Last week, we brought you the “Insurance Billing Round-Table,” the first in our three-part webinar series to educate health centers about commercial insurance billing. Continuing today is the second webinar, “Myths and Misconceptions”, which was held on March 15, 2012. In this webinar, our industry experts answered some of the common misconceptions on billing private insurance as well as listener questions. Featured speakers included Jennifer Lepus, director of University of Maryland – Baltimore County’s health center, and Nuesoft consultant Jim Goblish.
See below for a full transcript of the webinar as well as additional Q&As from the webinar participants. If you have additional questions about Nuesoft’s insurance billing service for college health, feel free to call us at 800.401.7422, ext 1.
Part 1- Welcome to our webinar, Myths and Misconceptions about Third Party Insurance Billing. In the first part, a health center director who is experienced in commercial insurance billing will talk about why they decided to start a program.
Julie: Insurance billing is a really hot topic right now in the college health world. Under the Affordable Care Act young adults can now be covered by their parent’s insurance policies up to the age of 26.
So, this opens a window for student health centers to charge private insurance companies for the services provided at your health center, which in turn will generate incremental revenue to help maintain or add to the level of services now provided to your students. This is a relatively new train of thought in the college health sector, and there is still a lot of misinformation and misunderstandings associated with it, which we hope to help dispel today.
It is important to all our listeners today to understand that when we discuss the concept of “billing private insurance on campus” that we mean more than billing a student’s private insurance for special services such as X-rays, lab tests, vaccinations, dermatology, and so on. What we are actually talking about is billing the insurance companies for the visit itself. Billing for office visits is the source of the greatest amount of reimbursement for health centers from a billing program.
Today, here to help us dispel or settle some of those myths is Jennifer Lepus, director of University of Maryland – Baltimore County’s health center. They currently bill and have been doing so since 2003. Welcome, Jennifer!
Jennifer: Thank you.
Julie: For the sake of transparency we do want to let everyone know that Jennifer was chosen because of her content expertise in student health insurance billing. She is not a Nuesoft client, and did not receive an honorarium, reimbursement, or other financial assistance for her participation in this webinar.
Also joining us today is a Nuesoft consultant– Jim Goblish. Jim is a content expert as well on college health insurance billing and has been a proponent of it for some time now. Welcome, Jim!
Jim: Thank you Julie. I just want to give a brief background. I spent my entire career in healthcare, a little over thirty years. Seven of those years were spent with a private billing agency where we bill insurance for private medical office. The last ten years I have been in college health; many of you might have worked with me. And I have worked with about twenty five university health centers now on billing programs where we helped outsource, as an outsource agency, the billing program to help them get implemented and be successful. Thanks Julie.
Julie: Thanks Jim. Jim will be here to help answer any tough questions that come up that are specific to your health center’s situation. We encourage you to ask questions as they come up. You can do this by simply typing it in the Question drop down box located on the right hand side of your screen. And we’ll answer as many as we can in the time allotted at the end.
Julie: Jennifer, I would like to get started with you and UMBC’s situation. Jennifer, think back pre-billing at UMBC. Tell us a little bit about the situation your health center was facing.
Jennifer: Back in about 2002, just like any health center we were seeing more and more of our state funding cut (were a state agency), and so the previous director, assistant director at the time, talked about this possibility of doing third party billing. We looked into it and found that, as scary as it seems, it was probably well worth it. And we had a very supportive Vice President of Student Affairs at the time who let us try it out and see how it would turn out.
Julie: Great. So what were some of the top concerns you had when you were starting it?
Jennifer: It’s a little overwhelming. The major concerns were number one, are we going to have enough staff? That seems to be the biggest question everybody adds. The other thing was, we didn’t want to short change any of our students, it terms of making sure they still received care, and good quality care. We did some research about how many of our students didn’t have health insurance. We didn’t want to turn anyone away, so that was certainly a concern. The other thing was frankly our providers weren’t used to have to do coding. There was a learning curve with that as well. The providers really had to spend some time learning about proper coding and all that goes into it. All major concerns… not something we could learn overnight. I would say it took us a couple years until we really got it down pat and were confident and comfortable with what we’re doing.
Julie: So when those concerns came up, how did you get answers and resolve them?
