Staying Independent...Together

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   RE: Emr /practice management
 From: Jean Antonucci
 To: Member Forum
 Posted: 11-27-2016 10:21
 Message:

Well just briefly  for what it is worth  Those advocating doing  the billing seem to have  staff and fathers in law:)I have neither   true I  know nothing of billing so there would be fear of the unknown  But while I am not of the ilk that says do only what  you can do  to work to the top of  your license   billing is complex  It isnt the gateway posting checking eligibility thing, it is the arguing, re submitting and answering patient  questions   The bottom line is that it is a moot point    If a doc spend 2 hrs a week doing all that  plus your initial learning curve  I think of it as me  plowing my own driveway  I COULD invest in the plow oh but do much better to earn money and pay someone  You folks are paying staff to help you   2 hrs a week of my time  is at minimum 2-3 medicaid patients 99213  $100-150 or at max 2 99214 harvard pilgrim MCHO at 130 each so $ 260  I spend far less on billing and    she answers questions  codes etc.

 I think it is preference. I would like coding and billin g to go away . If you want to  know where to get a good snow plow though...

:)

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Jean Antonucci
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Original Message:
Sent: 11-26-2016 09:38
From: Mamatha Agrawal
Subject: Emr /practice management

EHR discussion has changed to a billing in-house vs. outsourced discussion and I agree with the most recent post.

Sending claims only takes about 10 minutes per day. It takes another 1-2 hours per week to do everything else. Once in a while I will have a staff member call an insurance company to ask a question about a claim. 

I have done both ways and both ways work. Technology is much better now. When I was doing billing in-house 2002-2010 range, it was more difficult. I took a 3 year break while there was Meaningful Use dollars coming in and treated myself to the 7% of collections Athena took. I grew to resent that bill each month. 

Now I am back to collecting in-house and I can promise you that I have collected the exact same amount this year with in-house billing as I did with Athena last year. The first step is entering insurance correctly and checking eligibility. That takes the same amount of time with either system. Automatic EOB posting takes seconds. You can print statements and have staff send them or sign up for electronic statements for an additional cost. 

The worst part of doing in-house billing is the initial set up. There is a feeling of terror as one worries about cash flow and making sure that money is coming in right from the start. All the paperwork for electronic claims, remittance and deposits into bank account must be done correctly. Check and double check. If that's in place, you're good to go! 

Some male physicians in the past wrote in that they had a terrible time with outside billing companies and having their spouse come in and clean up billing worked very well! In my case, my retired father enters my payroll, Quickbooks and does all my online banking for me so I have a little time to do the billing. Having the luxury of a family member who cares pick up some of the slack really helps in an IMP. 

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Mamatha Agrawal, MD
Family Doctor CaryNC
Cary, NC
Live in Raleigh, NC
Solo since 2012
Practice Fusion and NueMD
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Original Message:
Sent: 11-26-2016 07:24
From: Margaret Coughlan
Subject: Emr /practice management

I am so grateful for everyone taking the time to reply to this discussion. Have fun with streamlined John on Athena! I think that term is an oxymoron!

I agree that paying 6% of billing is crazy, that is what Athena charges I believe.

I will look at Amazing Charts again. A colleage from residency had started it and I did not think to look at it now that it is part of a larger organization. But if you say you are happy with it Vahe, I will take a peak. The patient portal definitely has its pluses and minuses. Most patients use it appropriately, send me an email update a few days after the visit. I do have a handful that use it constantly and sometimes I question having it, but I claim to be available to them so this helps me to be more available. 

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Margaret Coughlan MD
Millbrook, NY
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Original Message:
Sent: 11-25-2016 15:30
From: John Brady
Subject: Emr /practice management

Hi Margaret,

I was on e-MDs for 13 years and switched to Athena in March of this year because I joined in with a horizontally integrated network which highly encouraged the change. The change has been awful. The workload involved in changing systems is IMMENSE. Even if the demographic info gets pulled over, every patient is essentially a new patient in terms of having to put in the current medical problems, FH, SH, Allergies, and potentially even Meds (Surescripts through Athena automatically loads that which is nice). That does not even include the downloading of the old information off my server and then uploading it into Athena as a pdf (which is nice to have but not nice to try and search through). Suffice it to say it will take at least a year for you to get back up to full speed when you change over. In regards to which EHR I like the best, e-MDs is really quite intuitive and nice to use but, at least as of early this year, its portal was horrible. Athena is bloated and slow and I believe far more difficult to document in. However, it has a nice portal and the fax server seems to work nearly flawlessly--which is nice. I am changing over to the "streamlined" version of Athena in the next month, so some things might be better, but I am guessing that some things will be worse as well. 

One other comment. I would disagree with Jean that "no doctor should do their own billing." I did mine until I changed over to Athena. Here is the way I would think about it. With automation and clearinghouses and Previsit checking of insurance eligibility, about 97% of your claims should go through without issue. The real issue is the amount of time it takes to post the claims and send out statements (and much of that can be mitigated by keeping a credit card on file). In my experience, it would take me about 50 minutes/week to package up the claims and send them to a clearinghouse (10 minutes/day). That time would be nearly the same if you are sending the claims to a billing company so I am not certain there is any way to save there. BUT, at least in my experience with e-mds and gateway edi, it would only take about 1 hour/week to post the EOBs and send out the statements. So doing the billing and collections is really about a 1-2 hour/week job. To pay someone 6% of ALL collections for 1-2 hours/week seems nuts to me. I mean if you collect $200,000 and pay 6%, you would owe the biller $12,000 = around $160/hr based of 75 hours of work/year which is more than I make. Personally, I would set up everything to be as automated as possible and try and find someone to upload the EOBs into the billing system and send out statements to the patients for $15/hour. They can even track down the denied claims--though, unless you are using codes you do not normally use, my experience is the claim is more likely to be paid if you send a patient a note and have them call. 

I hope this is helpful and I wish you the best in your transitions!

John

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John Brady
The Village Doctor
Newport News VA
757-223-0124
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Original Message:
Sent: 11-18-2016 06:37
From: Margaret Coughlan
Subject: Emr /practice management

Hello all,

I have been using Athena for over 4 years. It is quite expensive but very comprehensive.  They do my billing and posting as well as patient portal, etc. However I have issues with customer support lately so in the market to switch vendors. Two questions,  anyone love their emr/pm program?  Second, anyone switch after several years, how hard is it? That is one of the issues with this whole thing, we almost get stuck to keep the same one due to inertia...

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Margaret Coughlan MD
Millbrook, NY
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