BILLING SOFTWARE OR CLOUDS

This type of buyer...	Should evaluate these systems
Integrated suite buyers	Allscripts, MedLedger, CareTracker, SuiteMed
Inpatient care providers	Inpatient care providers Sage Intergy, athenaCollector, NextGen
Outpatient care providers	AllegianceMD, LeonardoMD, AdvancedMD
Cash-based providers	MDConnection, MediTouch
Outsourced services	Practice Admin, AdvancedMD, NueMD

WHY ClaimPay MD?

ClaimPay, LLC can help.  We offer our expertise combined with customized software solutions that result in additional income and reduced overhead.  We can even offer Electronic Health Records (EHR) solutions with internet access from anywhere.

We earn our practices a 10-30% increase in revenue.

We have local account managers and you and your staff will see us regularly.

We get claims are paid in most cases within 12-20 days.

We will train you with the best coding techniques.

We customize your billing process just for your practice.

We are persistent and tireless during the claim and appeal process.

We train your staff on the best practices for increased revenue.

We professionally handle all patient calls about billing.

We will do a monthly analysis of your practice and keep you informed.

Contact us today and benefit from the revenue increase your practice deserves along with the peace of mind that comes with the freedom to focus on good patient care.

THE HEALTH CARE FOUNDATION

THE HEALTH CARE FOUNDATION
P.O. Box 308,
Longview, WA 98632

• (360) 423-3591
• Mary Jane Melink,
  Executive Director
• thehealthcarefoundation@gmail.com
• 
  
• 
  

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HOW A MEDICAL CLAIMS CLEARINGHOUSE WORKS

Here’s the nuts and bolts of how it works. The medical billing software on your desktop creates an electronic file (the claim) also known as the ANSI-X12,  837 file, which is then uploaded and sent to the medical billing clearinghouse chosen. The clearinghouse then scrubs the claim, which means it is checking it for errors : arguably the most important thing a clearinghouse does; is scrub: which means to check for errors of submitted claims information.  Then once the claim passes inspection, the clearinghouse securely transmits (also very important) the electronic claim to the specified payer with which it has already established a secure connection, that meets the strict standards laid down by regulations which called HIPAA Transactions’. 

   

Sole Proprietors Insurance Costs and Definitions

Being a sole proprietor is the easiest way to start a new business. The business entity consists solely of one individual, the owner. Insurance coverage is very important for any business especially for a sole proprietor. It provides a safety net for sole proprietors in case of any unforeseen risks that occur in running the business. This is important since a sole proprietor guarantees a business with his own money as well as money from the business.

Errors & Omissions Insurance

Every business, regardless of size, should consider errors and omissions insurance. This is particularly important for sole proprietors who bear the financial burden of the business alone. This insurance covers when a business makes a mistake and the mistake causes financial harm to another individual or entity. This insurance protects a sole proprietor from having to fund the entire cost of defending against an action that occurs during work. This insurance can also be referred to as malpractice insurance or professional liability insurance. The average cost of errors & omissions insurance can vary from $500 to $2500 a year for a sole proprietor, as of July 2011.

General Liability

Another type of insurance for sole proprietors to consider is general liability insurance. This basic insurance covers injury claims, property claims and advertising claims. Most sole proprietors carry this kind of insurance since it covers all kinds of employment. Insurance companies require sole proprietors to fill out questionnaires answering numerous questions before they give quotes. Costs for general liability insurance depend on the location of the business, yearly revenue and the past claims history of the sole proprietor. It could be as low as $500 to as high as $15,000 a year for a sole proprietor, as of July 2011.

Related Reading: Sole Proprietorship & Health Insurance

Factors in Cost

There are many factors that are considered in determining the cost of insurance for a sole proprietor. These factors include the type of business being insured, the state where the business is located, the annual revenue for the business, the number of professionals providing service and whether or not there have been any claims in the past. Sole proprietors are the only individuals that need to be insured for their business, a factor that usually reduces the cost of the insurance.

Other Insurance

Besides general liability insurance, sole proprietors need to consider the cost of health insurance. Health insurance premiums can be deducted from sole proprietor's income for tax purposes. The price of a health insurance plan depends on a number of factors including the age of the individual and whether the individual smokes or is overweight. These risk factors typically lead to higher premiums. Health insurance premiums under a sole proprietor can range from $508.76 for an individual and $1,294.31 for a family as of July 2010.

Things to Consideration starting a Medical Home Based Office

We offer a complete billing solution:

• Create, submit, follow-up and post reimbursement.
• Bill patients and handle patient inquiries
• Advise customers on strategies or procedures that can increase collections and compliance with government mandates.
• Manage all patient and other data in compliance with government mandates.
• Provide customized management reporting designed to improve financial performance and contract negotiation outcomes.
• Flexible statistical reporting
• Productivity tracking
• Coding reviews

Please review our performance-based services and together lets meet those ends.

