Over the past month or so, we've seen so many side effects from insurance companies both opting in to provide insurance through the health insurance exchanges and opting out. Those that opted in are losing a lot of money right now due to the low number of enrollees. Those that opted out are also losing a lot of money because they lost several of their clients when they dropped them from enrollment.
Here's how those side effects are trickling down to medical practices: 1. Insurance companies that typically paid you within 15 days to 20 days are now holding onto that money and making more money in interest on it, leaving your cash flow suffering. I'm also finding that they you are not paying until you call asking where that money is. 2. Insurance companies are dropping claims stating, “We never received those dates” when the two dates before and the two dates after, all within the same batch, have been paid. This is resulting in your billing department having to follow up on all claims older than 30 days. 3. Insurance companies are creating narrow networks and patients are having difficulty finding in-network providers. This means that many of your patients may have to pay out of network rates. They not only have high deductibles, they also have high premiums. 4. Insurance companies are hiring outsourced auditors to review every single claim they have paid you. If they find one error, they're coming after that money. I once had to write a refund check for 4 cents. Yes, 4 cents. This can be devastating to your bank account. Essentially, these changes mean that your practice will be more and more strapped for basic cash flow. Payroll, expenses, administrative time chasing this money down, are all a drain to your business. Your businesses accounts receivable should be considered an asset until it starts costing your more to obtain that money than you are paid for that claim. Here are some tips you can implement right now to help you get through this new “norm.” 1. Be sure your billing staff is calling on claims older than 30 days to 45 days if you are typically paid sooner. 2. Your billing department should have access to your clearinghouse website and be able to prove that all claims were sent on time. 3. Start keeping a list of alpha-prefixes or some type of identifier that shows it's a newer plan and you are perhaps not in network. When calling and verifying, do not assume you are in network. Ask the rep: “Are we in network with this plan?” and if you are not, ask for out of network benefits. I'm also seeing that many specialties are not a plan benefit, so even if you are in network, your specialty may not be covered. In this case, you will need to turn the patient into a cash paying patient.
Keep your eye on your accounts receivable and your bank account. It is imperative that you own this area of your business in this volatile insurance fiasco.
Article By P.j. Cloud-moulds from Physicians Practice http://www.physicianspractice.com/blog/medical-practices-struggle-collect-payments-due-new-payer-tactics?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=18032014
Showing posts with label medical billing service. Show all posts
Showing posts with label medical billing service. Show all posts
Wednesday, March 19, 2014
Wednesday, March 5, 2014
Road to 10: The Small Physician Practice's Route to ICD-10 From CMS
CMS has created “Road to 10” to help you jump start the transition to ICD-10.
Built with the help of small practice physicians, “Road to 10” is a no-cost tool that will help you:
- Get an overview of ICD-10
- Explore Specialty References by selecting a specialty
- Click the BUILD YOUR ACTION PLAN box to create your personal action plan
http://www.roadto10.org/
Specialties include: Family Practice, Pediatrics, OB/GYN, Cardiology, Orthopedics, Internal Medicine and other.
Thursday, January 16, 2014
Friday, January 10, 2014
Choosing a Medical Billing Partner: 6 Questions to Ask First, This Article Gives You an Idea of What a Provider is Looking For.
By Sherri Dumford, CHBME, MBA Taken from Physician's Practice
In my almost 30 years of experience in healthcare billing, I’ve never seen more rapid change than today. Ever-evolving laws, regulations, and new reimbursement models make it imperative for shrewd physicians and administrators to align themselves with the most astute billing professionals to keep the practice healthy.
Here are the top six questions I advise practice leaders to ask themselves before selecting a billing partner.
1. What qualifications and credentials should I look for?
The billing firm must have policies and procedures that maximize the efficiencies of practice work flow and minimize the time it takes to get paid. In the wake of the HIPAA Omnibus Rule, billing companies also must have a rigorous compliance program that ensures the privacy, security and confidentiality of protected health information (PHI).
Billing company leaders who orient their staff assiduously and support continuous education, keep their firm and your practice on the cutting edge of industry developments. For instance, billing professionals who have achieved certification in the Certified Healthcare Billing and Management Executive (CHBME) program, offered through the Healthcare Billing & Management Association (HBMA), demonstrate a biller’s commitment to further their education.
2. What stipulations are essential to include in a contract?
An effective contract clarifies the billing company’s scope of work in detail, while specifying your practice’s responsibilities and pledge (e.g., to provide sufficient documentation for billing and authorization for services). Individual stipulations may vary from firm to firm, but should always contain the legal names of responsible parties, effective dates (including termination clauses), service reimbursement parameters, and an explanation of how reimbursements will be calculated, along with compliance requirements and scope of work. As always, whenever entering into a contract, seek legal counsel and do not be tempted to use a generic template as your final contract.
3. How can the billing partner help measure the health of my practice?
As reimbursement models continue to evolve, you will rely on your medical billing company to provide you with expert counsel in evaluating not only the health of your organization today, but also to make the appropriate preparations to meet future needs. Choose a billing company experienced in evaluating reimbursement data analytics, as well as one that can assess existing administrative policies, staffing levels, and IT resources so your practice can focus on what it does best— providing quality patient care.
4. What technological capabilities can I expect from a billing company?
Today, billing companies do much more than reimbursements. With their breadth of knowledge and expertise, billing companies may counsel you on the best technology to meet both your needs and regulatory requirements. Their experience with EHRs, practice management and billing systems, and other IT solutions, allows billing companies to integrate systems effectively, regardless of where they originate and reside. Whether you are looking for a new implementation or looking for an upgrade to your existing IT solution, the right billing company will be able to help zero in your focus of certified, respected vendors who have stood the test of time in meeting the clinical, administrative and financial needs of medical practices.
5. How important is it for the billing company to be "connected" to the revenue cycle management industry as a whole?
Because the business of healthcare billing is changing so rapidly, it is critical to partner with a billing firm that is playing an active role in the revenue cycle management industry and is constantly adding to its knowledgebase. You will want to investigate how the billing company is staying current with things like the transition to ICD-10; the use of PQRS (Physician Quality Reporting System) to make quality reporting pay; the types of relationships they have with your local payors; and how they stay abreast of regulatory changes that affect compliance and reimbursement.
As one example, the HBMA is a 700-member strong organization of billing companies that offers numerous educational programs to help members to stay on top of legislative, regulatory, and coding changes.
6. Since ICD-10 is one of the most significant changes the physician community faces, what preparation should I expect from a billing company?
Practices that aren’t prepared for the transition from ICD-9 to ICD-10 may see an immediate hit in revenue on Oct. 1, 2014. It may even serve as a death blow for some. Savvy practices will rely on billing companies that have completed end-to-end testing and have already performed the appropriate training for certified coders and are armed and ready to act in the event reimbursement issues arise due to adjudication issues with payors. This means they are keenly aware of which reimbursements should be based upon contracts, and evaluate any changes in denials or reimbursement trends. These efforts build upon an organization’s ICD-10 proficiency and work to ensure that reimbursement continues to flow to your practice.
Covering the above questions will help you find the best billing partner to help your practice thrive today and remain competitive in the future. But, I'm interested in your thoughts — beyond these six, are there additional questions or areas that should be included? Let me know in the comments section below.
Sherri Dumford, CHBME, MBA, is director of operations and external affairs for the Healthcare Billing and Management Association (HBMA). An established industry veteran, Dumford has worked in healthcare billing for more than 30 years, which includes serving as past president for HBMA. In her current role, she supports all aspects of the HBMA’s daily operations relative to membership, advocacy, and education, in support of HBMA strategic initiatives. E-mail her here.
Courtesy of Physicians Practice http://www.physicianspractice.com/blog/choosing-medical-billing-partner-6-questions-ask-first
In my almost 30 years of experience in healthcare billing, I’ve never seen more rapid change than today. Ever-evolving laws, regulations, and new reimbursement models make it imperative for shrewd physicians and administrators to align themselves with the most astute billing professionals to keep the practice healthy.
Here are the top six questions I advise practice leaders to ask themselves before selecting a billing partner.
1. What qualifications and credentials should I look for?
The billing firm must have policies and procedures that maximize the efficiencies of practice work flow and minimize the time it takes to get paid. In the wake of the HIPAA Omnibus Rule, billing companies also must have a rigorous compliance program that ensures the privacy, security and confidentiality of protected health information (PHI).
Billing company leaders who orient their staff assiduously and support continuous education, keep their firm and your practice on the cutting edge of industry developments. For instance, billing professionals who have achieved certification in the Certified Healthcare Billing and Management Executive (CHBME) program, offered through the Healthcare Billing & Management Association (HBMA), demonstrate a biller’s commitment to further their education.
