Top Medical Billing Services Review

Transcription

1 Top Medical Billing Services Review Sean Parker Health IT Consultant

2 About the author Sean has been associated with the Health IT industry, in one capacity or the other, for the past 20 years. He has seen the industry evolve from a monopoly, with a few key players, to a quagmire of big and small vendors. In his own words He likes to keep things simple. Combining this philosophy and his love for technology; Sean has ventured out to de-code technical jargon and excessive marketing gimmicks by Health IT vendors. If his hobby helps physicians avoid vendors looking out to earn a buck by selling substandard solutions-that s a plus. His previous paper EHR Vendor Pricing Analysis was very favorably received in the market. The response has prompted him to establish a free consultation service, namely EMR Specialists, for small and medium sized practices. Sean also likes meeting new people and learning from them. Feel free to get in touch with him if you have any comments or questions by ing at info@emr-specialist.com. Readers Reviews Very informative and helpful article. Well done. Peter Weiss M.D. Thank you so much for taking the time to help educate doctors. Neil Minikes, M.D. 2

3 Everything you need to know about the top Medical Billing Companies If selecting your electronic medical record vendor was not enough, physicians are now faced with another timely decision that must be made before the big bad wolf ICD-10 kicks in. And kick in it will, mark my words, even though the shenanigans in Washington are succeeding in creating a mockery of the CMS. So what is this big decision? There is no doubt that ICD-10 will have a profound impact on your practice. One area that will be the most vulnerable is your revenue collection and I don t need to tell you how damaging this could be. Add to this the lack of knowledge about ICD-10 on your biller s end or the unpreparedness of your vendor in sending out ICD-10 claims and you will have a recipe for disaster. Thus, you must decide now what your way forward will be. Do you have the resources to go at it alone or would it make more sense to bring a third party biller onboard to handle the financial side of your practice? For solo physicians especially, considering the paucity of staff vs. funds this decision might be integral for the longevity of their practice. In this analysis, my focus will not be on the why s of medical billing. There is enough marketing material circulating out there to help you decide whether outsourcing is the best way forward for you.thus, if outsourcing billing is not for you, don t read any further. If however, you are boggled by the numerous marketing campaigns launched by vendors to sell their medical billing services to you; read ahead for a comprehensive review of some of the top medical billing companies in the industry. 3

4 Going local, offshore or sticking to what you know Before I get into dissecting each medical billing company, let s explore some of the options out there for you. You can choose either of the following to bill on your behalf Local company Offshore Billing vendor Your own EHR vendor ( provided they offer billing services as well) There are a few pros and cons associated with each of these options. If it s a local company, you will have the benefit of on-site support. It s always nice knowing that if things are not working out, you can actually walk up to their office and push them into action. That s one of the reasons why many physicians have signed contracts with their local vendors. However, how do you find out if things are not going well for your practice? With local vendors, many practices are unable to monitor the performance of their billing company as there is no reporting mechanism in place through which practices can look at the aging of their claims. There is no real time financial aging summary, ability to view pending patient responsibility to name a few. Leaving that aside, these practices must still resort to calling insurances to verify insurance eligibility rather than relying on their billing software to do this task for them. Thus, not only do you have a very basic billing functionality but you are literally dependent on these vendors without any way of analyzing how they are performing.thus, all you get with a local vendor is a face but no quality. Moreover, this option is generally more expensive than the other two. With offshore billing companies, your problems are two folds. 4

5 a. Abominable support the accents, lack of understanding the US insurance system, keeping up to date with payer payment changes, the misfortune of being transferred from one support representative to another rather than having your own billing account manager b. Privacy Concerns- Are you willing to risk sharing your patient s financials across shores in this environment of ever increasing focus on protection of patient health information and the penalties associated with it? I think not. The positives though, these are less costly alternatives. Many of these companies charge you per claim rather than the standard percentage of collections model used across the industry. The third option is the one that I personally prefer. Outsource billing to your Electronic health Record (EHR) vendor. You will have the obvious advantage of dealing with a single vendor, saving you the hassle of following up or monitoring different vendors to ensure that they are delivering on their promises. Moreover, most vendors with billing service will offer you their EHR and PracticeManagement System (Medical Billing software) for free which will allow you to have some control/ insight into how your third party biller is performing. Be cautious however; don t get stuck into the worst of both worlds. If you are willing to take this plunge make sure that the EHR vendor you choose is a good one. You don t want to land up using a substandard system with a substandard service as it will affect your revenue as much as a bad billing company. Please read EHR vendor Analysis to evaluate top vendors in the industry. 5