Accounts Receivable Management: • Coding • Billing • Claims Processing & Follow-up • Payment Processing • Lockbox Services • Secondary/Tertiary Claims Mgt. • Internal Controls • Electronic Claims Mgt. • Paper Claims Mgt. • Daily, Weekly, & Monthly Reports • Audits • Patient Statements • Software and Network Solutions NEW PRACTICE CHECK LIST Financial Considerations     1. Prepare and present pro-forma financial package & obtain financing (Mini Business Plan). 2. Decide on business format. 3. Secure tax identification number (s). 4. Contract for legal services. 5. Contract for accounting services. 6. Secure business checking account (s). 7. Formulate fee schedule. 8. Contract with selected third party payors. Facilities & Design     1. Determine space needs. 2. Locate available space. 3. Negotiate lease. 4. Attorney review lease. 5. Secure floor plan and or space plan. 6. Arrange telephone service 7. Arrange for utilities. Professional Consideration     1. Medical Society Membership. 2. Local specialty group memberships. 3. Secure hospital privileges. 4. Secure relief coverage. 5. Secure telephone directory listings. 6. Secure County Medical Society directory listing. 7. Have business card printed. 8. Visit referring physicians. 9. Design and printing of announcements. 10. Mail announcements. 11. Secure DEA registration. Insurance     1. Secure agent(s). 2. Malpractice insurance. 3. Casualty Insurance. 4. Accounts receivable. 5. Office liability. 6. Non-owned auto. 7. Fidelity bonding for employees. 8. Property. 9. Umbrella liability. 10. Workman’s Compensation. 11. Auto. 12. Personal property 13. Health. 14. Disability. 15. Life. Medical Equipment & Supplies     1. Develop list of medical equipment. 2. Submit list for bids 3. Order equipment. 4. Check plans for equipment and special requirements. 5. Develop list of medical supplies and drugs. 6. Schedule meetings with drug reps. and secure samples. 7. Order drugs and supplies. 8. Secure clinical patient education information. 9. Oversee installation of medical equipment. Office Equipment & Supplies     1. Develop list of office equipment and furnishings. 2. Submit list for bids. 3. Order equipment and furnishings. 4. Develop list of office supplies. 5. Price compare supply vendors. 6. Order supplies. 7. Secure service contracts on major equipment. 8. Necessary printed items: a) Letterhead & envelopes b) Prescription pads c) Patient registration forms d) Patient history forms e) Patient progress sheets f) Record of surgery g) Medication record h) Lab report forms i) Patient Information Brochures j) Medical records releases 9. Order medical records system: a) Filing cabinets b) Charts c) Color Coding supplies d) Purging system e) Outguides 10. Secure insurance claim forms. 11. Secure magazine subscriptions for waiting room. Personnel     1. Determine personnel needs. 2. Recruit applicants. 3. Screen applicants. 4. Interviews. 5. Check references. 6. Conduct background checks. 7. Prepare personnel policy manual. 8. Prepare job descriptions. 9. Decide pay levels. Implementation & Installation of Systems     1. Appointment scheduling 2. Billing System/Billing Service. 3. Internal controls. a) Petty cash fund b) Change fund 4. Formulate operations policies and procedures. 5. Advertising.

The Procedure: • Coding (CPT, ASA, ICD-9, HCPCS and Modifiers) • Start/Stop Time Verification • ASA Unit Assignments • Concurrency Assignments (Direction & Supervision) • Labor Epidurals • Acute, Chronic Pain Mgt. • Contract Reviews/Negotiations • Reimbursement Audits • Encounter Sheet Development/All Specialities • Billing Paperwork Exchange Management

Cash Flow Forecast

1. Divide your sales or revenues into logical categories that have similar characteristics and respond to similar variables. Hopefully your financial statements or other management reports are grouping your revenues this way.

2. Analyze these categories over the last three years if possible.

3. Do some research in trade and economic publications about factors concerning your industry, your customers or client groups, your product, your geographical region, etc. This will serve to broaden your "horizons" and give you a larger frame of reference within which to make decisions. You can go to your trade association, the research desk at a public library, the library at a local college or university or the Washington Small Business and Technology Development Center and talk to their information specialist to get leads.

4. List and analyze the specific variables that will affect each category of your sales or revenues for your forecast period. This will involve a very thorough process that will consider several variables. Some of them are:

Price

Customer Demographics

Product Availability or Production Capacity

Marketing Plans and Budgets

Geographical Market Changes

Beginning Balance Sheets

Assets Transferred In To The Business
1	Office Equipment				$	1,000.00
2	Hours Invested to start up				$	3,200.00
	3. Total ATI						$	4,200.00
Assets Needed for Start-Up
1.  Land					$	-
2.  Building					$	-
3.  Equipment					$	2,500.00
4.  Furniture & Fixtures					$	250.00
5.  Renovations/Lease Improvements					$	1,000.00
6.  Initial Inventory					$	1,000.00
7.  Working Capital / Cash					$	1,000.00
8.  Intangible Assets*					$		1,000.00
9. Business Acquisition					$	-
	9.  Total Assets for Start-Up						$	6,750.00
10.  Total Project Cost = 3 + 9							$	10,950.00
11. Personal Funds you Plan to Invest					$	500.00
Other Sources of Equity^
12	Assets Transferred In = Line 3.				$	4,200.00
13					$
14					$
15.  Total Equity Investment = 11+12+13+14							$	4,700.00
16.  Outside Financing Needed = Line 10 - Line 15							$	6,250.00
* franchise fees, patent fees, trademark fees, etc.
^ equity must be "patient capital" meaning no repayment for 12 months or longer.
Washington Small Business Development Center  www.wsbdc.org
Supplied in cooperation with the North Dakota SBTDC