2. What stipulations are essential to include in a contract?
An effective contract clarifies the billing company’s scope of work in detail, while specifying your practice’s responsibilities and pledge (e.g., to provide sufficient documentation for billing and authorization for services). Individual stipulations may vary from firm to firm, but should always contain the legal names of responsible parties, effective dates (including termination clauses), service reimbursement parameters, and an explanation of how reimbursements will be calculated, along with compliance requirements and scope of work. As always, whenever entering into a contract, seek legal counsel and do not be tempted to use a generic template as your final contract.
3. How can the billing partner help measure the health of my practice?
As reimbursement models continue to evolve, you will rely on your medical billing company to provide you with expert counsel in evaluating not only the health of your organization today, but also to make the appropriate preparations to meet future needs. Choose a billing company experienced in evaluating reimbursement data analytics, as well as one that can assess existing administrative policies, staffing levels, and IT resources so your practice can focus on what it does best— providing quality patient care.
4. What technological capabilities can I expect from a billing company?
Today, billing companies do much more than reimbursements. With their breadth of knowledge and expertise, billing companies may counsel you on the best technology to meet both your needs and regulatory requirements. Their experience with EHRs, practice management and billing systems, and other IT solutions, allows billing companies to integrate systems effectively, regardless of where they originate and reside. Whether you are looking for a new implementation or looking for an upgrade to your existing IT solution, the right billing company will be able to help zero in your focus of certified, respected vendors who have stood the test of time in meeting the clinical, administrative and financial needs of medical practices.
5. How important is it for the billing company to be "connected" to the revenue cycle management industry as a whole?
Because the business of healthcare billing is changing so rapidly, it is critical to partner with a billing firm that is playing an active role in the revenue cycle management industry and is constantly adding to its knowledgebase. You will want to investigate how the billing company is staying current with things like the transition to ICD-10; the use of PQRS (Physician Quality Reporting System) to make quality reporting pay; the types of relationships they have with your local payors; and how they stay abreast of regulatory changes that affect compliance and reimbursement.
As one example, the HBMA is a 700-member strong organization of billing companies that offers numerous educational programs to help members to stay on top of legislative, regulatory, and coding changes.
6. Since ICD-10 is one of the most significant changes the physician community faces, what preparation should I expect from a billing company?
Practices that aren’t prepared for the transition from ICD-9 to ICD-10 may see an immediate hit in revenue on Oct. 1, 2014. It may even serve as a death blow for some. Savvy practices will rely on billing companies that have completed end-to-end testing and have already performed the appropriate training for certified coders and are armed and ready to act in the event reimbursement issues arise due to adjudication issues with payors. This means they are keenly aware of which reimbursements should be based upon contracts, and evaluate any changes in denials or reimbursement trends. These efforts build upon an organization’s ICD-10 proficiency and work to ensure that reimbursement continues to flow to your practice.
Covering the above questions will help you find the best billing partner to help your practice thrive today and remain competitive in the future. But, I'm interested in your thoughts — beyond these six, are there additional questions or areas that should be included? Let me know in the comments section below.
Sherri Dumford, CHBME, MBA, is director of operations and external affairs for the Healthcare Billing and Management Association (HBMA). An established industry veteran, Dumford has worked in healthcare billing for more than 30 years, which includes serving as past president for HBMA. In her current role, she supports all aspects of the HBMA’s daily operations relative to membership, advocacy, and education, in support of HBMA strategic initiatives. E-mail her here.
Courtesy of Physicians Practice http://www.physicianspractice.com/blog/choosing-medical-billing-partner-6-questions-ask-first
Thursday, January 9, 2014
Wednesday, December 11, 2013
Tuesday, December 10, 2013
How to Start Your Own Medical Billing Service, a Great Stocking Stuffer For the Entrepreneur in Your Family! On Sale! $19.99!
This would be an excellent stocking stuffer for that family member looking to start their own business. Or even for a stay at home Mom or Dad!
http://www.amazon.com/Start-Your-Medical-Billing-Service/dp/1484928180/ref=sr_1_1?ie=UTF8&qid=1386715770&sr=8-1&keywords=how+to+start+your+own+medical+billing+service
Comment on this post with your email address and I will invoice you directly for the low, low price of $19.99 (Ca sales tax will be applied for all California state purchases)! Regular price $34.99.
This offer is available for the rest of the month of December 2013! Order yours today!
http://www.amazon.com/Start-Your-Medical-Billing-Service/dp/1484928180/ref=sr_1_1?ie=UTF8&qid=1386715770&sr=8-1&keywords=how+to+start+your+own+medical+billing+service
Comment on this post with your email address and I will invoice you directly for the low, low price of $19.99 (Ca sales tax will be applied for all California state purchases)! Regular price $34.99.
This offer is available for the rest of the month of December 2013! Order yours today!
Monday, December 9, 2013
Is Your Billing Company Registered for HBMA's Free Professional Billing Service Locator Service?
Physician owners and medical practice administrators are already signing up and may be looking for you! Today, the HBMA unveiled the free, fully automated Professional Billing Service Locator (PBSL) service, a platform that provides an efficient way for physician owners and medical practice administrators to easily find a trusted, professional medical billing partner. HBMA developed the offering to help providers with the arduous task of navigating through the thousands of medical billing companies on the market to find a the HBMA member organization that will best meet their specific needs. After registration, the PBSL will immediately identify the specialties, service details, and contact information of the most relevant and qualified medical billing companies in the region that fit a medical practice's specific profile. Finding that perfect match with the right professional billing service will help providers secure appropriate reimbursement for services delivered, achieve timely claims adjudication, and reduce claims denials to lessen days in accounts receivable. To learn more about how to register your billing company into the PBSL directory, visit Professional Billing Service Locator or call 877.640.4262.
http://www.hbma.org/blog/is-your-billing-company-registered-for-hbmas-free-professional-billing-service-locator-service
http://www.hbma.org/blog/is-your-billing-company-registered-for-hbmas-free-professional-billing-service-locator-service
You Need to Adapt in Order to Survive: How Your Medical Billing Service Can Prosper During the Healthcare Industry Chaos
How Your Company Can Prosper During the
Healthcare Industry Chaos
By Patrick Phillips
The healthcare industry is facing a state of complete disorder and confusion: Uncertainty surrounding the implementation of the Affordable Care Act, the looming switch to ICD-10, EHR and "meaningful use" deadlines, hospital acquisitions of physician practices, new HIPAA rules, and Health Insurance Exchanges... the list goes on. It seems like a challenging time for medical billing companies – and it is.
The good news is that not only can you prosper, you can bring hope and financial stability to struggling practices and salvage some that would otherwise collapse and shut down (or get swallowed up by a hospital or other acquisition entity). How can you assure your and your clients' continued prosperity and growth?
Focus on becoming a full-service revenue cycle management company.
In today's dynamic marketplace, billing companies that do not keep up with the constant changes will be left in the dust by companies that do. You must not only stay current with what is happening in the industry, you need to make alliances with other companies that can provide services to your clients that will help them solve cash-flow challenges beyond just their medical billing. The more services you can offer to your clients, the more you will be perceived as "the expert" who can solve their cash flow problems.
A brief review of the latest issue of Billing will introduce you to vendors that can be valuable to you in assisting your clients with medical coding questions, HIPAA compliance, EHR Meaningful Use attestation, online document management, patient portals, integrated payment channels, patient collections, and other revenue cycle issues. Do not forget that HBMA conferences will introduce you to technology partners that can help you keep up with changes in this dynamic industry.
In today's dynamic marketplace, billing companies that do not keep up with the constant changes will be left in the dust by companies that do. You must not only stay current with what is happening in the industry, you need to make alliances with other companies that can provide services to your clients that will help them solve cash-flow challenges beyond just their medical billing. The more services you can offer to your clients, the more you will be perceived as "the expert" who can solve their cash flow problems.
A brief review of the latest issue of Billing will introduce you to vendors that can be valuable to you in assisting your clients with medical coding questions, HIPAA compliance, EHR Meaningful Use attestation, online document management, patient portals, integrated payment channels, patient collections, and other revenue cycle issues. Do not forget that HBMA conferences will introduce you to technology partners that can help you keep up with changes in this dynamic industry.
Make sure you are using a billing system that is fully integrated with an EHR system.
Many outdated, server-based billing systems are trying to patch together a practice management system with one of the new electronic health record systems designed by a different company or on a different platform. The company that developed the practice management (PM) system creates an interface with an EHR system developed by another company. Chaos generally ensues.
If this is the case with your PM system, you are only asking for headaches and a possible loss of clientele. EHR companies are dropping by the wayside every day. Some of them are also server-based. Trying to get them to work together with billing software is like using "bubble gum and bailing wire" and will only lead to ongoing issues in your company. Two different companies, with two groups of programmers, trying to keep all the different parts of both systems running smoothly is almost impossible and can lead to turmoil in your company.
