :idea:

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I use Advantage Billing based in NC. They travel down often. I tried doing my own billing, but it just wasnt working. Now it is one less thing i have to worry about. The fee varies based on who is paying. It can range from 3-10% of what they collect for you. Also, electronic and direct deposit is cheaper if you use a company(i think) since you dont have to pay for a clearing house. It wasnt cost effective for my new office to do it. It depends on the volume you have. Algos can give you more info on his experience.

:rolleyes: :rolleyes: Thanks for your input Dr. Todd.
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If your payor class mix is Anthem and Medicare primarily, then an in house system coupled with an EMR will be cost effective. Use an external mailing service for the bills...they are inexpensive and will save you endless headaches.
Our current billing service costs about 8.5%...way way too expensive, but they do a moderately good job with some notable exceptions such as billing for pump refills.
In the past we used a service costing 4.2% but the follow up on patient accounts was abysmal and the AR skyrocketed.
Once collections approach a million a year, the in house billing is definitely worth it.
EMRs usually come without the billing program attached except for Altapoint (inexpensive) or some of the much more expensive programs. An integrated billing program is not absolutely necessary. Many EMRs (Amazing Charts is a notable exception) will interface with several of the more common billing programs.

Thanks for you comments. Is the current company you are using PBN? I believe you had listed it in a previous forum. Also, I assume your billing company is able to download/upload demographical information from your patient base (amazing charts) without difficulty. But do you have to download patient billing information later in the day via a separate software provide by your billing company, and is this time consuming? Lastly, is it better to use your own EMR daily scheduler instead of using the billing companies? Thanks again.

I may be able to answer some questions, if you have some specifics. I own a billing service in CA, specializing in ortho and spine. I have handled billing for physiatry, also. I think a lot depends on your individual situation.

If you outsource your billing, you need to make sure the company is able to handle electronic billing, provides monthly written reports, provides you with a good contact person, has experience in medical billing (not dental or veterinary, etc!), and offers you a decent price.

In the situation of starting up a new practice, I would also suggest a person or company who can help you establish your new practice from the financial end---by helping set up your fee schedule, Medicare paperwork, insurance contracting, etc. These are critical areas for a new provider and many things need to be taken care of right away to ensure revenue starts coming in as soon as possible. Beware, some billing companies don't offer such services, or may charge you an arm and a leg for it.

If you hire someone to do the billing in house, I imagine you would want someone pretty experienced. The only problem with that is that the price for a good biller with experience is rarely less than $20/hr, especially here in CA.

Whether you deal with an in house biller or a billing company, be sure the folks are experienced with appeals to insurance carriers and follow up. You need someone aggressive to follow up on unpaid items....not someone that will just take the payment you got and move on. If a claim is paid incorrectly, it must be appealed. An experienced biller or company will have a method for handling such a workload.

In the case of a solo practitioner, especially a new provider, I might recommend a billing company. You won't have to deal with training an employee, worrying about the computer system and software and other ancilary details, and you won't be paying for employee benefits and such. Sometimes providers think they can do it in house cheaper, but I have found that in many cases, the stress and time involved takes away from any money saved by not having to pay a billing company.

A billing company, like ours, would be able to handle your situation. We charge a flat percentage of receipts, which is usually from 6-8%, depending on the specialty and volume. We don't nickle and dime providers for postage and claim fees--we include that in our overall percentage price. Should a provider be out of our area, we can set up for email, fax, or Fed Ex to get the data--whatever is convenient for the provider, and all of that is at our expense. We have several providers out of our local area and we find no problem with long distance issues. Gathering charge, medical, demographic ,and insurance data from your existing EMR should not be too difficult...often, data can be uploaded, downloaded, emailed, faxed, etc. very easily. Somtimes, direct access to your software system is authorized for the billing company to access your data over the internet, etc. There are many solutions available.

Cheaper is not always better, so you have to be careful in making your decisions about your billing. Don't hesitate to ask other providers for their opinions or ask for names of office managers, etc that may be able to offer you some advice. Billing is the financial backbone of your practice and you just can't afford for it to be done poorly.

If you have any more specific questions about what to look for or you decide you'd like to talk to us more about how we may be able to help you, please don't hesitate to contact me. I can be reached at [email protected] or 925-292-0395. More information about our company can be seen on our website at If we are not the right company to help you, I may be able to recommend someone for you--I have contacts in several states.

If you run across other folks who may need some advice, don't hesitate to pass on my info!

Elizabeth Williams
A&E Billing Solutions
Livermore, CA
I am just taking over billing (something I have no experience at) for a Pain clinic in NC. Currently the physician likes to trial TENS on a patient 2 times in the office and bill for it before he will issue a TENS unit for home use. (He does this to make sure it is helping the patient and that they are seeing some benefit). My question is, I was using code 64550 to bill for this but it eliminates the more expensive code for the office visit. I have done some research and thought we could bill 97799 "unlisted modality with physical medicine/ rehab service or procedure". If I bill for code 97799 will it eliminate the office visit fee? And how much does 97799 reimburse?

Also, I spoke with a physical therapist and she told me they bill 97535, "self care / home management training". Can I bill for this in a doctor's setting? Also, and I bill for that code and the office visit?

Thanks :0
Bill the office visit first, if he is doing E&M. Try to avoid anything that ends in -99 - it'll cost more to bill, send paperwork, write letters, etc, than you will collect for a TENS trial.

Why not use 97032 for the trials?
I thought that was the billing code for Ionto? Is it illegal to bill for that?
I thought that was the billing code for Ionto? Is it illegal to bill for that?

97033 is ionto. 97032 is application of e-stim
perfect! I am going to give it a shot and let you know what happens.

You are a doll, thanks for your help !:D