Re: Question about trying in house billing

[Pay_My_Claims]

show me the money!!! Love the credentials, but my money banks on ability. I have 15 years of experience, getting credentialed, but its just paper to me. Its only good to me for those that love to see the initials behind my names. Speaks nothing of what I can do only what I supposed to be able to do.

[Steve Verno]

I've experience this myself.  We had many meetings to discuss the many issues we found  Eventually, the company was terminated per the terms of the contract. Then it was onto finding another company to take over the reins  This required a newer contract to be developed by the in-house attorney to cover any loopholes the current contract was found to have.  That new company did not live up to the new agreement and was also terminated  It took 3 more attempts to find a company that did the job properly.  The performance issues were my duty, as practice manager, to monitor and to report to the provider.  The interim companies we hired had all the right credentials, bells, and merit badges, i.e., membership in all of the associations, BBB, and others. Excellent references, etc.   It was their revenue generating ability that caused their demise with us. 

[Pay_My_Claims]

The contract he signed should have had a cause for termination clause in it. This is his business, his livelyhood, he doesn't have to spare feelings when the job he is paying for isn't getting done. He should notify in writting his issues with the company and follow the contracted agreement for termination if he is unhappy. There is nothing stating that he can't research other software or another company. 

[Steve Verno]

I cant agree with Linda more.  Ive seen this firsthand.  Many many years ago, the providers decided to bring us in.  They used their own inhouse people. On Monday, none of the inhouse biling people came in to work.  We offered them the ability to keep their jobs.  When they said they werent coming back, they were terminated.  We went through their desk drawers and found tons of EOBs that were never worked.  Correspondence was never answered.  In one month, with less people, we doubled the income to $400,000.  We worked all the hidden paperwork and unworked AR. The next month we brought in $800,000. The next month $1,000,000. 

There is probably a contract with the outsourced billing company.  We've also ben there when the practice hired two billing companies. Checks went everywhee but where they were suppose to go. It was a hassl trying to keep track of everything.  Patients paid and were still billed because one billing company decided not to share the payment info with the other billing company. 

Ive also seen it where everyeone spoke with each other and few problems arose.  THe provider was always asking for tons of reports and would mistake who was doing what. Things went better when he went bak to one billing company. 

In house can be OK, but it can be a nightmare if you have untrained and inexperienced staff working your accounts. With one large practice I was called to evaluate was in serious trouble.  Their biller was self taught.  She wrote off everything, and never appealed any imcorrect payments or denials. She simply accepted what was paid as payment in full.  Her philosophy was that she didnt believed in billing a patient even for their deductible or coinsurance, nor did she believe in sending claim to seconary insurance companies.  Another audior and I both found she was costing the practice more than $1,000,000 in revenue. She was eventually fired and sued by the practice for their losses.  The providers won the suit.  YOu also have to explain to your inhouse staff that their paychecks are dependent on what they bring in.  Some Ive met think the doctor has a money tree outback. 

ON the other side, another practice I was called to, did their own inhouse billing,  The provider fired all of her staff except for the biller, who was doubling as the receptionist and was used when a chaperone was needed.  In this case, the problem was with the provider.  She didnt want to appeal any denials. She also wanted to accept what the insurance company paid with no secondary claims to be sent.  Her contracts were terrible. 

Based on her contracts, she agreed to an average payment of $5.00 per claim.  She didnt want her biller to work the AR.  Any suggestions made were met with, "I Cant do that."  Long story short, she went to work for a clinic.  They were not Medicare providers.  They sent every claim they had, to medicare under this doctor's name and medicare number. Medicare decided to audit all of the claims.  The clinic closed with the staff moving to parts unknown.  Medicare said there was fraud involved.  They sanctioned the doctor for 5 years. She had her license suspended for 2 years.  Every contracted carrier refused to process her claims staing they were under review.  They also went back 5 years and demanded refunds of all payments made citing fraud.