As painful as it may seem now, it may be a good idea to begin looking for a billing system that is totally integrated with an EHR system. That means that it was designed from the ground up by the same programmers in the same company. There are such systems available, and most of them are cloud-based (accessed securely 24/7 through a browser via the Internet).
Anything less than total integration of the two systems could be a disaster waiting to happen. Start your research now and find a system that will take you into the future, especially with any new clients you bring on. And, as part of your due diligence, make sure there is a way to import the data from your current system into the new system (at least the patient demographics). Then, begin to educate your current clients on why they need to start using an EHR, if they are not already, and why they might need to use a system that is fully integrated with your billing system.
Look for a system that has a way to electronically communicate with insurance company databases. You need one that checks for eligibility and automatically imports the patient data directly from the insurance company's database to create new patient charts. This will save you hours of data input and will help you keep employee costs under control. It will also prevent you from submitting claims that are sure to be rejected because the patient was not eligible for the service and it will keep the practice from spending time seeing patients that insurances will not cover. This will increase your revenue for that practice and will eliminate a large number of claim rejections as well.
Many outdated, server-based billing systems are trying to patch together a practice management system with one of the new electronic health record systems designed by a different company or on a different platform. The company that developed the practice management (PM) system creates an interface with an EHR system developed by another company. Chaos generally ensues.
If this is the case with your PM system, you are only asking for headaches and a possible loss of clientele. EHR companies are dropping by the wayside every day. Some of them are also server-based. Trying to get them to work together with billing software is like using "bubble gum and bailing wire" and will only lead to ongoing issues in your company. Two different companies, with two groups of programmers, trying to keep all the different parts of both systems running smoothly is almost impossible and can lead to turmoil in your company.
As painful as it may seem now, it may be a good idea to begin looking for a billing system that is totally integrated with an EHR system. That means that it was designed from the ground up by the same programmers in the same company. There are such systems available, and most of them are cloud-based (accessed securely 24/7 through a browser via the Internet).
Anything less than total integration of the two systems could be a disaster waiting to happen. Start your research now and find a system that will take you into the future, especially with any new clients you bring on. And, as part of your due diligence, make sure there is a way to import the data from your current system into the new system (at least the patient demographics). Then, begin to educate your current clients on why they need to start using an EHR, if they are not already, and why they might need to use a system that is fully integrated with your billing system.
Look for a system that has a way to electronically communicate with insurance company databases. You need one that checks for eligibility and automatically imports the patient data directly from the insurance company's database to create new patient charts. This will save you hours of data input and will help you keep employee costs under control. It will also prevent you from submitting claims that are sure to be rejected because the patient was not eligible for the service and it will keep the practice from spending time seeing patients that insurances will not cover. This will increase your revenue for that practice and will eliminate a large number of claim rejections as well.
I can predict the success you are going to have in your business – and in life in general – if you will tell me just two things: the people you associate with and the books (and periodicals) that you read. Do not get bogged down in the details of your billing business. You need to set aside time to attend industry conferences at least once a year and to read industry newsletters and books.
The person who does not read is no better off than the person who cannot read, so set aside time each week to read about our industry and keep up with the constant changes. Change is what life itself is based on, and if you are willing to change along with the industry, you and your clients will prosper.
Do not assume you will have your current clients forever.
You won't. Things change in medical practices: staff turnover, new policies and procedures, new government rules and regulations, competition, updated technology, and the marketplace itself. All these things can cause you to lose a client from time to time. You must always be marketing.
Whether you realize it or not, your competition in this industry is not just other medical billing companies. The practice itself is your biggest competition. All it would take is for a new office manager to come into one of your practices and decide that they would rather not outsource their billing: they think they can do it themselves more efficiently and more economically. You must keep reselling your clients on your efficiencies and on your cost savings versus doing the billing themselves internally. Provide them with revenue reports that delineate what percentage of billed dollars (expected) are actually being collected. Show them you are the expert in this industry by producing and providing to them a professional newsletter with articles that show that you keep up with the changes in the industry. HBMA has a newsletter you can purchase and tailor with your company logo (www.hbma.org).
Take the practice administrator (or the doctor) to lunch from time to time and show them printed reports that illustrate the revenue collections from both insurance providers and patients. Hold "Lunch 'n Learns" on a regular basis with your clients to bring them up to date on what is happening in the medical industry. Position yourself as the expert. People want to do business with "the expert" in every field.
When you buy a home, you do not want the new real estate agent: you want the guy or gal who has sold 100+ homes. When you look for a CPA, you do not want one who just hung out his or her shingle: you search for one who pays less than double digits of their own taxes and has a number of clients who they service. The same is true of a doctor's office. They want to feel that they are dealing with the company that can bring in every last dime that is due to the practice.
Continue to network with other business people in the community and join your local BNI group or chamber of commerce. Get out once a week and let people know you can solve the cash crunch for doctors and help them build their practices through your contacts.
Set up an automated way of keeping in touch with everyone you come in contact with who is a prospective client. Let them know that you are the only company that they should do business with. When it comes time for them to decide to outsource their billing, you are the only choice that makes sense. People do not buy when you are ready to sell – they buy when they are feeling the pain. Be at the top of their list when they decide it is time for change.
Remind your current doctors and office administrators that you are looking to build your business. Assuming you have done a good job for them, ask them for a referral. You would be surprised as to how many billing company owners never ask their clients for referrals. Do not just ask for the name of someone. Ask your client to pick up the phone and call the other doctor or office administrator and tell them how pleased they are with your billing service and that they think it would be in their interest to meet with you.
You can shrivel up and die in this ever-changing industry, or you can make the choice to grow and prosper, starting right now!
Everest College Announces Partnership with HBMA
Everest College, a provider of career-oriented diploma and degree programs at more than 100 campuses across the nation, recently announced an alliance with the most influential healthcare revenue cycle and management services association, HBMA (www.hbma.org). Under the agreement, HBMA will provide externship and placement opportunities within its large membership base for Everest's Medical Insurance, Billing, and Coding (MIBC) students and assist in the development of the school's MIBC curriculum.
"HBMA will help us enhance our MIBC program for our students. In turn, we'll be able to provide more well-trained, highly qualified students and graduates to work with HBMA member companies," said Anthony Mann, director of national employer development for Everest College. "For instance, Everest's externship, or '200 hour interview' as it is commonly referred to as, provides an in-depth opportunity for an employer to see a potential employee in their work environment. This opportunity opens doors to new externship and – and ultimately job opportunities – for our students and graduates."
"Currently, we are working on a website presence that will enable Everest students to view externship and placement opportunities, and to enable our membership base to view the credentials of Everest students. We are confident that our alliance with Everest will be fruitful in helping more graduates find employment, as well as provide our members with quality recruits," stated HBMA Director of Operations Sherri Dumford.
Barbara Lewis, director of talent management with HBMA member organization AdvantEdge Healthcare Solutions, shared that her organization has participated in Everest's externship program for a number of years and states, "Everest provides us with a qualified candidate pool that we can turn to when there is an immediate need for talent. These trained students and graduates are vested in our industry and are motivated to learn and do well."
If you are interested in finding out more about how your organization can participate in this program, contact Anthony Mann at anmann@cci.edu or (714) 913-7251 or Sherri Dumford at sherri@hbma.org or (877) 640-4262, ext. 201.
Courtesy of: http://www.hbma.org/news/public-news/n_everest-college-announces-partnership-with-hbma#.UpIbleU9JkQ.blogger
"HBMA will help us enhance our MIBC program for our students. In turn, we'll be able to provide more well-trained, highly qualified students and graduates to work with HBMA member companies," said Anthony Mann, director of national employer development for Everest College. "For instance, Everest's externship, or '200 hour interview' as it is commonly referred to as, provides an in-depth opportunity for an employer to see a potential employee in their work environment. This opportunity opens doors to new externship and – and ultimately job opportunities – for our students and graduates."
"Currently, we are working on a website presence that will enable Everest students to view externship and placement opportunities, and to enable our membership base to view the credentials of Everest students. We are confident that our alliance with Everest will be fruitful in helping more graduates find employment, as well as provide our members with quality recruits," stated HBMA Director of Operations Sherri Dumford.
Barbara Lewis, director of talent management with HBMA member organization AdvantEdge Healthcare Solutions, shared that her organization has participated in Everest's externship program for a number of years and states, "Everest provides us with a qualified candidate pool that we can turn to when there is an immediate need for talent. These trained students and graduates are vested in our industry and are motivated to learn and do well."
If you are interested in finding out more about how your organization can participate in this program, contact Anthony Mann at anmann@cci.edu or (714) 913-7251 or Sherri Dumford at sherri@hbma.org or (877) 640-4262, ext. 201.
