Medical Insurance

Whether you are a medical billing service, an employee in a doctor’s office, a provider or doctor, or some other worker in the medical billing field, it is so much better if you are proactive instead of reactive. We find that most offices operate in a reactive mode, including ours at one time. If you or your office is reactive, most of the day is spent putting out fires and dealing with what comes up. The day cannot be planned out and regular work usually falls behind. Something or things that needed to get done – didn’t. Basically your business or office is operating out of your control.

Not only are you operating out of control but your clients (if you are a billing service) are not as happy or satisfied as they should be. And if they are not happy there is a risk that they will stop using your service. If you are in a providers office your accounts receivable is probably not in control because the jobs required to keep them in control cannot be done because you are too busy putting out fires. You barely have time to get the billing done, let alone run and work aging reports (work being the operative word), file appeals, handle denials, and all the other things needed to keep the accounts receivable under control.

It is so much better to be handling the issues or jobs that if not handled will cause fires before they even get a chance to start to smolder. So how do you make the switch from fire fighter to fire prevention? It’s actually not as difficult of a switch as one might think. You must be determined that you are going to change things and then get the systems in place to prevent the fires. Instead of being reactive you need to learn to be proactive. Once you have switched your mindset, you need to get your actions to line up with your new mindset.

This is done by identifying what is causing the fires in your office. Is it providers calling because their receivables are down or because they are wondering why a certain claim or claims were not paid? This is a preventable fire. Think about it. If you were not so busy putting out fires the electronic reports and the follow up reports would be being worked regularly keeping the accounts receivable in check. Any unpaid claims would be resubmitted, appealed or acted upon in some appropriate way. This will eliminate many of the provider calls for these reasons. Some will still call, but you will have answers for them on the first call not even allowing a spark, let alone a fire. Everyone remains calm and the provider is reassured that you are in control and on top of their account. This method is so much better than “FIRE!”

Sometimes it is actually a person in your office that is causing the fires. An employee that just enjoys drama or cannot operate unless there is total chaos. It seems unreal, but it is actually quite common. Personally I hate drama and chaos and cannot understand how anyone would want to create them. Unfortunately I have seen it first hand so I know these people exist. If you have someone in your office like this most likely they will have to go in order for you to turn things around. It is very unlikely that you can get them to change.

What else is causing fires in your office? If you take a step back and determine how the fires are starting there is almost always a way that they could have been prevented. Take immediate action and you will see big changes very quickly. It will be well worth the effort it will take you to make the changes.

Let’s take, for instance, health care service providers, those in a bid to save money try and do all possible tasks themselves, without even considering, whether they are fit to perform them or not. As a result, the tasks do not yield desired output. The solution to it is doing tasks that fit your skill set best then only the best of the results could be achieved.

Medical billing is one such service that helps medical practitioners, hospitals, health care service providers to achieve specialized and gainful results, without putting in too many overspecialized efforts. The above discussed entities often stay engrossed in serving the patients for utmost customer satisfaction. In such a case, they either would need to hire a team of expert professionals (who could process the medical billing for them to help recover their due payments from patients’ insurance companies on time, along with due follow-up), and bear their monthly compensation and maintenance cost or outsource their tedious task to an expert medical billing service provider. The latter is a more specialized, cost efficient and an effective option.

Health care service providers lose millions of dollars annually due to under pricing, coding errors, missed charges and un-reimbursed claims of their medical services. To avoid this, it is important that experts with latest technological and software knowledge provide customized solutions to meet individual clients specific requirements. All this could well be ensured by adept medical billing service.

It involves a lot of complexities but trained medical billing service providers ease and uncomplicated the process to help medical organizations recover their dues. Deft billed understand the basic and major medical coverage plans, such as the Health Maintenance Organizations (HMO), Fee-for-Service Plans, Preferred Provider Organizations, Point-of-Service Plans and know the different methods of billing patients and understand the medical billing industry and all its complexities.