6 Medical Billing Companies being evaluated 1. athenahealth 2. CureMD eclinical Works Kareo 1. athenahealth athenahealth remains one of the oldest billing companies out of the lot. I have already reviewed their product in one of my vendor pricing analysis but will present it here for people who have not read it. This is a large practice product. The system is complicated, requires a lot of clicks and change of screens to get tasks done. This functionality works well for hospitals and large practices where each step of a patient s clinical encounter is recorded by a different person, such as a nurse practitioner or a medical assistant. However, in small to medium sized practices, many times a physician is handling most of the clinical encounter and would like to record things on one screen rather than having to jump from one screen to another. athena takes HIPAA laws quiet seriously. However, they might have gone a little too overboard with it. Practices have complained that they have to sign in every single time that they see a new patient. This wastes time, especially when the navigation in the solution is not simple. Implementation is another area where athena does not work well. They promise to get you 6

7 implemented in less than six weeks however, for most practices the implementation time period can stretch to 11 weeks. Again, a big practice or a hospital can spare staff and compromise on the revenue loss generated by such long periods of implementation but not small to medium size practices. In terms of their billing service, athena either charges a flat rate per provider or a percentage of annual collections, whichever is greater. They offer you their EHR and PM for free in this case. Their support is professional and generally competent which is hard to come by nowadays. On average as a billing company and a provider of medical billing software athena is a good choice. However, the complete package which includes the EHR is not the best fit for small to medium sized practices. 2. CureMD I have reviewed CureMD s software in one of my previous analysis. In terms of their product, I found their EHR relatively easy to manage and navigate through. Their solution is specialty specific and offers enough customization for a practice to personalize it according to its size and workflow. However, I don t think their system is a good fit for hospitals at this time (they don t cater to inpatient facilities). In terms of support, CureMD has done well. They provide numerous support options (chat, ticket and telephone) to cater to their clients. CureMD Medical Billing services also handle patient statements at their end, relieving your staff to perform other meaningful activities. They also handle patient billing queries at their end. If you sign up with CureMD for your revenue cycle management, you will not only receive a dedicated billing manager but also an implementation manager who will be your go-to person for any type of queries. 7

8 Advanced Claim scrubbing, de-coding difficult rejection responses and helping clients resolve rejections, even if they don t outsource their billing to CureMD are value added services that are getting the company positive reviews in the industry. If you outsource billing to CureMD, you get their EHR and PM for free. This, I believe, is a good deal. Their integrated EHR and PM is a better solution than most of their competitors in the market. They have focused heavily on usability and ease of use, two things that physicians want and EHR vendors normally ignore. 3. eclinical Works 2.9% for your billing. That tag line there is a best seller. Who would not want to outsource their billing to them when other medical billing companies charge so much more? My response: Why do you pay so much for an iphone when there are so many Sony s and Samsung s doing the round? I honestly tried looking at a few positives and except for their price there is nothing that I could find. If you are content with such minimal functionality and support, Practice Fusion will give you the same thing for free! eclinical does not offer you the best value for your buck. Their product is pedestrian, their support is horrible. This should give you a general idea of their billing service as well. You might think that you are - saving money with a 2.9% contract. However, you are eligible for this rate only if you are earn ing $54,000 or above per month. In this era of declining reimbursements, hardly anyone would qualify for this condition. Also, their customers have reported incidences where their claims were sent to the wrong payers or denials were not resolved as the billing staff at eclinical was not up to date with payer payment rules. 8

