What is the main advantage to using your billing service?

For starters, we are the oldest and largest dermatology-only billing service in the country. Representing 85+ dermatology practices with over 325 providers in approximately 32 states, we have the expertise, reputation, and longevity. Just see what our providers have to say. Click on Testimonials and we’ll let our clients do the bragging.

Is there minimum revenue that I must generate to qualify for your billing service?

We evaluate our clients based on the size of their practice, growth potential, and many other factors. We specialize in group practices but can accommodate practices in the $800,000 to $1,200,000 range. One size fits all.

We just did an analysis to determine what we now pay for our billing staff. It turned out to be just under six percent of our overhead. How do we justify paying your company more than that figure if our practice generates $1 million in net receipts and we are currently spending $60,000 in billing related costs, how can we justify the increase in overhead?

You may be estimating your present expenses based on your billing costs during the past 12 months. Those costs will not remain the same in the months ahead. You should consider all billing-related expenses that could (and most likely will) increase. Staff salaries may increase, benefits costs may rise, software and hardware support fees escalate, and you may need to upgrade hardware or software. Even the cost of stamps, statements, CMS-1500 forms and other office items may increase. And if your practice grows or takes on additional providers, you will incur additional costs.

With a billing service, your expenses are fixed for the duration of the agreement and may be reduced if your volume increases. As your practice grows, it is the billing service that will need to add staff and absorb any additional costs while you pay the same commission rate.

Another consideration is the fact that in-house employees are paid the same salary and benefits and other costs remain fixed (computers, phone, etc.), even if your practice generates less money from month-to-month. For example, if you take off two weeks during July and your gross charges decrease by 50 percent (let’s say from $100,000 to $50,000), the following month your net receipts will decline by 50 percent. With in-house billing, your overhead expenses remain the same.

Since a billing service’s rate is based on posted collections for the previous 30 days, in the above example your August bill will decrease by the same percentage as your gross charges. Therefore, instead of paying your usual percentage of $100,000, your costs will be based on $50,000. That is a significant savings! Most practitioners take an average of four to six weeks of vacation annually. In larger groups, the total weeks of vacation are multiplied by the number of providers so the savings can be substantial.

Sometimes practices will experience a seasonal or weather-related decline in gross charges. So you should be aware of all potential decreases in productivity and consider all the savings you would realize by paying a rate based only on actual money posted without the need to support an underutilized staff during low-volume periods.

Here are a few important questions to consider:

  1. How much money did you lose from billing errors? (Charges entered incorrectly, timely filing limits missed, misuse of modifiers, lost revenue due to bundling, etc.)
  2. How many write-offs were made that should have been appealed or sent for review (non-contractual)?
  3. How much money in your accounts receivable (A/R) cannot be collected?
  4. How much money has been lost due to inconsistent patient statements or delays caused by slow claims processing?
  5. What about your exposure to embezzlement? (It is zero with our service).

There are many potential sources of lost revenues in your practice. Most of the clients we service have seen a significant increase in their revenues even without an increase in patient volume as a result of quality and timely billing and follow-up.

Staff turnover

The costs associated with staff turnover are estimated to run between $25,000 and $50,000 per employee which includes the expense of replacing and training new staff.

Limited office space

Many practices have limited space. Insourcing Inga Ellzey and her team frees up space for additional exam rooms that may have been previously occupied by desks, filing cabinets, computer stations and other equipment.

Improved patient service

By insourcing the Inga Ellzey Billing Companies, you’re able to free up phone lines for patient care and scheduling. You no longer have to spend valuable time handling patient inquiries about claims status or owed balances.

Why do you require an agreement? Can't you arrange month-to-month billing?

You will find that few, if any, professional billing services work on a month-to-month contractual basis. Signing an agreement with a billing firm is similar to signing a long-term apartment lease. Most apartment owners require tenants to commit to a yearly lease. In rare cases, where an owner rents month-to-month, tenants leasing by the month must pay a substantially higher monthly rate. The established, reputable firms in our business always require a long-term commitment.

Our agreements spell out in detail the responsibilities of both parties, the costs involved (so there are no surprises), and the processes and penalties for terminating an agreement for cause or non-cause. Agreements eliminate costly attorney’s fees should either party fail to live up to their responsibilities.

Without a long-term written agreement, you have no recourse if your billing firm fails to meet your expectations or legal obligations. Agreements protect both parties.

I feel like I would lose control over my billings if I outsource. How can you assure me your billing service is doing a good job?

