Billing question (Full Version)

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ADK PT -> Billing question (April 29, 2008 10:08:35 PM)

Hello All,
I am investigating opening an outpatient clinic in upstate NY and am wondering if anyone has any words of wisdom regarding hiring someone in clinic to do insurance billing vs contracting the services out to a billing company.  Thanks in advance for the help. 



ianwvu -> RE: Billing question (May 3, 2008 3:30:23 AM)

IN HOUSE IN HOUSE IN HOUSE!!    That’s what I recommend.   My partner and I were outsourcing billing for a little over a year and it was a nightmare.  We were constantly baby sitting them, making calls, clearing up patient issues because they kept screwing up.  Sending bills when they weren't warranted, pissing patients off with their lack of understand about what’s going on.  Its difficult because when you outsource, they really have no idea what’s going in the clinic, and in terms of when to bill, who to bill, what is proper reimbursement (they coded alot of our BCBS incorrectly and we were getting 50% cut on our  reimbursement for a good 2 months until I caught on, and brought it to their attention).  They are robots, who bill, get checks, and deposit, that’s it, no insight or investigation into situations.  I have heard several similar complaints from other people. 
Now that we are billing in house, we are seeing returns on our billing and actually making numbers as we expected, instead of working our tails off, and still coming up with negative for the month (expense>payment).  The difficulty is finding someone you can trust, and will work to get your money.  I could go on for a while on this subject, but I'll just stop now.  Hope this helps!



SJBird55 -> RE: Billing question (May 3, 2008 6:25:58 AM)

I outsource.  Every once in awhile there are issues, yes.  I outsource to a company that only does rehabilitation/physical therapy claims.

The issues I have experienced are generally related to some insurance company wanting "special" numbers on the 1500 form that are different numbers than all the other insurance companies.  This can be a problem for the biller when billing electronic claims because new "rules" need to be written.  Then, sometimes the clearinghouse doesn't recognize that an error wasn't made and the clearinghouse kicks it out before it reaches the insurance company EDI.  With the "special" numbers issue, I always get paid, but the poor patient is categorized as out-of-network, even though the special numbers were what were supposed to indicate in-network status.

I hate denials... denials = extra work.  My office administrator does all the front end work and knows as best as she can all the details about insurance coverage for the patient - co-pays, deductibles, # visits, duration... whatever.  After I evaluate a patient, I immediately provider her with an ICD-9 code and the anticipated procedural codes that will be billed during the episode of care.  She logs onto the insurance company internet site and verifies that the procedural codes are acceptable for the ICD-9 code.  We have very, very few denials for that reason.

That -59 modifier is an important modifier.  That modifier helps reduce duplicate claims.  The main time this is a problem for me is when I have a patient attending for 2 different problems under the same physician and I use 97140 on both problems.  The 97140 gets denied on one of the claims as "duplicate."

We communicate frequently with regard to billing issues when they arise. 

Checks come directly to me or the bank account directly deposited.  The EOBs come to me.  In the case that a check is direct deposit, my biller is responsible for providing me with the EOB ASAP.  I look at every EOB and look for denials.  When I see a denial or a problem, there is immediate communication on that account.  The company I use doesn't get paid until my deposit log matches the ledger.

I know that I did not want the headaches - I can follow up and communicate - but billing crap is always changing and that electronic stuff can be a pain.  I outsource so I don't have to have all that on my shoulders.  They are a great part of my team.  Sure, mistakes happen.  I made a huge one back in March - I misinterpreted one major insurance company and all my statements went out with an inaccurate "allowed" amount because I screwed up.  That was my mistake that I can't blame anyone except myself.

As with anything, you just have to find a reputable company if that is the direction you want to take.



ianwvu -> RE: Billing question (May 4, 2008 3:28:52 PM)

SJ,   It sounds like you are doing 75% of the billers work, and are still having to pay them their 7-8%, I do less work with in house now than I ever did when outsourcing.  Granted their are always differences between billing companies, but just going off what you said, looks like you have to be a diligent watch dog for your billing company so you can be assured of your money with less screw ups.    



SJBird55 -> RE: Billing question (May 4, 2008 8:59:43 PM)

I view them as part of my team.  Most billers do not contact insurance companies to learn about benefits.  And, yes, I always look at my EOB's... very, very easy to look down the "allowable" column and see numbers and be on the look out for 0.00.  Takes very little time.  Different insurance companies have different ICD-9 and allowable procedural codes.  That kind of stuff can't always be worked into a system accurately.  Since I am the one providing the service, it is in my best interest for me to know what is payable upon beginning the episode of care.

Billers shouldn't be left out there hanging and it shouldn't be assumed a biller is always going to know the ever changing rehab world.  As an owner it is my responsibility to know not just my role as a clinician, but also to know rules/regulations both from a clinical view and from a billing view. Communication is key - whether is it in-house or contracted out.



ianwvu -> RE: Billing question (May 5, 2008 10:26:36 PM)

I guess that was the issue I have with billing companies, I DO assume they should be up to date on what fee schedules are, and be able to notice if something is not being paid correctly, that is their job after all.  Maybe I expect to much from them, but going in house has given me freedom and ability to check all my worries and babysitting time at the door.   One issue I also ran into is the amount of money sitting "out there" waiting to be recouped just kept growing.   The thought is "well the billers don't get paid if they don't get our money".  For me and other therapist, that basically translated into the billing company working really hard on, lets say, the 3K outstanding patient bill, but the $200-$300 claims just sit, and sit, and then they are joined by other "small" claims that fall through the cracks.  We had so much money sitting, with no follow up, that it got to be rather ridiculous.



SJBird55 -> RE: Billing question (May 6, 2008 6:23:53 AM)

I hear what you are saying.  It irritates me when I see my 90-120 and >120 columns increasing.  I have about $2,500 total sitting out there between those two columns.  (It is part of business to have outstanding crap because of the "system" in which we work.  "Playing" with insurance companies isn't fun.  There are some cases where it just seems that the company just doesn't want to pay and assumes you'll just go away and let the $200 slide.)  Generally I look into those accounts and if I see ledger activity, then I know the biller is doing something... if I don't see ledger activity, well, I have multiple, multiple emails - a question on each of the accounts...



ADK PT -> RE: Billing question (May 7, 2008 8:07:39 PM)

Thank you both so much for the detailed information and discussion.  I appreciate the time it took to respond to my post.



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