Courtesy of: http://www.hbma.org/news/public-news/n_everest-college-announces-partnership-with-hbma#.UpIbleU9JkQ.blogger
Monday, October 14, 2013
Medical Billing Disputes: Finding Peace between Patients and Billers : Don't Be This Billing Service!
Your front-office staff is great. They check patients in, smile, schedule, and do everything right. The doctor or nurse sees the patient, listening intently for any clue that might help them solve whatever the problem. The patient leaves happy.
Then the bill arrives. The patient has a coinsurance they need to pay, and are very willing to do so, but it appears something has gone wrong with the insurance payment amount. They call the number on the statement to pay the bill, and get a not-so-friendly customer service representative. Things go downhill from there. A month later, the patient comes back into the office beside themselves, acting like a lunatic waving a bill around. Once you bring them into a private room away from the rest of your patients, you find out the problem: The patient has been fighting with your billing company for over a month to get a better understanding of what has happened.
This scenario happens far too many times. The office provides excellent service and the billing department — not so much. What is a practice manager to do? First, try to identify the actual problem and go from there.
Here are some tips on conflict resolution between your practice, the patient, and the billing department.
1. Identify the person in the billing department who the patient has been dealing with. Find out the rest of the story, as it could be the patient only had one interaction with the billing department, and the employee could have been trying to explain that the bill was part of the patient deductible and coinsurance. When patients don't want to hear what they don't understand, they start to argue.
2. Once you have a clear understanding of the problem, find out where the customer service portion of the patient experience failed. If it was lack of follow up with the patient or if the representative was indeed rude, that should be addressed with the billing department's manager.
3. Take this opportunity to create a plan with the billing manager to address overall customer service opportunities within the department and how you would like a very specific level of customer service to your patients.
This should include:
Article By P.j. Cloud-moulds of Physicians Practice http://www.physicianspractice.com/blog/medical-billing-disputes-finding-peace-between-patients-and-billers?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=24092013
Then the bill arrives. The patient has a coinsurance they need to pay, and are very willing to do so, but it appears something has gone wrong with the insurance payment amount. They call the number on the statement to pay the bill, and get a not-so-friendly customer service representative. Things go downhill from there. A month later, the patient comes back into the office beside themselves, acting like a lunatic waving a bill around. Once you bring them into a private room away from the rest of your patients, you find out the problem: The patient has been fighting with your billing company for over a month to get a better understanding of what has happened.
This scenario happens far too many times. The office provides excellent service and the billing department — not so much. What is a practice manager to do? First, try to identify the actual problem and go from there.
Here are some tips on conflict resolution between your practice, the patient, and the billing department.
1. Identify the person in the billing department who the patient has been dealing with. Find out the rest of the story, as it could be the patient only had one interaction with the billing department, and the employee could have been trying to explain that the bill was part of the patient deductible and coinsurance. When patients don't want to hear what they don't understand, they start to argue.
2. Once you have a clear understanding of the problem, find out where the customer service portion of the patient experience failed. If it was lack of follow up with the patient or if the representative was indeed rude, that should be addressed with the billing department's manager.
3. Take this opportunity to create a plan with the billing manager to address overall customer service opportunities within the department and how you would like a very specific level of customer service to your patients.
This should include:
- Friendly customer service representatives for your patients.
- If the patient is not satisfied with the level of service, they should be allowed to speak with the manager immediately.
- Follow up with patients. If the representative says, "Let me call you back on that," a phone call best be made within a specific time frame; in most cases 24 hours in a good rule of thumb.
- • If your office is unsure how an insurance is going to pay a claim and the patient needs to be seen multiple times for similar treatments, it is reasonable to ask the billing department to follow a claim from beginning to end. They can then call and let your office know if the insurance is imposing a copay, coinsurance, or deductible for the patient to pay. Your office can then inform the patient. Good billing departments can get most claims through to the major payers in less than two weeks.
Article By P.j. Cloud-moulds of Physicians Practice http://www.physicianspractice.com/blog/medical-billing-disputes-finding-peace-between-patients-and-billers?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=24092013
Monday, October 7, 2013
How to Code, Negotiate After-Hours Reimbursement at Your Practice
There are codes in the CPT® code book to report services a physician provides during "nontraditional" hours. If you prove that it’s in the payer’s best interest, third-party insurers may allow additional reimbursement for after-hours services.
Medicare and payers that strictly follow CMS guidelines will not pay additional reimbursement for after-hours services. However, you might succeed with private payers in negotiating payment for after-hours codes as part of a contractual agreement, especially if you use savings potential as leverage. Have your negotiator make it clear to the insurer’s representative that you’ll willingly send patients to the emergency department (ED) instead of offering in-office after-hours services, but that ED services can cost as much as 10 times more than comparable physician services.
To further demonstrate cost savings, you could also start billing all applicable after-hours codes for your practice. Over time, you will have compiled an archive of claimed charges, which you can use to show the insurer how often you provide these services. In this report to the insurer, consider adding data on the much higher price of ED visits for the same services.
If your practice already maintains regular hours on evenings, weekends, or holidays, and you provide a service during those times, you should skip 99050 and use 99051 — Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service.
If a 24-hour facility requests that your physician provide a redeye or early-bird service, AMA guidelines allow you to claim 99053 — Service(s) provided between 10:00 p.m. and 8:00 a.m. at 24-hour facility, in addition to basic service, in addition to the basic service. Code 99053 can be used whether the provider is already at the facility, or if the physician has to make a special trip to care for the patient. The code 99053 can only be used if the service provided occurs at a 24-hour facility, such as an ambulatory surgical center (POS 24), urgent care facility (POS 20), or emergency department (POS 23).
Emergency department physicians may report 99053 for services rendered between the hours of 10 p.m. and 8 a.m. The American College of Emergency Physicians fully supports this use of 99053, stating that this code is appropriate for late-night services, "especially given the nighttime practitioner availability costs typically incurred by all medical practices, including emergency medicine."
G. John Verhovshek, MA, CPC, is the managing editor for AAPC's publications. He has written, co-written, and edited dozens of coding and compliance resource manuals, including the Part B Survival Guide (1st edition) and The Official CPC Certification Study Guide (1st edition). E-mail him here.
Article By G. John Verhovshek, MA, CPC http://www.physicianspractice.com/coding/how-code-negotiate-after-hours-reimbursement-your-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=03102013
Medicare and payers that strictly follow CMS guidelines will not pay additional reimbursement for after-hours services. However, you might succeed with private payers in negotiating payment for after-hours codes as part of a contractual agreement, especially if you use savings potential as leverage. Have your negotiator make it clear to the insurer’s representative that you’ll willingly send patients to the emergency department (ED) instead of offering in-office after-hours services, but that ED services can cost as much as 10 times more than comparable physician services.
To further demonstrate cost savings, you could also start billing all applicable after-hours codes for your practice. Over time, you will have compiled an archive of claimed charges, which you can use to show the insurer how often you provide these services. In this report to the insurer, consider adding data on the much higher price of ED visits for the same services.
Know the Codes
Based on the CPT®/AMA guidelines, you may report 99050 — Services provided in the office at time other than regularly scheduled office hours, or days when the office is closed (e.g., holidays Saturday or Sunday), in addition to basic service — for any service provided in the office at a time when the practice would normally be closed (e.g., weekends or evenings). Code 99050 is reported in addition to the code for the basic service.If your practice already maintains regular hours on evenings, weekends, or holidays, and you provide a service during those times, you should skip 99050 and use 99051 — Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service.
If a 24-hour facility requests that your physician provide a redeye or early-bird service, AMA guidelines allow you to claim 99053 — Service(s) provided between 10:00 p.m. and 8:00 a.m. at 24-hour facility, in addition to basic service, in addition to the basic service. Code 99053 can be used whether the provider is already at the facility, or if the physician has to make a special trip to care for the patient. The code 99053 can only be used if the service provided occurs at a 24-hour facility, such as an ambulatory surgical center (POS 24), urgent care facility (POS 20), or emergency department (POS 23).
Emergency department physicians may report 99053 for services rendered between the hours of 10 p.m. and 8 a.m. The American College of Emergency Physicians fully supports this use of 99053, stating that this code is appropriate for late-night services, "especially given the nighttime practitioner availability costs typically incurred by all medical practices, including emergency medicine."
G. John Verhovshek, MA, CPC, is the managing editor for AAPC's publications. He has written, co-written, and edited dozens of coding and compliance resource manuals, including the Part B Survival Guide (1st edition) and The Official CPC Certification Study Guide (1st edition). E-mail him here.