Jennifer: We actually part worked with some companies that have done third party billing as well as other colleges that have done third party billing. People are very willing to share their expertise and they answered a lot of our questions. We also lucked out personally in the way we hired. We hired a woman that had medical background, billing experience. We shifted over some of our front desk staff to be billing staff. The other thing again is we asked other people with expertise to come in and do training, setting extra time aside for those that have to learn it. So that’s how we handled a lot of those concerns.
Julie: Was there any information floating around that made you uncomfortable about billing?
Jennifer: Well anytime you have major change, it’s a little uncomfortable. I guess the number one concern, was that we didn’t want to lose any of our students. And make sure they didn’t stop getting the healthcare that they needed because of any barriers through insurance. Once we worked out with our students that were under-insured or not insured at all, we actually allow them to do a payment plan and work with them very closely with our financial aid office. We felt pretty confident we were getting all the information out there we needed and our students were continuing to come into the university’s health services. We did surveys to see how many of our students didn’t have insurance. We’re very lucky because only about 8% of our students didn’t have insurance, so it’s not the majority. As we go forward, if the Healthcare Reform stays the way it is, everyone at some point will have to have insurance in the next couple of years, so that will be helpful.
Julie: Was there anything that really made you start to decide to start billing? Was there a final piece of the puzzle?
Jennifer: We thought that since most of our students were covered by their parents insurance and our health fees were being cut, so we say it as, if it’s a service out there, why aren’t we utilizing it? That’s what pushed us to do this. I come from a health education background so I’m very much supportive of prevention. When I saw that the revenue we could generate could be put back into a health education program, that was key for me. And others felt the same. It’s not that we’re generating the revenue for materialist things, obviously, the revenue is generated to put back into the healthcare of our students.
Julie: The last question, specific to your school’s situation is, what red tape or authorities needed to be involved when making the decision?
Jennifer: We went through talking to our general counsel to make sure everything was on the up and up. We worked with the attorney general to also make sure we had everything in line. In terms of liability insurance with providers, we had to make sure we had all the right equipment. In terms of red tape, it’s very important to have buy-in from the higher ups. This is a pretty big movement, so it’s nice to have to support from whoever oversees the health center, such as Student Affairs. It’s important for them to see the benefit of insurance billing. There is a balance. Let me back up because there is a balance. I have heard people frustrated that their VP’s want them to do it solely to raise revenue. You really have to look into your own school and see if it’s going to be worth it and that the money really will go to help the students. You have to get the key stakeholders- VP of Student Affairs, General Counsel, the President would be wonderful, and the students as well. It’s important you sell to the students and explain why you’re doing it. Especially if they are used to paying something like $10 a visit and then it becomes just like a regular doctor’s office and you’re paying a bill. It could be a little concerning, so you just have to explain it.
Part 2- Shifting Gears: Common Questions and Myths
Julie: Let’s shift gears a little bit now that we know about your health center’s situation. In talking with most of the schools nationwide we’ve heard several questions and concerns from Health Center Directors and other various levels of staff about starting a program for billing private insurance. Let’s run through some of concerns and you can explain what you knew about it prior to your decision to bill. If it’s one you haven’t heard or wasn’t a concern at UMBC, feel free to tell us that too.
For our listeners, if one of these questions is a concern at your school and you don’t feel you got a complete answer please let us know by asking a question about it. We can get more in depth later.
So, one of the concerns was that “If we bill health insurance, do we have to eliminate our health fee?”
Jennifer: We did eliminate our health fee. I’ve heard schools that don’t. The way they get around it, is because the health fee is something you charge to every student and because these schools are doing education and prevention, they can still continue to charge it. Every student benefits from it so they can still charge. We didn’t go that route, but we’ve heard schools that do that. They aren’t double charging, that would be unethical if it’s solely for revenue building, but if you charge everybody and you’re giving health education to everybody, then yes, you can still charge that health fee.
Julie: The next question is “can we really bill for office visits?”
Jennifer: Absolutely. That’s one of the things our providers are trained on. There are different levels of office visits. We did very thorough training. What’s great now is some of the electronic health records out there will help code for you and make suggestions. So yes, that’s one of the main areas we generate revenue. Like I said, our students are insured, so we are primary care providers for some folks. We are in-network with a lot of the major insurance companies and so we’ve already worked out with them what they will pay us back for some of those visits. So if we charge the students $55 for customary visit, we might have a contract with say Blue Cross Blue Shield that we only collect $40 of that money.