9 In short, don t fall for the 2.9% flat rate for billing. Unlike the percentage of collections model, eclinical has no incentive to increase your collections, which might explain the poor service. They will be earning the same amount irrespective of whether your collections increase or decrease. In the long run, you might end up losing money just because you fell for the 2.9 % gimmick. 4. Kareo Kareo has grown immensely over the past years and one of the main reasons for their growth has been their billing staff. They invest time to ensure that their clients get paid by regularly conducting sessions with the practice owners regarding ways of improving their billing and by keeping up to date with payer payment changes. With Kareo, a physician s work ends at the creation of the super bill. The Kareo team takes it over from there, scrubbing the claims for errors before sending it out to ensure that the denial rate is reduced. If however a rejection is received, the Kareo team works with the practice to ensure that the errors are fixed and the claim can be resubmitted again to expedite payment. The company also assists a practice in handling patient statements. It posts patient statements via or regular mail if needed. It also handles any customer support regarding billing, relieving your front desk from answering complicated billing related queries. Thus, three thumbs up to Kareo for their billing service. However, as robust as their billing service is Kareo s EHR is a letdown. It is a small system built with very basic functionality. Honestly, expecting more from a system that is free would be asking too much. 10 9

10 Kareo has ventured recently into the EHR market and will take time to develop a sophisticated system. This perhaps is a red signal for those who want to outsource billing to a company supported by a good EHR system as well. Their EHR does not support specialties well; they don t provide you with customized templates for your practice, you can either create your own by using their Template Editor Tool or pay extra to get assistance from Kareo. Moreover, their trainings are in the form of recorded tutorials or weekly webinars rather than a one-on one training program with the practice. To me this is a big no. All practices have their own learning curve and should have their training programs designed in a way that suits them. My advice to the company would be to address this issue so that they can offer their clients a complete deal rather than a good service not supported by an equally good product. For more queries contact : info@emr-specialist.com. 10

11 Appendix

12 How to assess the performance of your billing department? 1. Get a claim aging report from your medical Billing software or Billing Company 2. What is your figure for outstanding claims above 120 days? 3. Compare the % of all accounts receivable (ARs) over 120 days with the average % for your specialty.* Rule Your % = MGMA Benchmark Your % < MGMA Benchmark Your % > MGMA Benchmark Your Billing Department is performing on average. Your Billing Department is performing exceptionally well Your Billing department is underperforming Example Pediatric Practice = 4% of all ARs above 120 days. MGMA Average = 17 % Your % < MGMA Benchmark Your Billing Department is performing exceptionally well Medical Specialty Your A/R MGMA Benchmark Performance Matrix Chiropractic Dermatology Family Medicine General Surgery Infectious Disease Internal Medicine Neurology OBGYN Orthopaedic Pulmonary Disclaimer: Medical Group Management Association (MGMA) annual cost and revenue survey 2012 Be careful about how the aging report is created. The correct way to calculate the aging of insurance accounts is to run your accounts receivable reports based on the date of service and not when the insurance is billed. This will give you an accurate accounting of how old your claims really are and how well, and quickly, your billing staff is following up on unpaid and denied claims. 12

13 Things to remember before you outsource Read the contract How does the company define Collections? You should only pay for the amount that the billing company will work on i.e., payer reimbursement or patient balances, nothing more. Many billing companies define collections as your practice s complete revenue and charge you even for revenue they did not help you collect. Don t fall for this practice, else you will end up paying significantly more. If you find yourself dealing with such a company, this is a good indicator to leave them. Avoid Bait Marketing Tactics Many companies advertise low rates to attract uneducated buyers and build a market share. These companies generally do not provide you with full suite revenue cycle management services or have an elevator clause associated with the low rate. Always read the fine print in any billing service contract. a) Many low rate vendors have a minimum revenue requirement, which is set high, thereby making the low offer ineligible or unattainable. b) Some low cost vendors only offer one time submission for each claim and do not provide services such as working on denials or resubmitting claims. In these cases the burden of working denied claims and collecting unpaid balances shifts back to the physician s staff. If your billing company can t work your denials they are truly not worth your money. Term of Contract Be wary of vendors who may want to lock you into long-term agreements without any history with your practice or accountability or performance metrics in place. Standard contract lengths are 24, 36, 48, and 60 months. Billing contracts ideally should be for a year with renewal subject to the performance of the company. Who owns the data? When the agreement is terminated, who owns the data? In some situations the data is held hostage by the RCM vendor to avoid or discourage termination. No performance guarantees Most reputable RCM vendors offer some type of performance guarantee. However, some RCM vendors do not offer any type of performance guarantee or stand behind their services at all. Those are the types of RCM vendors that you ll want to avoid. 13