Article By G. John Verhovshek, MA, CPC http://www.physicianspractice.com/coding/how-code-negotiate-after-hours-reimbursement-your-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=03102013
Monday, September 9, 2013
Friday, September 6, 2013
Top 10 E-mail Etiquette Tips
Who do you and your colleagues communicate with via e-mail at your medical practice? At a minimum, it is likely you communicate with patients, vendors, and each other. Is there anyone that you exclusively (or almost exclusively) communicate with via e-mail?
E-mail is a wonderful tool, but unlike phone or face-to-face communication, the medium poses challenges when it comes to conveying the tone you are trying to imply. E-mail can also be damaging, especially when an e-mail is misunderstood. Here are 10 tips to help keep the perception of your e-mails on point.
1. Keep e-mails brief and to the point. Make your most important point first, and then provide supporting details if necessary. Paragraphs should be short and easy to read.
2. Watch your tone. Without the nonverbal cues of face-to-face conversation, your tone can get lost in the translation of an e-mail. The more to the point you can be the better. Also using words like "please" and "thank you" can go a long way.
3. Don't assume the tone or intent of an e-mail you receive. In the same respect that you should watch your tone, never assume the intent or tone of an e-mail you receive either. It is always best to ask specifically the intent of the e-mail, as we all know what happens when you assume.
4. Don't reply when irritated or angry. When sending and receiving e-mail, the best solution when you feel offended is simply not to be offended (pretty good general life advice too). You are likely getting worked up over something that is simply an error in the translation of the tone. If you find yourself reading an e-mail and becoming irritated, step away for a minute and calm down before replying.
5. One e-mail per subject. Even when you are e-mailing patients, it is best to send one e-mail per subject so that it is easily referenced again by the subject line. If you find yourself sending three or more e-mails, consider sending one e-mail with multiple attachments rather than including pages of text in the body of a single e-mail.
6. Use zip files when sending attachments. Also make sure that the receiving person will be able to open the file. PDF is often the best format for documents; most systems can open it.
7. Always use "if –then" options. Using "if-then" options cuts down on the back and forth of e-mailing, especially for appointment times. For example:
"Can you bring Mary in for a follow-up appointment at 3 p.m. on Wednesday? If not then please give me three additional days and time frames you could bring her in (For example, Wednesday before 10 a.m. or Friday after 1 p.m.)."
8. Avoid typing in all small caps or all upper caps. This can make your e-mail look lazy (small caps) or like you are shouting (all upper caps). This is one of the most basic rules. However, with so many people communicating from their mobile devices, it often falls by the wayside.
9. Limit text formatting. Just because your e-mail service or program offers text formatting options doesn't mean you should use them. Avoid underlining unless it is a link. Various fonts and colors can make the e-mail difficult to read, and can often times seem unprofessional.
10. Always sign off with care. Use words such as "Thanks," "Sincerely," "Best regards," for closing e-mails. This is polite, respectful, and conveys a nice tone.
Be sure to use care and common sense when using e-mail as a tool to communicate with your colleagues, staff, and patients.
Article By Audrey "Christie" Mclaughlin, RN
http://www.physicianspractice.com/blog/top-10-e-mail-etiquette-tips-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=03092013
E-mail is a wonderful tool, but unlike phone or face-to-face communication, the medium poses challenges when it comes to conveying the tone you are trying to imply. E-mail can also be damaging, especially when an e-mail is misunderstood. Here are 10 tips to help keep the perception of your e-mails on point.
1. Keep e-mails brief and to the point. Make your most important point first, and then provide supporting details if necessary. Paragraphs should be short and easy to read.
2. Watch your tone. Without the nonverbal cues of face-to-face conversation, your tone can get lost in the translation of an e-mail. The more to the point you can be the better. Also using words like "please" and "thank you" can go a long way.
3. Don't assume the tone or intent of an e-mail you receive. In the same respect that you should watch your tone, never assume the intent or tone of an e-mail you receive either. It is always best to ask specifically the intent of the e-mail, as we all know what happens when you assume.
4. Don't reply when irritated or angry. When sending and receiving e-mail, the best solution when you feel offended is simply not to be offended (pretty good general life advice too). You are likely getting worked up over something that is simply an error in the translation of the tone. If you find yourself reading an e-mail and becoming irritated, step away for a minute and calm down before replying.
5. One e-mail per subject. Even when you are e-mailing patients, it is best to send one e-mail per subject so that it is easily referenced again by the subject line. If you find yourself sending three or more e-mails, consider sending one e-mail with multiple attachments rather than including pages of text in the body of a single e-mail.
6. Use zip files when sending attachments. Also make sure that the receiving person will be able to open the file. PDF is often the best format for documents; most systems can open it.
7. Always use "if –then" options. Using "if-then" options cuts down on the back and forth of e-mailing, especially for appointment times. For example:
"Can you bring Mary in for a follow-up appointment at 3 p.m. on Wednesday? If not then please give me three additional days and time frames you could bring her in (For example, Wednesday before 10 a.m. or Friday after 1 p.m.)."
8. Avoid typing in all small caps or all upper caps. This can make your e-mail look lazy (small caps) or like you are shouting (all upper caps). This is one of the most basic rules. However, with so many people communicating from their mobile devices, it often falls by the wayside.
9. Limit text formatting. Just because your e-mail service or program offers text formatting options doesn't mean you should use them. Avoid underlining unless it is a link. Various fonts and colors can make the e-mail difficult to read, and can often times seem unprofessional.
10. Always sign off with care. Use words such as "Thanks," "Sincerely," "Best regards," for closing e-mails. This is polite, respectful, and conveys a nice tone.
Be sure to use care and common sense when using e-mail as a tool to communicate with your colleagues, staff, and patients.
Article By Audrey "Christie" Mclaughlin, RN
http://www.physicianspractice.com/blog/top-10-e-mail-etiquette-tips-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=03092013
Tuesday, August 27, 2013
EHR Data Interface Issues for the Third Party Biller
Is the Industry Moving Away From Your Billing Model?
An article by Ron Sterling taken from the May/June issue of HBMA Billing.
Third party billers face a variety of business and technical challenges in interfacing with electronic health records (EHR) and other systems. Indeed, some of the initiatives in the healthcare industry will continue to complicate the establishment and maintenance of data interfaces for the foreseeable future.
Business Challenges
If you go back a few years before Meaningful Use, there were over 1,200 practice management system (PMS) vendors and a couple of hundred EHR vendors. During that time, the third party billers and/or practice management system vendors had the access to, and the attention of, physicians who needed to get their claims out of the door and paid. Consequently, it was the EHR vendors that would offer to accommodate interfaces with medical billing systems. Indeed, a variety of PMS vendors touted their systems as a gateway to a variety of EHR options for their physician clients.
Today, newly introduced integrated PMS/EHR products and EHR acquisitions by PMS vendors and vice versa have led to fewer, if any, billing system options for many EHR buyers. From integrated systems (that by design and business model do not interface with other products), to vendors that will not interface with other options, many vendors have established themselves as one stop shops for medical billing, EHR solutions, and, in some cases, RCM services. Indeed, some vendors have exclusive or "preferred" clearinghouse relationships for the handling of standard HIPAA transactions. In essence, more and more vendors want to position themselves as the only source for healthcare software solutions and services.
That is not to say that there are not EHR vendors who are eager to interface with a variety of practice management systems. However, the industry is moving to fewer interfaced solutions and more integrated offerings. Indeed, the majority of "new" solutions are integrated PMS/EHR offerings.
Healthcare Industry Changes
Related to the business challenges, the Meaningful Use initiative will affect interface strategies for all PMS and EHR products. For example, Stage 2 Meaningful Use core (required) measures include secure messaging with patients and providing electronic access to patient medical information. In most cases, this requires the use of a patient portal.
Patient portals can provide both medical billing and clinical interactions with patients. As importantly, most patient portals are designed to interface with one product line of medical billing and EHR products (such as Centricity PMS/EHR or NextGen EPM/EHR). Patient portals are not typically designed to interface with one vendor's practice management software containing billing data and a different vendor's EHR that houses clinical information. If the patient portal is separately interfaced with a PMS from one vendor and an EHR from a different vendor, the patient portal may not "know" how to properly route the message. In practice, however, patients may exchange secured messages with the practice on both billing and clinical issues.
A strategy that may include a separate patient portal for clinical issues and one for medical billing purposes presents a variety of operational challenges, including coordinating patient access and even accurately routing information. As importantly, separate patient portals will undermine support for the Patient Centered Medical Home and Accountable Care Organizations. For example, a patient who accesses the medical billing patient portal may not be reminded about a clinically-driven patient service issue.