We can answer your question with a few other questions:

  1. How much money did you lose from billing errors? (Charges entered incorrectly, timely filing limits missed, misuse of modifiers, lost revenue due to bundling, etc.)
  2. How much control do you have now?
  3. How accountable is your in-office staff to you now?
  4. How do you know your in-house staff is doing a good job?

There’s a good chance you do not have the control or accountability you think you have in your billing department. Many practices experience a false sense of security because they have an on-site billing staff sitting at a desk(s) down the hall. Unfortunately, many practices have no formal audit processes in place. They do not review write-off reports, do not know if all charges went into the billing system accurately, and whether patients are receiving regular statements. They don’t have the time to monitor how fast bills are processed or the time spent on follow-up. Owners rarely have the time to examine insurance aging reports on a weekly or monthly basis.

Unless you or a reliable, designated staff member is actively reviewing and monitoring all aspects of your billing staff’s work, you have no clear idea of your staff’s effectiveness or how much money you may be losing. By insourcing us, you can save lost dollars and improve your bottom line. Our Bottom Line Reports provide you with the instant ability to analyze your practice by provider, location, and the practice as a whole. What’s more, our agreements require us to do your work within 72 hours of receipt eliminating delays in processing and payment.

Our quality billing service, ranked among the top 50 in the United States, gives you real-time access to your account so you can immediately see the dates of service being entered, the turn-around time from date of service to date of posting, the amount of each write-off and reason for the write-off, and the status of aging by carrier. In short, a detailed look at the status of your billings is at your fingertips at any given moment.

What benchmarks should I look for from a billing service?

The Healthcare Billing and Management Association, the only professional association for billing services, has established the following benchmarks of excellence.

  1. Turnaround time from date of service to date of posting should be no longer than 45 days. This assumes a clean claim.
    1. With the increase of electronic remittance, the turnaround time for many of the larger carriers, including Medicare, has been reduced to two to three weeks and in some cases less. There will always be carrier denials. If there is a problem with claims requiring a review, redetermination, or hearing, that can add 30 to 90 or more days to the payment cycle.
    2. This 45-day turnaround time also equates to having no more than 1.5 months of gross charges in your insurance aging. For example, if your practice averages $100,000 in gross charges every month, then the total insurance A/R should not be more than 1.5 times that figure (or $150,000).
  2. Over-90-day outstanding insurance claims should not regularly exceed 10 percent of your entire gross charges.
    1. In the above example, if your total insurance A/R is $150,000, the over 90-day outstanding revenues should not exceed $15,000.
    2. In addition, those claims that fall into the over-90-day category should be in some review, re-file, or redetermination status.

We surpass all benchmarks!

  1. We are reimbursed for claims an average of 23-25 days from the date of service.
  2. We usually collect between 96-99 percent of all CPT-coded claims after contractual write-offs.
  3. No more than 8.7 percent of the total insurance A/R for our clients averages more than 90 days.
  4. Some of our clients have as little as 3 percent over 90 days. Do you know what your in-house staff’s benchmarks are?

What about patient owed-balances? Do billing services contact patients who fail to pay their bills or ignore the payment plans they agreed to?

We are not a collection agency. Collection of bad debt is regulated by federal statute, the Fair Debt Collection Practices Act, and is enforced by the Federal Trade Commission. The regulations under the Act are complicated and arduous. Infractions are severely fined and could result in prison time. Therefore, we only bill patients, answer patient questions regarding their bills through our toll-free 800 number (all calls are recorded), and forward patient accounts to collection entities as authorized by each client practice. No collections are initiated by our billing services.

How does your billing service establish its rates? Some billing services offer rates as low as 4 percent. Why is your rate higher?

First of all, our billing services’ commission rate is not high compared to industry averages. According to the Healthcare Billing and Management Association, the rates for dermatology billing range from a low of 6.75 percent to as high of 8 percent. Average billing rates for contracts in 2014 were 6.7 – 7.50 percent.

Our charges are all-inclusive with the exception of the following which clients must pay themselves:

  1. Cost of opening and maintaining a bank lock box
  2. Cost of mailing information to our billing service offices
  3. Cost of their monthly EMR maintenance fees (minus our subsidy for client that qualify)

We currently charge only 6 percent for Mohs codes 17311 to 17315 and only 6 percent for clinical and pathology claims. Rates for other claims are negotiated based on the number of providers in each practice, practice volume, percentage of Medicare patients, length of an agreement, and other criteria. Each negotiated agreement is unique and is influenced by these various factors.

The bottom line rate when you factor is all the costs eliminated in your practice and our outstanding results, the blended rate for most practices averages between 5.5% -to 7.5%. Some practices are lower and some higher again based on practice statistics.

