Posted by ClaimCare Resources on Wed, Feb 24, 2010 @ 03:27 PM
Everyone in the medical billing field is hopeful that Congress will act to defer (and ultimately eliminate) the proposed 21% fee reduction for Medicare. Keep in mind, however, that March 2010 collections will likely suffer a delay even if the fee cut is deferred. The coming months will be a challenging time for medical practices and medical billing companies.
In January 2010 Medicare had a 2 to 3 week delay in processing claims because they needed to update their system after Congress deferred the 21% Medicare fee reduction. As of today, Medicare is still catching up in their claims processing (a fact that have not officially acknowledged). ClaimCare found that as of February 23, 2010, Medicare was still at least a week behind in their typical claim processing time frame. And this level of a delay happened when Medicare had plenty of advance warning concerning the deferral, so you can imagine what delays could result when they have less advance notice. In addition to this delay, Medicare had a system problem that resulted in multiple weeks worth of secondary claims not crossing over properly. This Medicare system problem has compounded the delay in collections.
There is every reason to expect another delay in Medicare payments in March 2010 if Congress issues a last-minute deferral of the 21% fee reduction. Based upon past evidence and experience, if Congress does issue a deferment, we anticipate a 2 to 3 week delay in the Medicare claims processing and payments. Therefore, when thinking about your cash flow for March 2010, you should plan for at least an additional 2 to 3 week delay for Medicare payments.
If Congress decides to delay the fee reduction for only 30 to 45 days (as they are considering), then this problem will be repeated and exacerbated in April if they pass yet another last-minute deferral. Practices and medical billing companies need to plan on Medicare collections being less predicable and fairly erratic over the next few months. As I stated earlier, this is a challenging time to be a medical practice or a medical billing company.
_____________
Copyright 2010 by Carl Mays II. Carl is President and CEO of ClaimCare Medical Billing Service, one of the largest medical billing companies in the United States.
Posted by Carl Mays on Sat, Oct 10, 2009 @ 12:20 AM
The Good, the Bad and the Ugly is a 1966 epic western film starring Clint Eastwood, Lee Van Cleef and Eli Wallach in the title roles. One of the most popular and well-known westerns made, the film is regarded by many critics as a classic. It was one of Time magazine's "100 Greatest Movies of the Last Century." I explain all of this because Jean and I quite frequently refer to experiences, situations or people as The Good, the Bad and the Ugly.
The descriptive phrase came to mind earlier this week as I was reading a sports reporter's perception of a football game. The writer described one player as doing a "good" job in fulfilling his responsibilities. He then quoted a coach who said a player made a "bad" decision. The writer went on to quote another coach who said it was an "ugly" win.
And then yesterday, as I reclined in a hospital bed awaiting the endoscopy procedure I get the pleasure of experiencing every five years (tongue-in-cheek), a nurse who was looking at information on a form asked me what I do as CEO/president of Carl Mays' Creative Living, Inc. When I told her I am a professional writer and speaker, she asked me what I write and speak about. I explained my specialization is in human relations, motivation, leadership, teamwork, communication and performance improvement. I then added I have spoken to quite a number of healthcare groups, including hospitals.
The nurse responded, "I've been to some meetings like that." She paused and then continued, "Do you think that type of thing really works?" I replied, "Well, do you think what you do as a nurse really works?" She looked at me with sort of a deer-caught-in-the-headlight expression, and then nodded her head and said, "Yeah." I told her, "Your job works if you are a good, professional nurse who knows what you are doing and if the patients with whom you work are cooperative and come in with the right attitude. Am I right?" She nodded and said, "I guess so." I continued, "The meetings we're talking about work if you have a good, professional speaker who knows what he or she is doing and if the people who attend the meeting come with a cooperative spirit and the right attitude." The nurse said, "I guess you're right." I replied, "Well, I've made over 3,500 presentations - so either it works or I've been able to pull the wool over many people's eyes through the years." She nodded her head and said, "Good point."
After a pause, the nurse commented, "But, you know, it won't work if the leaders don't buy into. You've got to have support from the leaders if it's going to work." I replied, "There is always a ladder of accountability - from the top to the bottom and from the bottom to the top. Every leader on every level and every team member on every level, who is accountable for tasks and responsibilities rather than making excuses or blaming others, is a part of the solution and not a part of the problem."
The nurse nodded her head and said, "You're right." And then, I thought of the phrase that had been brought to mind earlier during the week and told her, "But in every organization of any kind, you always have The Good, the Bad and the Ugly." She laughed and nodded her head.