Julie: I think you touched on this, but the next question is “Would we have to bill students for parts of the bill not covered by the insurance claim?”
Jennifer: You don’t have to. It depends on what contracts you have. You can do that. We take all insurances and have the students sign a statement that says if you’re not covered, you are responsible for it. I want to say this too, just so everyone is aware… one of the things we love about it is that every new patient that comes in, has to meet with one of our insurance staff. We have them sit down with the students and go over what type of insurance they have, what it covers, what kind of expenses to expect. The students really appreciate that. They also get a walk-out statement that explains everything and how they are going to be billed.
Julie: What about the un-insured students?
Jennifer: We work very closely with our Financial Aid office. We help them from the get-go and work with them with payment plans. In certain situations, we can refer them out to local agencies as well, but like 99.99% still come to see us because they know we will work with them.
Julie: Another concern we have heard is, “Do we have to collect co-pays?” because they can be a barrier to students coming in.
Jennifer: I’m not sure about “have” to collect, it depends again on the contract you have with the insurance. We do collect co-pays. Honestly, it’s not a barrier depending on the way you set it up. I’ll give you an example. Our financial office does not like when we collect cash. So we give our students the option of checks, their campus card, and the most popular option is for their co-pay to be billed to their student account. I get a lot of follow up questions about that because that could spark if a parent sees that and have questions. But it’s a very generic statement of “health visit.” But yes, we do collect co-pays.
Jim: I would like to add to Jennifer’s answer. In working with 25 schools to date, some of them do express concern about charging the student a co-pay. As an advocate for the schools and working to get them in-network with the insurance companies, we’ve been able to arrange for the co-pay to be covered by the health fee. It is considered by the insurance company to be a prepaid co-pay and there is no additional charge to the student, no cost sharing. That is something that seems to be a trend in the insurance billing world for college health.
Jennifer: That’s great news, I didn’t know about that.
Part 3- How much revenue can we expect from starting an insurance billing program? We answer more answers to common questions.
Julie: Another question we’ve heard is how much reimbursement should /could we expect annually?
Jim: It varies of course. The amount of reimbursement depends on your program. I have found from experience that the billing of office visits is the biggest component of your reimbursement. Lab visits, x-rays, etc is just a small 10 or so percent of it. Therefore, a small school of three, four, or five thousand students could expect anywhere from $50,0000 to $100,000 in net funds. I’ve worked with schools that have twenty of thirty thousand students, and they get over a million dollars in reimbursement per year, net to them. So it depends how well you set up your program, what you bill for, if you’re in net-work, etc.
Jennifer: We’ve been averaging around $300,000 to $350,000 a year and we’re a university that has thirteen thousand students. But we’re also a university where most of our students are local and continue to go to their primary care doctors in the area. I think we do really well. The $350,000 more than covers the salaries of those in our department and like I said it’s helped us establish our health education program. When people ask me if it’s worth it, I explain to them we just purchased a new electronic health record system, which was costly. It’s wonderful but costly and it paid for the whole thing. That’s just to put it in perspective of how much you can put back into your program.
Jim: Those are good points Jennifer. And I do want to emphasize that when you do an insurance billing program, your administration cannot expect you to produce the whole budget—it’s a supplement to your budget. It can be very helpful to allow you to maintain or grow your services, but is not your total expenditures.
Julie: Jim, what is the usual cost of outsourcing our insurance billing program to an outside agency?
Jim: The usual cost of outsourcing to an agency, such as Nuesoft’s billing service, can vary. The Nuesoft program is 20% of your collections. This means not what you bill, but what you actually collect. We feel that providing a full service in the outsourcing versus what Jennifer is doing—a tremendous job, over two years to get the program established. We bring in experts to help with the coding programs, the credentialing, the in-network contracting, setting up the policies, the communication to the parents and students—that this 20% fee helps make sure you are successful right from the start. Its performance based so there is no other cost for these services expect for percentages of collections.
Jennifer: We’re one of the campuses that do it ourselves but there are many campuses that have another party like Nuesoft doing it for them. And they’ve been very happy with that.
Julie: That’s great. So will billing insurance be a negative to students and their parents? What advantages are there for the students?