The expert billers are also well versed with the terminology & soft wares most often used in a medical office like MediSoft, AdvantX, Surgi Source, etc. Besides they also hold expertise in electronically filing claims, and possess knowledge on the most common types of insurance policies. Billing experts are also well aware of spreadsheets, electronic mail, database management, and possess contemporary word processing skills, proficient in bookkeeping for the most flawless bill raising and hassle free recovery.

Nowadays, we all agree that finding a good job is very difficult. Although we are a fresh graduated from a university, we still find difficulty in getting a good job. We need to be smart and have enough skill so that we can be chosen the work in a very good company. Therefore, we should prepare it well before we enroll ourselves in a university. We should choose correct study program so that we will get good job later on.

If you want to work in the health care industry, you are in the right tract since working in health care industry is very promising. One job that you can do in health care industry is medical biller. You can join at a medical billing training program if you want to be a medical biller. Fortunately, many universities also provide that program for you. The training program will bring you to have a successful job in your future. If you can choose the best training, you will be guided by some professional medical billers that have a lot of experiences in guiding a training program. Of course it will be very useful for your future career if you want to be a medical biller.

If you can be a medical biller, you will get high salary. It is very interesting, right? Some medical billing training programs only have affordable fees but you will be able to work in the health care industry with high salary. If you are smart and want to work in the health care industry, joining at a medical billing training program will be the best decision for your future. So, what are you waiting for? I suggest you to go to the internet and search some institutions which provide medical billing training program for you. I am sure that you will have enough finance for your future. It will bring you to a happy family, then. Let’s try!

When starting a medical billing business there are many things to think about and writing a contract is just one of them. There are many expenses in getting started and most of us just starting out don’t want to spend our limited investment money on an attorney. So what do many of us do? We “google” sample medical billing contract and use what we think sounds good and make up a contract for our business. That can be a big mistake.

That’s what we did sixteen years ago when we started our business except there was no ‘”Google” then. But we basically searched until we found a sample, very simple contract and modified it for our use. For several years we told ourselves that it was fine and if it wasn’t working out for the provider then it wasn’t working for us either and we should move on and find new clients. It took us a long time to realize that in several situations our simple contract was actually the reason things were not working out.

When you first start your medical billing business you have no idea of the things that can go wrong in a relationship with your clients so you do not know what needs to be included in a contract. Our first contract did not even specify the responsibilities of either the provider or ourselves. It is amazing we were able to find providers willing to sign our contract. If you don’t include the responsibilities of each party in the contract how does it protect either of you when the relationship starts to fall apart? And if neither party knows their responsibilities, how can you expect that the relationship will work?

Here is an example. You specify in the contract that it is the obligation of the provider’s office representative to supply you with all the payment remittances but you are not getting them which is causing you to do a lot of extra work in contacting the insurance carriers to check status on claims that were already paid. It is upsetting to spend three or four hours calling insurance companies to find that the claims were paid but the doctor’s office missed sending you the eobs. When the doctor has signed a contract that says that he will designate a person responsible for that purpose you can nicely inform the person responsible for getting you the eobs that this is such an important issue to you that it is written into the contract that the doctor signed that you are to be provided with the eobs. You can also include a provision in the contract to specify what you can do if the provider is not providing you with the eobs.

Another important example is an issue you will undoubtedly run into – your payment. Many people who start this business are used to receiving a regular paycheck. When you make the move to being an entrepreneur and owning your own business you can only write yourself a paycheck if your providers pay you. You need an understanding with your providers as to when you are going to be paid for your services. Doctors are often not the best businessmen and are sometimes not very good about paying bills on time. Especially when you are first starting your business it is vital that your provider understands when you expect payment and that you have something well written to protect you if you end up with someone interpreting the language of your contract in court.

Each year you are in business you find additional things that need to be added to your contract. New situations arise that you realize should be covered in your contract. So how do you cover everything that needs to be covered? You need a list – actually several lists. You need a list of what you feel the provider’s responsibilities are. You need a list of what you feel your responsibilities are. You want to imagine a symbiotic relationship with your providers and then list the reasons this relationship works and put those actions in your contract as responsibilities of yourself or the provider.