Technical Challenges
Most interfaces are based on the Health Level 7 (HL7) structure. However, various aspects of HL7 are open to interpretation by vendors. Indeed, a variety of PMS and EHR vendors do not strictly support the HL7 standard. For example, some vendors use general HL7 messages instead of designated HL7 messages to send information. In other instances, the information in a message is not placed in the expected place but in a comment or supplemental area. Indeed, some vendors do not use the standard code sets, and instead use text fragments. In each case, the effort to establish the interface may require a painstaking evaluation of the vendor's "HL7" implementation.
Even after achieving success, the interface may have to change to address evolving coordination of information requirements between the medical billing and clinical record functions. For example:
- The Meaningful Use Stage 1 measures require ethnicity and race information that is commonly captured in the PM systems but is needed by the EHR to track provider performance and qualify for the EHR incentive payments from Medicare or Medicaid.
- Meaningful Use Stage 2 will require sharing of contact information and email addresses.
- The HIPAA omnibus rules will affect the information needed to track HIPAA Privacy and Disclosure as well as support exchanges with patients. As a practical matter, most medical billing and EHR interfaces do a poor job of coordinating HIPAA privacy and disclosure status for patients.
In light of these increasingly complex business and technical challenges to interfacing medical billing and EHR products, third party billers may need to establish their own preferred relationships with EHR vendors. However, such relationships will be under increasing competitive pressure and user demands to provide a more coordinated approach to patient service and provider relationships.
Right, wrong, or indifferent, the healthcare industry is moving towards comprehensive solutions to meet patient service challenges and optimize provider performance. Consequentially, the PMS/EHR vendors are addressing those needs. A myriad of changes that affect physician relationships with patients and the expectations of patients and payors will complicate the use of interfaces with EHR products and inhibit the efficiencies needed to manage patient care and service. As importantly, interfaced systems may complicate reporting for quality, operational, and management purposes.
Therefore, interfacing between PMS and EHR systems may present a tactical solution to meet physician needs in these relatively early stages of the transition to EHRs, but present a strategic challenge to address evolving healthcare business and patient service models. Third party billing organizations need to recognize these business and service issues in order to provide a clear strategic path for how your services and products will evolve to meet the new demands that your clients are facing.
Courtesy of: http://www.hbma.org/news/public-news/n_ehr-data-interface-issues-for-the-third-party-biller
Three Mindsets for Growing Your Business and Sales
(An article by Ron Karr, taken from the July/August issue of HBMA Billing)
Scott called me and wanted to know how he could close more deals. It seemed as though every time he walked into a practice, the walls would go up and office managers and doctors would be rude and unwilling to listen. Scott was going in to tell them how great his system was and how he could save them time and money. He was a threat to peoples' jobs and nobody wanted to deal with him. Sound familiar?
Scott changed his approach from competing against what they are currently doing to having conversations on how partnerships with his company can produce better results. He created different mindsets that enabled his audience to want to hear what he had to say without feeling threatened.
But here is the catch! Scott did not do this in a one-sided conversation. He got the doctors and practice managers to talk first about where they wanted to take their practices and what goals they had identified for their billing systems. Once he figured out where their struggles were, he then presented his systems and results in the context of what was important to each particular practice. When the managers and doctors heard his pitch, they felt like it was fully customized to address their issues.
Scott always knew that this was important. What he did not realize is that you need to treat each alliance as a client. In other words, don't just ask them for referrals. Do what you do with the doctors: ask about where they are trying to take their businesses, then discuss how partnering with you can help them get there.
Today, Scott and his company are enjoying great results from operating with these three mindsets. They are closing new accounts and creating alliances with influencers in their industry who are opening a lot of doors for them.
Scott started seeing results initially in the quality of the conversations he was having, which led to more opportunities and eventually more business.
What mindsets do you operate from? For doctors to switch third party billing companies or to go to a third party biller, they need to hear a compelling reason. That only comes when you operate from the right mindset.
Courtesy of: http://www.hbma.org/news/public-news/n_three-mindsets-for-growing-your-business-and-sales
If I ask you not to think about pink elephants, what will you think about? Be honest! You're thinking about pink elephants! But why would you, when I asked you not to?
The answer is simple: the mind cannot process the negative. If you are about to go into an account hoping to not lose the sale, what do you think is going to happen? You will lose the sale. The opposite is thinking about the deal you are going to close. Thinking about what you want to achieve, instead of what you don't want to have happen, makes all the difference in the world when it comes to your success in sales. Thinking about closing the deal puts you in an entirely different mindset that allows you to have the right conversation to make it happen.
Your mindset is the difference between closing more business and losing it. We have identified three critical mindsets that top producers use to grow their business. They are:
The answer is simple: the mind cannot process the negative. If you are about to go into an account hoping to not lose the sale, what do you think is going to happen? You will lose the sale. The opposite is thinking about the deal you are going to close. Thinking about what you want to achieve, instead of what you don't want to have happen, makes all the difference in the world when it comes to your success in sales. Thinking about closing the deal puts you in an entirely different mindset that allows you to have the right conversation to make it happen.
Your mindset is the difference between closing more business and losing it. We have identified three critical mindsets that top producers use to grow their business. They are:
- Creation vs. competition
- Openings vs. closings
- Alliances vs. lone ranger
Creation vs. Competition
Too many sales executives go into sales calls trying to beat their competition instead of creating better results for their customers. To build a value proposition that is second to none, you must concentrate on generating better results rather than competing against the processes already employed by the client. This is what Scott Nadell, Director of Sales for a third party billing company in New York, does.Scott called me and wanted to know how he could close more deals. It seemed as though every time he walked into a practice, the walls would go up and office managers and doctors would be rude and unwilling to listen. Scott was going in to tell them how great his system was and how he could save them time and money. He was a threat to peoples' jobs and nobody wanted to deal with him. Sound familiar?
Scott changed his approach from competing against what they are currently doing to having conversations on how partnerships with his company can produce better results. He created different mindsets that enabled his audience to want to hear what he had to say without feeling threatened.
Openings vs. Closings
After switching his mindset to one of creation, Scott then looked at how he presented his position when introducing himself to prospects. Instead of telling them how great he was, he provided actual statistics on how much money his company had successfully billed and collected for its clients. He positioned his company as a valued resource that helps practices increase their profits and revenues through an efficient billing and collection system.But here is the catch! Scott did not do this in a one-sided conversation. He got the doctors and practice managers to talk first about where they wanted to take their practices and what goals they had identified for their billing systems. Once he figured out where their struggles were, he then presented his systems and results in the context of what was important to each particular practice. When the managers and doctors heard his pitch, they felt like it was fully customized to address their issues.
Alliances vs. Lone Rangers
Scott then decided to take the same approach when it came time to creating alliances with other parties, such as attorneys and accountants. He realized that being introduced to a new prospect by one of their trusted advisors greatly reduced the amount of time it took to gain his prospect's attention and interest. If your attorney says that you need to speak to a service provider who is going to help your business, you are going to have that conversation.Scott always knew that this was important. What he did not realize is that you need to treat each alliance as a client. In other words, don't just ask them for referrals. Do what you do with the doctors: ask about where they are trying to take their businesses, then discuss how partnering with you can help them get there.
Today, Scott and his company are enjoying great results from operating with these three mindsets. They are closing new accounts and creating alliances with influencers in their industry who are opening a lot of doors for them.
Scott started seeing results initially in the quality of the conversations he was having, which led to more opportunities and eventually more business.
What mindsets do you operate from? For doctors to switch third party billing companies or to go to a third party biller, they need to hear a compelling reason. That only comes when you operate from the right mindset.
Courtesy of: http://www.hbma.org/news/public-news/n_three-mindsets-for-growing-your-business-and-sales
Choosing the Right Clearinghouse - Five Essential Qualities
An article by Bill Marvin from the July/August issue of HBMA Billing (www.hbma.org).
In the healthcare billing industry, the clearinghouse you work with has a huge impact on your business. The more efficiently your clearinghouse processes and returns your information, the faster you and your clients will get paid and the more payments you will collect. Therefore, knowing the right qualities to look for in a clearinghouse is crucial to the success of your business.
To gain insight into what billing services need from a clearinghouse, I interviewed Kevin Milam, owner of a company that does billing, consulting, and accrediting for clients across several states. We came up with five essential qualities to look for when researching clearinghouses to ensure that you are making the best decision for your business and your clients.
In the healthcare billing industry, the clearinghouse you work with has a huge impact on your business. The more efficiently your clearinghouse processes and returns your information, the faster you and your clients will get paid and the more payments you will collect. Therefore, knowing the right qualities to look for in a clearinghouse is crucial to the success of your business.
To gain insight into what billing services need from a clearinghouse, I interviewed Kevin Milam, owner of a company that does billing, consulting, and accrediting for clients across several states. We came up with five essential qualities to look for when researching clearinghouses to ensure that you are making the best decision for your business and your clients.
