Re: EMRs

[Guest guest]

I do them all myself, but we have recently

added a very part-time RN.  She is really functioning more as a front desk

person but may also start to assist me in some of these clinical tasks.  We are

also not really paying her an “RN wage.”  My overhead is better

than traditional but certainly not the ultra low amounts some here have.  I’d

say my overall overhead is maybe 35% or so.  As with a lot of us, my

malpractice is one of my biggest costs (even just 1.5 yrs out of residency).  I

own my building, which is a renovated house of ~ 1200 sq ft (not paid off though). 

Those test devices I use were somewhat costly at first but I had a hospital guarantee

to cover those things.  They are pretty simple tests, except the A1C can be

somewhat “finicky” & will get all screwed up if you mess up a

step.  I generally only do tests that are fairly quick, & that is why one

reason I have not been able to do many EKG’s (untangling wires, booting

the software, hooking it up to patient, getting it to print, etc).

Re:

EMRs

Chad:

I use eMDs after a hospital startup. I bought

eMDs instead of hiring staff. 1.5 years later my wife and I still do not

have any staff, but the EMR lets us practice the way we want. We are

paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am

opening my own FP practice in January with hospital backing. I

am looking at opening paperless, but torn between

low overhead

(Amazing Charts) and e-MD's. My lease

payment on e-MD's would factor

into my overhead and thus take away from my bonus while

I am owned by

the hospital and, of course, I would take over the

lease pymt if i buy

the practice, which I plan to do. I'm 31

years old, moving back to my

hometown, and opening solo. Any input on AC

vs. eMDs? Any input on

if AC has a lab interface, CCR capability, and

document mgmt yet? Any

input on starting a practice in general and on

opening with an EMR?

Thanks,

Chad Jumper, MD

cmjumper@...

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[Guest guest]

,

You realy cannot look just at individual claims. I too would not be at 90-100 if I just looked at individual codes, but will complete physicals, labs all total divided by number of visits shows billed charges of 106-110 and I collect about 80% billed charges.

Brock DO wrote:

I find it very hard to believe the number of people on the list that say they have a per claim reimbursement average of $90 - $100. I do a lot of 99214’s & a fair amount of OMT (osteopathic manipulation) on top of those. Even with a 99214 plus 2-3 body parts of OMT I might barely make $95 in a single visit. But average that? No way am I averaging near that. I still inevitably have some 5 – 10 minute 99213 visits too & that will really drop that average & I have very few 99215’s to raise it back up. Maybe the reimbursement here in Ohio is very poor compared to other states.

-----Original Message-----From: [mailto: ] On Behalf Of Brady, MDSent: Friday, October 21, 2005 11:02 AMTo: Subject: RE:

EMRs

I would guess I am averaging about the same amount per claim. The key to doing billing yourself is to keep it simple. I generally only use the E & M codes and use very few procedural codes. Yes, I probably lose money by not drawing blood (or billing for it), not doing EKGs in the office, and only doing a nominal amount of CLIA waved tests (Strep, Urine preg, dip U/A), but I don’t have to try and figure out all the ins and outs of billing. In general, the E & M coding remains the same so keeping up with this is not that difficult. Yes, every once in a while I mess up (ex. I took off a toenail on someone with medicare), and trying to figure out how to code the procedure quickly becomes crazy, but I then have some wonderfully nice coders I can call to try and figure out what I should do. The emr makes the whole process easy and after the

first month or so it becomes rather rote. Most of the denied claims are for the same reasons (so they are generally really easy to fix). Yes, I do have a larger A/R >120 days than I would like to have (around $12,000 after 2 ½ years) and would like to outsource that out, but I am still collecting >97% of allowable. I can’t compare what I’m doing to what a billing company can offer (I never looked into using one), but most are probably not going to be quite that good. After all, they are looking to do a job, while I’m looking to try and feed my family.

Note: One of the differences is that I do have anxiety that everything I’m doing is wrong and I might end up being sued for insurance fraud. But again, keeping it simple seems to minimize that risk.

-----Original Message-----From: [mailto: ] On Behalf Of Lowell KleinmanSent: Friday, October 21, 2005 11:30 AMTo: Subject: RE:

EMRs

It would be interesting to compare amounts collected per claim, on average. I am not positive, but I suspect I am averaging about $90-$95/claim. I am using a billing company and am spending about 35k/year doing so. I have always been under the impression that my collections with a billing company would be greater than doing it by myself.

Lowell

Lowell Kleinman, MD

Family Practice of San Ramon

5601 Norris Canyon Rd.

Suite 340

San Ramon, CA 94583

(925) - 866 - 8080

From: [mailto: ] On Behalf Of Brady, MDSent: Thursday, October 20, 2005 3:36 PMTo: Subject:

RE: EMRs

I usually average 60-70 invoices a week.