You need a list of everything that you have ever heard of going wrong in a medical billing business between the provider and the biller. You need to decide how you would avoid those situations if possible and cover how it would best be handled in your contract if unavoidable.

What you are charging your provider and how you will get paid is a fairly important part of your contract. Are you charging a percentage, a flat rate, or a per claim fee? Is it clearly defined how you are charging? Is the percentage on what is billed out or what is received? Are patient payments included? If charging per claim, what constitutes a claim? Is it a line on a claim form or is it per page?

You also need to take into account what will happen when the relationship ends. It may be expected, as when someone retires, or it may be unexpected but you need to have a plan in place for when the relationship ends. It will be a much better parting of ways if you have a plan of action for how things will be handled.

The whole reason for a good contract is to protect you but your contract can do much more than protect. You can weed out potential problem providers that will drive you crazy. If you are not in agreement with your providers on what each of you will be contributing to the relationship then the likelihood of the account going smoothly is very small. Don’t make the mistake of skimping on an important part of your business that may save you from defending yourself in court down the road. Make sure you take the time and experience of others to get everything you need covered in your contract.

Drawing up a business plan is one of the initial steps in setting up the medical billing business. Before that, the form of business organization you want to set up has to be finalized – whether a sole proprietorship, partnership or a corporation. All the formalities like registration, permits and licenses and other requirements as mandated by law need to be fulfilled before starting operations. Simultaneously, a name has to be conceived for the new business.

The best of business models can go haywire if there are cost over-runs. Hence, having an investment budget in place is of utmost importance. The start-up cost will depend on a few factors such as your risk-taking ability, business requirements, the type of equipments to be sourced, etc. The minimum seed capital can be anywhere between $3,000 to $5,000. A few basic things required for smooth operation will include computers, fax, modems and internet connections, back-up systems (to prevent the data from going kaput!) and last but not the least, office supplies. Insurance forms, coding and other reference books, medical billing software and office furnishings will form a part of the initial expenses that will chip off a major chunk of your seed capital. Just the medical billing software can set you back by around $500.

You need to do a bit of research before you zero in on the best software for your business. Stick to software that can be updated as your business grows. A software provider with good after-sales service should be given preference at the time of finalizing the chosen provider. Always ask for a demo so that you get first-hand experience of the software.

To market your business is the next step which will need a great deal of time, money and energy. Getting clients can be an uphill task if you are not aggressive. It is advisable to start locally and make a list of doctors in the vicinity. To get started source the list from a list vendor for a fee. Next, send e-mails or direct mails with brochure, detailing the service that you offer. Immediately follow-up your mailings with phone calls. This will create an impression in the prospective client that you mean business.

Put up a website. Blogs can be an effective tool to market your business. Cold calls can be resorted to but it is not advisable, since doctors are sometimes involved in emergency situations and may not appreciate being interrupted. Hence, the next best option is to leave your business cards and other marketing materials with the receptionists.

Using referrals is another age-old technique to gather clients. You can begin with approaching your family doctor, introduce your business to him and ask for referrals to other doctors who may need your services. As you build customers, use referrals to grow your business since it is the most cost effective way to grow your business.

Offering value-added services is a sure-shot method to provide your business the needed impetus. The growth of your business is directly proportional to the degree and level of satisfaction of your client/customer. Provide additional services like electronic fund transfer “EFT”, third-party collection service, remote back-up service, and digital scanning of medical records.

The economy is in recession and most doctors want to lower their costs and improve collections. It is a great time to start a medical billing service.

First of all medical billing and coding are basically two different functions. You can focus on billing or medical coding or a combination of both. Oftentimes people think you must train in both billing and coding but that’s not the case. Oftentimes in the company you work for as a medical biller you’ll receive work that comes to you already coded.