Jennifer: When I do the parent orientations, parents have a very positive reaction because most of them are already paying for their children’s insurance anyways. They seem relived that it is one less fee. Like I said, we don’t collect the health fee. Because they are familiar already with what the co-pays are, it’s not usually a surprise. We also have a policy that our students can purchase as well, that is very reasonable in cost. If the parents want to look at how much it would be to just buy the student health insurance plan, then they can do that also. They seem pretty relieved about it because it’s not one more thing they have to pay for and they’re pretty comfortable with that.
Jim: I think that’s an excellent point Jennifer. Basically parents worry about their students and if they’re covered by their insurance plan- does the student go out to the emergency room if their health center does not cover or accept the insurance plan? This helps makes it more logical that they go the health center since they do accept their insurance. And then more and more of these services are covered and I think they feel better about that rather than having to pay out of pocket. So all the feedback we’ve received has been positive from the parents and students’ point of view.
Jennifer: I agree.
Part 4- We tackle some of our listener’s questions.
Julie: One of our listeners submitted a question. Do you have participating provider agreements with several insurance companies? How many? What about Medicaid? What if a student has a non-participating plan? Do you hold the student responsible for the entire bill and not contractually adjust?
Jennifer: We are in-network with the big ones- Blue Cross Blue Shield, AETNA, United. We are participating providers with all the major ones. When a student comes to us that is maybe from out of state and is in a insurance plan that we’re not participating providers with or, for example, has an HMO, we still will bill that insurance company but we explain to the student that if it’s not covered then they may be liable or they would be liable for the difference in the amount. We have a pretty good track record of getting something from those insurance companies because usually they recognize that the student is away from home and they will cover some of the costs of that.
One of the things I say in orientations to students and parents is that before they come to campus is to call their insurance company and explain their particular situation so they understand up-front what they are going to be dealing with. And that’s when it maybe a better idea to buy a student health insurance plan we offer. And we’ve had a couple of people that have decided to do that. They thought it was more equitable to buy the student health insurance plan than to have a smaller plan and be paying more out of pocket.
The question about the Medicaid, we just recently signed an agreement where we had to do some Medicaid- offer some reimbursements through Medicaid. It’s pretty limited. What we’ve done with those folks is work with them in terms of a payment plan and such. That took a while to get going but we finally got that up and running in the last couple of months.
Jim: I just want to add that when you use an outsourced agency like our Nuesoft service, our goal is to have a minimum of 80% of all your plans included in-network. So our staff goes to work to get you credentialed and in-network. We strive to beat that 80% in the second and third year of the plan. It typically increases. And we will bill for out-of-network and often as Jennifer said that reimbursement does come in. And if it’s a small amount, you do have the right when it’s out-of-network, to do balance billing to collect the balance. I think one of the keys is our record shows that 90% of the claims we submit on behalf of our clients are clean claims–they go through the clearing house and are submitted properly to the insurance plan. And that means you get very few denials, very few claims kick-back. And that allows for the claims to be paid within 7-14 days pretty routinely, so that is the good news.
Julie: Alright Jennifer, we have another question from one of our listeners, Ronda. She wants to know, do you have a set co-pay amount such as $10 or do you collect the co-pay listed on the student’s insurance card?
Jennifer: We collect what’s listed on the insurance card. So with our new electronic health care system we scan the card in. And as I mentioned before, part of the first visit is they’re required to sit-down with an insurance expert on staff and they explain all that to them- what they’re co-pay would be and so on. So we go by what’s on the card.
Julie: Can you bill for mental health services?
Jennifer: Our university’s counseling center is separate from our office. In fact we had a discussion about this- whether or not we should start billing for psychiatric services since it’s an MD. At this point we do not. Our counseling center does collect a fee, and so they don’t charge for any of their visits. So they offer free visits to anyone that needs counseling. So it’s a separate office but I do know that there are schools, I think University of Nebraska might be one of them that does bill for mental health services.
Jim: And I agree with Jennifer. As a billing agency we want to bill as much as we can because we get paid as a percentage. So we’re very willing to bill for mental health services covered under the insurance plan of the student. And our staff and billing experts tell me mental health billing is actually easier than medical health services, although sometimes more documentation is required. So we’re glad to bill and get reimbursement to support the mental health program as well.
Julie: Alright we have another question for Jim. What is the range and average percentage charged by private billing companies other than Nuesoft?