-----Original Message-----From: [mailto: ] On Behalf Of Lowell KleinmanSent: Thursday, October 20, 2005 6:30 PMTo: Subject: RE:

EMRs

How many bills do you have a week? I have around 125 and there is no way that would take me a few hours a week just to send out the statements and post the easy EOBs, not to mention the hard ones.

Lowell Kleinman, MD

Family Practice of San Ramon

5601 Norris Canyon Rd.

Suite 340

San Ramon, CA 94583

(925) - 866 - 8080

From: [mailto: ] On Behalf Of Brady, MDSent: Thursday, October 20, 2005 11:38 AMTo: Subject: RE: EMRs

,

Yes, that amount of time is getting out today’s bills and does not include entering EOBs or doing the secondary or tertiary billing. Entering EOBs takes about 1 hour a week (maybe 1 ½ hours if it was a busy week), and the following up of bills >120 days takes significantly more time. My point was, however, if you can collect 90% of billing through 1st pass (at 10 min a day), is it worth while paying $20,000-$30,000/year for someone to do it for you (particularly if it is not as accurate or patient friendly). My hope is to allow technology to input the EOBs for me (hopefully coming in later versions of e-mds) and hire out the f/u of long term invoices not paid after 90-120 days. To me, that minimizes the output of money to someone else and keeps me in the billing loop, but also minimizes the hours of time spent trying to figure

out claims which are likely not getting paid anyway.

-----Original Message-----From: [mailto: ] On Behalf Of Brock DOSent: Thursday, October 20, 2005 11:47 AMTo: Subject: RE:

EMRs

I assume that he means just sending out that day’s bills takes 10 minutes, not entering EOB’s, etc?

-----Original Message-----From: [mailto: ] On Behalf Of Lowell KleinmanSent: Thursday, October 20, 2005 10:30 AMTo: Subject: RE:

EMRs

– how are you doing billing in that short amount of time???

Lowell

Lowell Kleinman, MD

Family Practice of San Ramon

5601 Norris Canyon Rd.

Suite 340

San Ramon, CA 94583

(925) - 866 - 8080

From: [mailto: ] On Behalf Of Brady, MDSent: Thursday, October 20, 2005 8:02 AMTo: Subject:

RE: EMRs

,

I think you raise an excellent point. Why am I doing my own billing if I can instead be seeing patients and making much more money? The answer is twofold. First, the initial billing is done after hours (when I would not be seeing patients) and takes all of 10 minutes and results in about 95% of claims being paid. The secondary and tertiary billing is what takes a lot of time. Although I am looking into contracting to have my claims >120 days done for me (at 8% of collections), getting the initial stuff off really takes little time and saves a lot of money. The second reason is that you learn a lot about your patients by keeping up with the billing. Knowing who owes me money gives me insight into who might not be able to afford medications or other procedures, who may not be able to get food regularly, etc. I am also sure that there are

very few billing mistakes (which erodes patient satisfaction). Distancing ourselves from doing the “menial” tasks of medicine due to a perception of cost-savings leads to an erosion of the doctor/patient relationship which has caused medicine to be in the state its in today, but that’s just my feeling.

-----Original Message-----From: [mailto: ] On Behalf Of Brock DOSent: Thursday, October 20, 2005 9:32 AMTo: Subject: RE:

EMRs

I’m still trying to convince myself that the no staff model is smart business. What do you say to someone that tells you that you are really paying your biller/EKG technician/lab tech/receptionist/etc (assuming you are doing these things yourself) $150- $200 per hour instead of $8 - $12? Yes, I agree keeping over head low is very important but I can also see the other view point; namely, a doctor can bill $250/hr & a receptionist/biller, etc can not. Some would argue that if we can currently see “x” number of patients/day on the no staff model, then we could easily see “x + 5” or more by hiring other staff & it would more than pay for itself. I’m just playing devil’s advocate a bit here because these are some of the counterarguments I’ve been presented with. Of course, I also realize that running a lower

total volume practice has other benefits such as fewer refills/after hours calls/more time with each patient/etc.

-----Original Message-----From: [mailto: ] On Behalf Of EglySent: Thursday, October 20, 2005 7:50 AMTo: Subject: Re:

EMRs

Chad:

I use eMDs after a hospital startup. I bought eMDs instead of hiring staff. 1.5 years later my wife and I still do not have any staff, but the EMR lets us practice the way we want. We are paperless once old paper charts are scanned into the system.

Use both and get prices up front.

Lots of others can speak for AC.

I am opening my own FP practice in January with hospital backing. I am looking at opening paperless, but torn between low overhead (Amazing Charts) and e-MD's. My lease payment on e-MD's would factor into my overhead and thus take away from my bonus while I am owned by the hospital and, of course, I would take over the lease pymt if i buy the practice, which I plan to do. I'm 31 years old, moving back to my hometown, and opening solo. Any input on AC

vs. eMDs? Any input on if AC has a lab interface, CCR capability, and document mgmt yet? Any input on starting a practice in general and on opening with an EMR? Thanks,Chad Jumper, MDcmjumper@...

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