So you could be on the coding end or billing end. Some companies do both in-house. But the simplest and most effective route is to focus on one or the other. Both require training usually and to add coding you would have to add quite a bit of training. If you just take medical billing training, course or a program you can get your training done and get your certificate, in some cases, and you’re ready to get a job.

One of your concerns of course will be to find out how much money you’ll make as a medical biller, billing specialist or assistant, medical coder or medical insurance specialist. When you start checking around and looking for jobs you will find that the titles come by various names. So keep that in mind. A medical insurance specialist usually does both billing and coding.

The kind of money you’ll make as a biller or coder will depend on how much experience you have and what billing and/or coding training you have. At a bare minimum you should be able to get a wage of at least $12 to $15 an hour starting out. The more recent and long-term experience you have will increase your job starting salary quite a bit.

So you can see that the level of education you have, whether you have a certificate or not and amount of experience will be a factor in the salary you receive. Check all your local job sources and human resource departments at hospitals, clinics and insurance companies to see if you can get an idea of job requirements and salary range for specific jobs they have opening for. A medical billing certificate is not always necessary. A trade school, vocational, billing or coding school gives out their own certificates plus there are national exams you can take and pass to earn a certificate in your field also – for example as a Medical Billing Specialist. Local colleges and universities have billing or coding classes and programs in some cases.

You need to check with your local schools and compare them with online schools. Make sure you understand what you’re signing if you’re asked to sign a contract for any online education. Your local colleges may also have online programs so you can get the medical billing and coding education you need that way also. Federal financial aid and money is set aside for online classes also.

Never bring a knife to a gunfight.

Sean Connery, the Untouchables

Thirty years ago, one of our billing office employees told me an interesting story. While previously working for a large insurance company she had been instructed to throw away every third batch of bills. The insurance companies knew that many of these claims would never be followed-up, further increasing their profits.

Although many things have changed in 30 years, health insurers are still inventing new and creative ways to avoid paying providers. Companies still routinely deny, underpay or delay payments, both to practitioners and hospitals. The cited article is about a settlement against the major carriers for these offenses in California.

Many of the techniques are not new. Legitimate bills are not paid, and inquires are met with old standby tricks like rude, under-trained employees, multiple similar sounding plans, and slow payments. However the insurance companies have a very powerful new weapon, mind-numbing complexity. Smart computer scientists have built billion dollar systems to exponentially increase the requirements for claim submission. Any deviation from these arcane rules will be identified and flagged as a reason for denial. The process is further complicated by frequent and ambiguous rule changes, which are often not published, and can only be inferred from the pattern of rejections.

The resulting mismatch is equivalent of bringing a knife to a gunfight. Individual providers, larger groups and hospitals do not have the resources to successfully confront the computer and software firepower deployed by the insurance companies. When faced with an incomprehensible, unexplained, and frequently incorrect rejection, poorly trained and overworked billing office personal are forced into the cavernous abyss of the appeals process, designed to further frustrate, confuse and delay. Up to 1/3 of doctors bills are not properly paid, in large part due to the success of the insurance company tactics.

Although the California legislature acknowledged the issue(many states haven’t even gone this far), the insurance companies managed to make certain the penalties would be trivial. The fines are totally inconsequential to the bottom lines of these multi-billion dollar companies.

The vital point for the health care provider to understand is that there will be no “rescue” by the legislature, the medical societies, or the goodwill of insurance companies. Anyone submitting bills on a regular basis needs to take responsibility and obtain the tools to win the battle against these corporate behemoths. I helped start Vericle to even the odds in this battle. Yuval and his team have developed the tools that enable the provider to thrive on the complexity. Insurance companies are bullies, and will back down when confronted with a comprehensive and powerful system that calls their bluff. Vericle is such a system.

Readers must realize that the complex systems arrayed against the practitioner cannot be defeated by moral rectitude and hard work. Being right helps, but don’t forget your gun.

Reference: Duke Helfand, “California’s largest health plans are fined nearly $5 million,” Los Angeles Times, November 30, 2010