Jim: There are probably a range of options. One is you can go to a local company that does billing much like my earlier career that provides billing services. The negative is that they don’t understand college health- some of the special circumstances like a student getting an EOB- their parent for special tests, pregnancy tests and so on. And also you often don’t bill in the summer so local companies have a learning curve. They range from 7% to 10%. And I was just told by another school that the local company charged 15%. Often they don’t have the ability to do credentialing with the major insurance companies from out of state. We actually provide services in all fifty states. We submit claims for providers in all fifty states.
Then there’s another company that does specialize in college health billing and their published rate is 50%. They feel if they do a good job for you they earn 50% for all their work. And you get 50% which is incremental, something you didn’t get before.
We’ve looked at our experience, our capabilities and we feel 20% is a very fair return to us for our work. It incentivizes us to do a good job on your behalf and allows you to hopefully be more successful in net total at the end of the year more than if you tried to do it on your own. So that’s sort of where we are coming from. The range is great.
Julie: Jennifer, another question for you. How do you know if the student’s insurance is valid?
Jennifer: We actually as part of that meeting, if we have time we’ll check right then and there. If not, as I mentioned we scan the insurance and then we still talk to the student. But then our insurance staff will check the insurance to make sure that it is valid. We’ve also had situations where students had forgotten their insurance card. We still see them and we just ask them to bring their insurance card with them within the next a few days. Most do and some who don’t though then we bill the amount to their student account and that usually gets them in here quickly with their insurance card because then we can just reverse that and then bill their insurance.
Jim: And if I may add, part of a full service that we offer is electronic eligibility verification. So if a student does submit bad information or their coverage changes because their parents’ job changes. Without having to go to a website or customer service, you can instantly and automatically confirm the eligibility with our service so that when your students waiver out of your student health plan you can confirm that without extra work on your staff.
Julie: Jennifer, who handles the denied claims at your school?
Jennifer: It’s one of our insurance- we have three folks that handle our insurance billing and that includes the policy that we sell. So it’s through that office that they handle the denials. And often times they’ll resubmit just to see, you know once again and from that point on decide if it’s something that the student has to pay or its something that we just write off.
Julie: And Jim, what about third party company? How are the denied claims handled?
Jim: Denied claims is a key. At the American College Health Association (ACHA) meeting last year in Phoenix another school presented their billing program and it was successful. They generated good funds but the presenter documented that 35% of all claims in college health are denied and rejected. And as Jennifer pointed out, you’ll have to have staff to follow up diligently with that. Both for the students to their parents, on their behalf, and for you, the college, to get reimbursed ones that you deserve.
That’s where we really feel we’ve earned our money. In addition to you getting set up successfully and credentialed, we fight every claim. We make sure they’re scrubbed and submitted cleanly. And then if there’s any reason the insurance company denies them, we work with the students, with the parents, with you, to follow up on that claim and make sure that if there is appropriate coverage, it is reversed. And not only denied claims but claims that are paid partially, we follow-up and work on your behalf. And again, we have an incentive to do that. And that helps especially smaller schools where staffing and your ability to hire extra staff is limited– we do that work.
Part 5- We finish up answering all your questions and concerns.
Julie: Jennifer, how much extra staff did you have to hire when you started your program?
Jennifer: We actually did not have to hire that many more. We hired all in all one and a half more person I guess you could say. We took some of the folks that were working at the front desk and retrained them to do the insurance billing. So it was about one and a half position that was hired to handle those.
Julie: Another concern we’ve heard is, how can we code for services that we’ve never coded for?
Jennifer: Well, there are a lot of good seminars out there. Community colleges and colleges offer it as well. And like I said, some of the new electronic software have coding capabilities built right in. But there are books that people can get. It’s well worth it to hire a professional to come in and train your staff. There are a lot of different options. But like I said there are always seminars out there that people can take. Or if you are hiring new staff, hire someone that has that training. We had an expert come in and train our providers and that was very helpful.
Jim: Jennifer is correct that coding classes are available. We have certified coders on staff so we will teach those classes as part and then there’s follow-up. But an important step is we also do audits very frequently- initially then quarterly afterwards. We ask you to pull records and we compare it to what you’re coding to make sure you’re not over-coding, up-coming or down-coding and could code it better. And we feel those audits are very important for the success of your program and to keep you in compliance.