When looking at rates, you should always find out which charges are not included. Many billing services charge extra for the cost of stamps, patient statements, CMS-1500 forms, and other expenses. When negotiating an agreement, make sure the billing service itemizes all extra expenses and explains the procedure for raising fees during the agreement period.

Remember, all PM system costs are covered in full under our agreement. You should consider how much you are now paying monthly or yearly for software that we offer free of charge.

How do I know that your staff is not embezzling money from our company?

This is another question that we like to answer by asking another question, “How do you know that your in-house staff is not embezzling money from you now?”

Our billing companies have eliminated this risk by requiring all of our clients to open and maintain a bank lock box. All insurance checks, patient payments, and credit card information are funneled directly through the bank’s lock box. No money whatsoever is handled by our billing service staff.

In addition, our company conducts background checks on all of its employees and carries several types of insurance as added protection against any staff wrongdoing. To date, we have never had an incident of theft.

Will you handle my billing even if some of my partners do not want to outsource?

No, because groups are paid based on one group NPI number. All checks go to the group. Trying to apportion our services based on each provider would create a logistical nightmare. Our policy is all or nothing.

Do you give any volume discounts? Our practice generates more than $3.5 million in receipts each year, so we feel we're in a position to negotiate rates.

Yes, we have a formula for determining the commission rate for each practice based on numerous criteria including patient volume. Actual annual receipts are just one of the factors we use.

We also give reductions based on the number of providers, percentage of Medicare billings, and collections stemming from Mohs. The percentage of clinical lab and pathology charges are all used in our blended commission rate as is a discount for using an EMR and our PM system.

What about cosmetic and other services dispensed over-the-counter? Do I need to pay you a percentage on my cash business?

No. Our agreement allows you to break out cosmetic services and product sales. You must, however, forward all claims for medically necessary services to our billing service for processing even if the patient has no insurance and pays cash for his or her clinical services.

Are you familiar with billing for PAs and NP services?

Yes. More than 60 percent of our clients have Physician Assistants and Nurse Practitioners. We regularly bill for their services in both incident-to and general supervision settings.

Will you help in the credentialing process if our practice hires new providers?

At the present we do not have a fully functioning credentialing component. Our staff, however, does all the Medicare credentialing and “assists” in credentialing commercial carriers, although we are in no way responsible for outcomes as we only try to coordinate your credentialing process with the needs of the billing service.

What if I get sick during an agreement period and cannot continue to practice? Am I responsible for fulfilling the remainder of the agreement?

Our agreement is based on the amount of money we collect for our clients with a $1,000-per-month minimum. This means your monthly invoice cannot fall below $1,000 in any one month. It is not added to the charges; it is just a minimum.

We have, through the years, dealt with many special circumstances. In each case, we have always worked with the practice and/or its successors in an honest and compassionate manner.

I would like to go into an agreement with your company and know I can entrust my practice to you, but what if you retire? What happens if you are not at the helm?

Thank you for thinking about the concept of retiring. I have eliminated the hectic deadlines of writing journal articles, publishing my own newsletter, retiring the Fax Hot Line, and many other responsibilities that had put immense pressure on me and limited my personal time.

I now dedicate 100% of my work hours to the billing services and will continue to do so for years to come. I really enjoy bringing the billing companies to new levels of outstanding service and the capability to offer my clients more and more benefits and resources.

All that being said, my companies are successful because I have so many quality individuals overseeing the organization supported by certified and highly trained staff members.

Rob Manjura, Vice President of the Inga Ellzey Billing Companies, brings the next generation of “Ellzey” to the companies. After spending five years learning the processes from the ground up, he was given the title after graduation from one of the top business colleges in the country with a degree in Economics and Finance.

Risa Kanavas, Director or Billing Operations, has been with me since day one and oversees our East Coast, West Coast, and Pacific Northwest billing divisions. In addition, each location has a general manager and we have supervisors for each of the various departments. Many department supervisors have been with our companies for years; most with tenure well over ten years.

“I provide and will continue to provide leadership and guidance to my staff and I expect to do so for many years to come. I do not see myself sitting at home watching soaps or knitting. Even if I travel more in the future, I will always be available to provide the support my staff needs via e-mail, fax, phone and FedEx. I do not expect to retire from my hands-on involvement with my companies for a very long time

When you do business with one of The Inga Ellzey Billing Companies, you will always have me as your practice partner. I will assure that your practice is profitable, legally compliant, and that our relationship is one of mutual trust and respect.