1. Knowledgeable and Immediate Customer Support
Having access to a knowledgeable, responsive customer service team is critical in any industry. For a billing service, waiting multiple days for an issue to be resolved can result in delayed payment, so choose a clearinghouse that allows you to log an inquiry 24/7 and that will respond to you within 24 hours. How can you tell for sure if a clearinghouse offers high-quality customer support? "Generally, if you receive immediate acknowledgement and responses to inquiries while you're researching a clearinghouse, you likely will receive the same treatment as a customer," says Kevin. Also, review the clearinghouse's commitment to customer service hours and responses in its contract. In most contracts, these performance elements are known as Service Level Agreements (SLAs) and are contractual commitments, sometimes with penalties.
2. Quick Claim Responses (Claim Status)
Once you submit claims to your clearinghouse, you should know within minutes which claims went through and which claims need to be corrected and resubmitted. "The longer you have to wait for claim responses, the longer it takes before you can correct any errors," says Kevin. "This delays cash flow for you and your clients and potentially leaves money on the table." Clearinghouses that tie claim status back to individual claims will save you time in the submission process.
3. Consistency and Accountability with 835s
You should receive an 835 and payment within a consistent timeframe so that you can post and reconcile your payments quickly. "With clearinghouses I've used in the past, I have received 835s weeks or even months after receiving the payments," says Kevin. "There was no consistency." When you can count on receiving 835s and payments within a day or two of each other, you and your staff won't waste time tracking down delayed 835s or payments for posting and reconciliation. Furthermore, the payment trace numbers or check numbers should re-associate with the 835s so that you can reconcile the payments more efficiently.
4. Efficient Claim Information
"It's not enough to have all of the claim information in your system," says Kevin. "You need to be able to use that information efficiently across multiple staff members at the same time." For example, if you can view a summary of all claim statuses on an 835, your staff can immediately identify which payments to post and which claims to reprocess. Additionally, your staff should have the ability to update the claim statuses as they reprocess claims or post payments, so that they don't duplicate any work done on the 835. This enables you to track all claim activity from a summary report or dashboard without wasting time looking at each individual claim.
5. Usability
For a billing service, it's key to be able to train your staff to use your system, especially as your staff changes or expands. Choose a clearinghouse with easy-to-use features like human readable claim responses and 835s; detailed and customizable reports hosted in a secure, private cloud; and a minimal number of clicks required to complete your workflow. "The steps required to process claims should make sense," says Kevin. "If you can't easily train your staff to use your system, it won't benefit you."
In addition, it is important to choose a clearinghouse that is accredited by the Electronic HealthCare Network Accreditation Commission (EHNAC). Some states and many payers will require you to use an EHNAC-accredited clearinghouse.
When you research clearinghouses, be sure to speak with existing customers, whom you can ask about each of these qualities. As the industry pushes for greater efficiency, it becomes even more important for your business to save time and money. Working with a clearinghouse that has all five of these qualities will help you to simplify your day-to-day processes, increase your cash flow, and help your business and your clients' businesses thrive.
In addition, it is important to choose a clearinghouse that is accredited by the Electronic HealthCare Network Accreditation Commission (EHNAC). Some states and many payers will require you to use an EHNAC-accredited clearinghouse.
When you research clearinghouses, be sure to speak with existing customers, whom you can ask about each of these qualities. As the industry pushes for greater efficiency, it becomes even more important for your business to save time and money. Working with a clearinghouse that has all five of these qualities will help you to simplify your day-to-day processes, increase your cash flow, and help your business and your clients' businesses thrive.
Courtesy of: http://www.hbma.org/news/public-news/n_choosing-the-right-clearinghouse-five-essential-qualities
Opportunities to Expand and Keep Your Business
By Steven Peltz, from the Jan/Feb issue of HBMA Billing
As a medical practice consultant, one the first areas of a medical practice that I evaluate is the billing department or billing company of a practice that has hired me. In my capacity as the president-elect of the National Society of Certified Healthcare Business Consultants (NSCHBC), I have had informal discussions with HBMA President Don Rodden, CHBME, about the consulting services that billing companies provide to practices, sometimes without understanding how important their role is to the practice.
I was introduced to HBMA by Government Relations Committee Chairman, Barry Reiter, CHBME. He and I have discussed the constant chaos that the healthcare delivery system is in and identified some of the opportunities that arise from that state. You may not know it, but many of you are already consulting, and if you have not set up your engagement contracts wisely, you are missing out both on revenue and having your client understand and appreciate all the value you bring to the practice. As practices merge and are acquired by hospitals, it is a good idea for your company to offer more than one line of service. Here are a few examples of what I do; you may want to consider adding these services to your company if you do not already offer them.
Over the years, I have established a benchmark of what a practice's accounts receivable (A/R) should look like. It is not cast in stone and is not fail proof, but it is a simple measuring tool that I use. I take the A/R temperature of all new clients and put it on a bar graph, then compare it to my benchmarks (see page 24). I then demonstrate to the potential client that by using the graph, their money is worth less the longer it is owed to the practice. I point out that either their billing company or billing department is not meeting the standard. I also break down the front end of the billing process and identify disconnects in the data collection process, such as: poorly trained staff, lack of reconciliation, monitoring, and the final decision with respect to collections.
Reducing the lifetime of debts that your company must collect begins at the point of service. Collecting co-pays at the time of each practice visit reduces postage, cuts billing staff time, and increases cash flow. Increasing the consistency of this front end collection means training the practice's staff to train the patients. For example, the front end staff may say to the patient, "Your co-pay today is $20" and then stop and wait. A more effective script for collecting co-pays may be, "Your co-pay today is $20, and we accept cash, checks, and credit cards. How would you like to pay?" A subtle but important difference, and while it will not work 100% of the time, it will result in increased revenue. Then, tell your client that you will monitor the success of their front office staff in collecting co-pays and refresh the front staff's training a few times a year. Finally, track the front staff collections on a monthly (or less frequent, but consistent) schedule and meet with your client enough times for your client to develop trust in you as a part of the management team.
When patients call to schedule appointments, do the front desk staff members ask for enough information to check insurance eligibility and acquire authorizations, when appropriate, before the visit?
Is there a daily, weekly, or monthly close that reconciles the cash, personal checks, credit card receipts, and insurance checks with the end-of day and end-of-week computer report and the bank statement? This is a simple way to make sure all the funds go into the bank and not into someone's pocket.
Does the office manager or billing department / company supervisor produce a monthly report that compares the charges and collections of the past month with the same month last year and two months before? This will spot and identify trends before they become problems.
During the first few meetings with your client, be prepared to bring something to the discussion that demonstrates the depth and scope of your knowledge and how your expertise will add to the success of the practice. For example, each year Medicare changes their codes; you could explain which, if any, impact the practice. If it is a primary care practice, establish a referral-based report. Identify how many dollars are sent out of the practice and to what specialties. Are there ways to recapture some of those dollars? Is the PCP or the specialist asking enough questions and documenting enough to code one level higher, if appropriate? I usually tell the owners(s) that the practice needs a preventative audit at least once every year and especially after a new provider is hired. When they ask why, I give them examples of other practices that have had to write checks back to payers.
When your client brings in a new provider, do you offer to credential the provider or bring in someone who can? Do you discuss ancillary sources of revenue that other practitioners use that can also be applied to that practice?
You probably already do between 80% and 100% of the above suggestions, but does the client understand how these services impact their practice? The point is whether your client knows that you provide these services. Yes, I know that they do not want to pay more for services that they think should be included, but that is not a reason to forgo informing them of all you do. Enhancing the services that you offer discourages clients from shopping for competing providers – it is much less expensive to keep a client than it is to get a client. Also importantly, by enhancing your services, you become more appealing to potential new clients when you make sales calls and offer to analyze their operational efficiency.
As a consultant, I either know the answer to the question or where to get it. You should be no different. With the constant change in the healthcare delivery system, you need to be constantly enhancing your product and empowering your clients with more opportunities.
Courtesy of: http://www.hbma.org/news/public-news/n_a-reminder-opportunities-to-expand-and-keep-your-business
As a medical practice consultant, one the first areas of a medical practice that I evaluate is the billing department or billing company of a practice that has hired me. In my capacity as the president-elect of the National Society of Certified Healthcare Business Consultants (NSCHBC), I have had informal discussions with HBMA President Don Rodden, CHBME, about the consulting services that billing companies provide to practices, sometimes without understanding how important their role is to the practice.
I was introduced to HBMA by Government Relations Committee Chairman, Barry Reiter, CHBME. He and I have discussed the constant chaos that the healthcare delivery system is in and identified some of the opportunities that arise from that state. You may not know it, but many of you are already consulting, and if you have not set up your engagement contracts wisely, you are missing out both on revenue and having your client understand and appreciate all the value you bring to the practice. As practices merge and are acquired by hospitals, it is a good idea for your company to offer more than one line of service. Here are a few examples of what I do; you may want to consider adding these services to your company if you do not already offer them.