Julie: Let’s go to another listener question. For plans that require prior approvals, who is responsible for obtaining the prior approvals for each visit? Is it the student or student health services staff? What if the approval is denied? Is the student held responsible for the charges?
Jennifer: If it’s an insurance like an HMO where they have to have a situation where they have to be 50 miles or more away from their home, we will work with the insurance company to get that prior approval. Sometime we do ask the student if it’s ahead of time for them to do it, but sometimes they don’t do that and we will follow-up with it. There are times that when it doesn’t come through, the patient is responsible for that but we try everything we can to make sure that we got all our ducks in a row so that doesn’t happen. That’s what’s so nice about having the insurance staff is that they work with the students to get everything that they need as quickly as they can.
Now obviously if a student comes in with an emergency we won’t have time to get the right referral or that kind of information. We’re still going to have to see the student. If it becomes a major issue that’s how we work with the student- some kind of a payment plan or, don’t tell everybody, sometime we write it off or whatever we have to do. For the most part, we’ve been very lucky in the sense that our insurance folks have been getting everything that they need.
Jim: And I want to add another dimension. The good news about insurance billing and college health is you don’t, unless you have a very sophisticated health center with lots of physicians and services, most of the services you bill for are pretty straight forward- office visits, some other tests, vaccinations, Gardisol. Therefore it doesn’t come up too frequently. Under the Affordable Care Act, preventative services do not require any cost sharing, no co-pays. Women’s health coming in 2013- no co-pays, no deductible, no cost sharing. So some of the billing situations are going to be simplified.
Julie: Another listener question. What clearinghouse is used to verify insurance eligibility?
Jim: For Nuesoft, we have over 7,000 providers in the private medical world that submit claims through our software. So we are our own clearinghouse. Therefore, we have arrangements, electronically, with all the major and many of the smaller insurance companies where they’ve agreed contractually to confirm eligibility. Now I want to make clear, its not 100%. Some insurance companies do not co-operate. But for the most part, the answer is it’s our own clearinghouse under our own control. And I don’t know if you, Jennifer, do electronic eligibility verification.
Jennifer: A little bit but I can’t speak to specific companies that we use but we do a little bit of that, as well as we do a lot of our own.
Julie: Another question we’ve heard is can we get reimbursed for nurse and nurse provider visit?
Jennifer: Absolutely. My staff, I’ve got three nurse practitioners and 50% family practice doctors, and yes we bill for the nurse practitioner visits. We even bill for our medical assistants, I mean they’re working underneath the direction of nurse practitioners but just immunization and things like that. We also bill for that so yeah, absolutely.
Julie: Do the providers have to be credentialed and with whom?
Jennifer: They do have to be credentialed and we check that all out through the national provider data-base. And there are some, depending on who you’re going to be participating in-network, they have some rules for what type of liability insurance they have to carry and those types of rules. So we can do all that. And I know Jim can probably talk about how Nuesoft could do that for you I’d assume.
Jim: Right, thank you Jennifer. We do in fact do it for our university clients. And I give a very emphatic ‘yes’. Providers do have to be credentialed. The insurance companies feel they cannot reimburse you unless your providers are legitimate. And it’s sort of a detailed process, but we take that over for you. And our staff of experts has learned that we can also credential the facility rather than the providers although the providers are part of that process. So we need your co-operation to give us basic information on each provider, their medical school, their nursing program, their educational programs. But then we take care of getting them properly credentialed with each insurance plan.
Julie: We have time for one more listener question. This one is for Jim. Do you have to have the Nuesoft electronic health record to use the billing service?
Jim: Interesting question. No, you do not. In two regards: one is we provide our billing services, and electronic processing submission for any software you are using. So you could be using a competitor, any of the private systems out there. And we have an interface to grab your data and make sure it goes through our clearinghouse so we’ll be glad to set up your billing program. And then I’ll be honest we have some of our Nuesoft clients who are not using our electronic medical records, just our practice/ clinic management software, and we are billing for them so we’d love for you to look at it, consider using it. But the answer is no, you do not need our EMR to do a billing program.
Julie: So Jennifer and Jim, thank you so much for joining us today. Hopefully we helped shed some light on the subject matter to all of our listeners. And to all our listeners, thank you so much for participating. The final part, part three of our webinar series will be on April 12th and that will cover implementation and success–so you can learn more about what happens after you’ve actually made the decision to start billing. Thank you everyone!