Staying Independent...Together

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   RE: Billing
 From: Michael Safran
 To: Member Forum
 Posted: 07-13-2017 14:33
 Message: Craig,

Thanks for your submissions.  Can I pick your brain a bit about Practice Mate.   (I know Peter L. has suggested it several times.)   I just went on web site and had chat session with sales.

Practice mate is both your practice management software and sends claims to the clearinghouses?
Does it do all the things a typical PMS can do?
Besides the double entry issue you mentioned with your EMR and PMS, are there things that it cannot do, that you wish it could?

Can it handle multiple fee schedules?
Scrub claims that are not clean.?
Electronic remittance?
Auto post?
Send out bills to patients?
Run aging reports?

Mike S

Also, I concur with Melissa.  If your "biller" is also doing other tasks - checking out, scheduling next appt. collecting copays and payments, etc, not to mention more clinical issues like vital signs, helping track down missing labs, test results, pharmacy calls, etc. it makes sense to keep all billing in house.  The personal connection with patient is invaluable.

There is definitely a learning curve but it is more so with the software and the insurance game issue.   As the doctor you will need to learn many of those things anyway, even if you farm out billing and pay 8%..

And remember.  Billing companies take 6-8% of low hanging fruit.  Most of that now is just click and send and money appears in your bank account.

You will still need someone to keep an eye on things, especially the claims that are not clean.    That takes time and is the frustrating part.   The doctor can do all of that but I predict will be burning out very soon.   Much better for your mental health to have an employee do that.   If they are bright, they will learn the game with you and give them a thank you bonus.

Michael S. MD
Original Message:
Sent: 07-13-2017 12:25
From: Craig Ross
Subject: Billing

95% of billing is straight forward.  5% drives me insane.

I use Office Ally Practice Mate.  It's separate from my EMR (yes, dual demographic entry) and costs $20/mo (free if >50% of billing is to commercial insurance b/c they get $$ from them).

The 5% that is painful:
- Did a visit at assisted living last month.  Changed the location of service from "11" to whatever it is.  BUT, totally didn't consider that home visits have different E/M CPTs.  I billed 99214 but it should have been a different code.  Now I need to re-work it.
- Getting paid for all the little add ons.  99406 (Tob cessation), 96127 (PHQ-2, PHQ-9, ADHD/Vanderbilt Tools, PSC), 96110 (HYH, MCHAT, Ages/Stages).  It's a pain to understand when to use and when not.  Don't get me started for all the Medicare add ons (G0444, etc).  They make a difference.  If used right, it can be $5-$15 more per visit.  The problem is some insurances pay with no patient responsibility, some pay but goes toward deductible/copay, and some don't.  The problem is, if you bill and the insurance accepts but it goes to deductible, some patients aren't keen on getting a $10 charge for their ACA preventive exam ("no copay or deductible").  It's a minefield that a biller can help with.
- THE BIG ONE: Insurance rejections.  What a PAIN.  Hours of hold time on the phone.  I had one Medicaid customer service person tell me that 99214 wasn't a valid E/M per CPT guidelines so I couldn't bill with the E/M 9938X (preventive service).  I told her that 9938X was a preventive procedure code and 99214 was an E/M code.  She then told me that the computer says differently so I was wrong and don't know by CPT rules.

So I'm hiring a biller.  She charges 6%.  I'm not comfortable with that bc 95% of my claims are simple and paid quickly.  Why should I pay her $8 per claim when I still have to send her the info.  It's just as easy to send my clearinghouse the same info.  So I'm negotiating with her to:
- Work the insurance privileging.
- Do claims audits at an hourly rate.
- Work my rejections at with 12% charge.
- Be available for consultation.

That's my 2 cents ... an more.

Craig Ross, M.D.
Family Medicine/Owner
South Arbor Family Care
Ann Arbor, MI
M: 734-756-8446
W: 734-707-7075
Original Message:
Sent: 07-13-2017 09:52
From: Melissa Weakland
Subject: Billing

Hi Jessica, as Jean said this conversation comes up now and again. You can search and find the old posts on this system. On my phone the search function appears in the main menu drop down area.

my practice is over 10 years and I'm happy and enjoying. We started with an outside biller but then soon moved to using staff who do other tasks for us. We found that using someone who knows us and our patients s bit- we recoup money much higher.

Over the years we've never hired anyone with billing experience. It's really not too complicated. Maybe we miss some money here and there but from what we save by having our own staff is huge cost savings.

Right now we have someone 10 hours a week. She is also our bookkeeper. She mostly spends time posting payments and invoicing patients. She also does the follow up needed-calling insurance to understand why no payment, calling patients for same reason.

i have the name of a local biller that another local IMP, Bruce Williams, gave me. He loves her. I'll hopefully remember to send you off line in email if helpful.


Melissa Weakland MD
Ballard Neighborhood Doctors
Seattle WA
IMP since 2007
Original Message:
Sent: 07-12-2017 11:47
From: Jean Antonucci
Subject: Billing

The  billing in or   contracted out  conversation goes on periodically and people's opinions are always strong
 I would add that as I have watched IMPs over  the tlast decade  those who have lasted have often NOT been doing the billing Billing causes burnout   As to 8 %   that is standard and for the service of someone taking the calls and arguing with  insurers and knowing  the rules  although I make no argument that coding  as it is should even  exist!11, 8% in a small practice might be?? under 10,000 a year  If you have an employee  you pay them and do their payroll taxes and W 2 and w 4 whatever,   need ot think about benefits/ space/ secret santa parties etc And workers comp And supervising them In a tiny practice You need  a person to  take in the deposits and another t o  deposit them for safety. Etc.

     Jean Antonucci MD
     115 Mt Blue Circle
     Farmington ME 04938
ph 207 778 3313   fax 207 778 3544


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