Over the years, I have established a benchmark of what a practice's accounts receivable (A/R) should look like. It is not cast in stone and is not fail proof, but it is a simple measuring tool that I use. I take the A/R temperature of all new clients and put it on a bar graph, then compare it to my benchmarks (see page 24). I then demonstrate to the potential client that by using the graph, their money is worth less the longer it is owed to the practice. I point out that either their billing company or billing department is not meeting the standard. I also break down the front end of the billing process and identify disconnects in the data collection process, such as: poorly trained staff, lack of reconciliation, monitoring, and the final decision with respect to collections.
Reducing the lifetime of debts that your company must collect begins at the point of service. Collecting co-pays at the time of each practice visit reduces postage, cuts billing staff time, and increases cash flow. Increasing the consistency of this front end collection means training the practice's staff to train the patients. For example, the front end staff may say to the patient, "Your co-pay today is $20" and then stop and wait. A more effective script for collecting co-pays may be, "Your co-pay today is $20, and we accept cash, checks, and credit cards. How would you like to pay?" A subtle but important difference, and while it will not work 100% of the time, it will result in increased revenue. Then, tell your client that you will monitor the success of their front office staff in collecting co-pays and refresh the front staff's training a few times a year. Finally, track the front staff collections on a monthly (or less frequent, but consistent) schedule and meet with your client enough times for your client to develop trust in you as a part of the management team.
When patients call to schedule appointments, do the front desk staff members ask for enough information to check insurance eligibility and acquire authorizations, when appropriate, before the visit?
Is there a daily, weekly, or monthly close that reconciles the cash, personal checks, credit card receipts, and insurance checks with the end-of day and end-of-week computer report and the bank statement? This is a simple way to make sure all the funds go into the bank and not into someone's pocket.
Does the office manager or billing department / company supervisor produce a monthly report that compares the charges and collections of the past month with the same month last year and two months before? This will spot and identify trends before they become problems.
During the first few meetings with your client, be prepared to bring something to the discussion that demonstrates the depth and scope of your knowledge and how your expertise will add to the success of the practice. For example, each year Medicare changes their codes; you could explain which, if any, impact the practice. If it is a primary care practice, establish a referral-based report. Identify how many dollars are sent out of the practice and to what specialties. Are there ways to recapture some of those dollars? Is the PCP or the specialist asking enough questions and documenting enough to code one level higher, if appropriate? I usually tell the owners(s) that the practice needs a preventative audit at least once every year and especially after a new provider is hired. When they ask why, I give them examples of other practices that have had to write checks back to payers.
When your client brings in a new provider, do you offer to credential the provider or bring in someone who can? Do you discuss ancillary sources of revenue that other practitioners use that can also be applied to that practice?
You probably already do between 80% and 100% of the above suggestions, but does the client understand how these services impact their practice? The point is whether your client knows that you provide these services. Yes, I know that they do not want to pay more for services that they think should be included, but that is not a reason to forgo informing them of all you do. Enhancing the services that you offer discourages clients from shopping for competing providers – it is much less expensive to keep a client than it is to get a client. Also importantly, by enhancing your services, you become more appealing to potential new clients when you make sales calls and offer to analyze their operational efficiency.
As a consultant, I either know the answer to the question or where to get it. You should be no different. With the constant change in the healthcare delivery system, you need to be constantly enhancing your product and empowering your clients with more opportunities.
Courtesy of: http://www.hbma.org/news/public-news/n_a-reminder-opportunities-to-expand-and-keep-your-business
Compliance FAQs... How Much is Too Much?
How much information can a biller leave on an answering machine when calling for address or insurance updates?
Answer: Because the biller cannot know for sure who will listen to a message, even when calling a telephone number provided by the patient, it is wise to leave the minimum amount of information necessary to accomplish the reason for the call. Various legal concerns, including the HIPAA Privacy and Security rules, state that confidentiality and privacy laws and debt collection statutes and regulations can be implicated and should be taken into account.
A bare bones message may contain little or no revealing information while still accomplishing the task.
EXAMPLE 1: "This message is for [patient]. We are calling to verify your current mailing address (or insurance information) in order to bill for recent medical services you received. Please contact us at xxx-xxxx during office hours."
Here is another message scenario that gives minimal information.
EXAMPLE 2: "This is Medical Billing Office calling for [patient]. We need to contact you for an updated / corrected mailing address (or insurance information). Please call us at xxx-xxxx at your earliest convenience."
EXAMPLE 2: "This is Medical Billing Office calling for [patient]. We need to contact you for an updated / corrected mailing address (or insurance information). Please call us at xxx-xxxx at your earliest convenience."
Various factors should be considered in deciding how to draft scripts or instructions for your staff regarding outbound messages.
- What is the purpose of the call / message?
- Who is the provider / client? Are they well known in the community?
- Do they practice in a sensitive specialty, such as family planning, mental health, etc.?
- Is there a reason you would need to disclose the client's identity or other detailed information at all?
- What would be the risk if someone other than the patient or a close family member heard the message?
If additional information would be helpful and would not unnecessarily reveal personal health information (PHI) or sensitive information, it can also be included in the message.
EXAMPLE 3: "This message is for [patient]. I am calling for the billing office at [General Hospital Radiology Group]. Please contact our office to update your mailing address (or insurance information)."
CMS has published FAQs that are generally related to this question. By analogy, they support the conclusion that a biller may leave a minimum amount of information on an answering machine to solicit a response and gather information to enable proper billing.
The official HIPAA FAQs can be found on the website of the DHHS Office of Civil Rights at www.hhs.gov/ocr/privacy/hipaa/faq/index.html.
From the Office of Civil Rights HIPAA website:
May physician offices or pharmacists leave messages for patients at their homes, either on an answering machine or with a family member, to remind them of appointments or to inform them that a prescription is ready? May providers continue to mail appointment or prescription refill reminders to patients' homes?
Answer: Yes. The HIPAA Privacy Rule permits health care providers to communicate with patients regarding their health care. This includes communicating with patients at their homes – either through mail, phone, or in some other manner. In addition, the Rule does not prohibit covered entities from leaving messages for patients on their answering machines. However, to reasonably safeguard the individual's privacy, covered entities should take care to limit the amount of information disclosed on the answering machine. For example, a covered entity might want to consider leaving only its name, number, and other information necessary to confirm an appointment, or ask the individual to call back.
A covered entity also may leave a message with a family member or other person who answers the phone when the patient is not home. The Privacy Rule permits covered entities to disclose limited information to family members, friends, or other persons regarding an individual's care, even when the individual is not present. However, covered entities should use professional judgment to assure that such disclosures are in the best interest of the individual and limit the information disclosed. See 45 CFR 164.510(b)(3).
In situations where a patient has requested that the covered entity communicate with him or her in a confidential manner, such as by alternative means or at an alternative location, the covered entity must accommodate those requests, if reasonable. For example, the Department considers a request to receive mailings from the covered entity in a closed envelope rather than by postcard to be a reasonable request that should be accommodated. Similarly, a request to receive mail from the covered entity at a post office box rather than at home, or to receive calls at the office rather than at home are also considered to be reasonable requests, absent extenuating circumstances. See 45 CFR 164.522(b).
A covered entity also may leave a message with a family member or other person who answers the phone when the patient is not home. The Privacy Rule permits covered entities to disclose limited information to family members, friends, or other persons regarding an individual's care, even when the individual is not present. However, covered entities should use professional judgment to assure that such disclosures are in the best interest of the individual and limit the information disclosed. See 45 CFR 164.510(b)(3).
In situations where a patient has requested that the covered entity communicate with him or her in a confidential manner, such as by alternative means or at an alternative location, the covered entity must accommodate those requests, if reasonable. For example, the Department considers a request to receive mailings from the covered entity in a closed envelope rather than by postcard to be a reasonable request that should be accommodated. Similarly, a request to receive mail from the covered entity at a post office box rather than at home, or to receive calls at the office rather than at home are also considered to be reasonable requests, absent extenuating circumstances. See 45 CFR 164.522(b).
Thursday, August 15, 2013
How To Start Your Own Medical Billing Service Available on Kindle... And FREE to Amazon Prime Members for a limited time!
Please feel free to borrow this book from Amazon's lending library if you are an Amazon Prime member. Just be sure to leave your review after you read it, even if it is just a star rating.
http://www.amazon.com/Start-Your-Medical-Billing-Service/dp/1484928180/ref=sr_1_1?ie=UTF8&qid=1376581210&sr=8-1&keywords=how+to+start+your+own+medical+billing+service
Your opinion matters to me!
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