My gastroenterologist was pleased with the results of my endoscopy - and, thus, so was I. Next week, I have the opportunity to experience my five-year colonoscopy. The saga of The Good, the Bad and the Ugly continues.
______________
About our guest Blogger:
© Carl Mays, father of ClaimCare CEO Carl Mays II, is an author and speaker at over 3,500 events. Contact Carl at carlmays@carlmays.com or 865-436-7478. His motivational speaking and book information can be found on http://www.carlmays.com/. The Student Mentoring site MyMerlin.Net for students and others is based on his book and program, "A Strategy For Winning."
Posted by Carl Mays on Tue, Sep 29, 2009 @ 12:52 AM
Regular readers of this column know I have emphasized previously that according to the American Management Association, 90 percent of all problems in any organization is a direct result of poor communication.
One breakdown in communication that happens frequently is when we use a certain word in order to express ourselves and then the hearer takes the word in an entirely different way than we intended. With this in mind, and tongue-in-cheek, I share something from The Washington Post.
The newspaper annually publishes winning submissions to a contest in which readers are asked to supply alternate meanings for commonly used words. Some recent winners include: coffee (noun): the person upon whom one coughs; lymph (verb): to walk with a lisp; flabbergasted (adjective): appalled by discovering how much weight one has gained; abdicate (verb): to give up all hope of ever having a flat stomach; esplanade (verb): to attempt an explanation while drunk; negligent (adjective): absentmindedly answering the door when wearing only a nightgown; flatulence (noun): emergency vehicle that picks up someone who has been run over by a steamroller; circumvent (noun): an opening in the front of boxer shorts worn by Jewish men.
Another breakdown in communication occurs when we mispronounce a word or when we misspell a word in a memo, e-mail message or some other document. A tiny alteration may tremendously change the meaning of what we were attempting to express. Such misuse of the language can produce destroyed relationships, lost jobs, lost money and other dire consequences. So looking at another communication barrier with tongue-in-cheek, I mention that The Washington Post also publishes winning submissions to its annual Mensa Invitational in which participants are asked to choose any word from the dictionary, alter the word by adding, subtracting or changing one letter, and then supply the altered word with a new definition.
Some of these recent winners include: intaxication (noun): euphoria at getting a tax refund, which lasts until you realize it was your money to start with; cashtration (noun): the act of buying a house, which renders the subject financially impotent for an indefinite period of time; reintarnation (noun): coming back to life as a hillbilly; decafalon (noun): the grueling event of getting through the day consuming only things that are good for you; bozone (noun): the substance surrounding people that stops new, bright ideas from penetrating; giraffiti (noun): words or images spray-painted very, very high; caterpallor (noun): the color you turn after finding half a worm in the fruit you are eating; Beelzebug (noun): Satan, in the form of a mosquito that gets into your bedroom at three in the morning and cannot be cast out.
In my "Are We Communicating Yet?" book I pose the rhetorical question, "Why is there such a failure to communicate?" And then in response I emphasize that one reason is because people fail to keep in mind that good communication does not occur merely because an intended message has been presented. More important than what is said or written is how others perceive and respond to what they receive. The greatest obstacle to good communication is the assumption communication has taken place when it hasn't. The Washington Post contests present a humorous, clever way to exemplify how easily messages can be distorted.
______________
About our guest Blogger:
© Carl Mays, father of ClaimCare CEO Carl Mays II, is an author and speaker at over 3,500 events. Contact Carl at carlmays@carlmays.com or 865-436-7478. His motivational speaking and book information can be found on http://www.carlmays.com/. The Student Mentoring site MyMerlin.Net for students and others is based on his book and program, "A Strategy For Winning."
Posted by Carl Mays on Wed, Sep 23, 2009 @ 05:37 PM
On the occasions when I tell Jean something such as, "I'm going to the post office, drop by the pharmacy, then on to the bank, and I may swing by the hardware store on the way back," she often replies with something like, " Well, maybe I'll see you again today." She knows when I "go out" there is no telling how many people I will run into and strike up a conversation with - and just how long I may be gone - unless I have a definite time by which I must return.
But I don't plan these encounters. I just know that when I do run into people and they want to talk, or they look like they need someone to talk with them, to give them some acknowledgement, or maybe a "pick-me-up," I feel that if conversing with them can make a difference in their days then I want to do it, with no second thought. And, I usually enjoy it.
Og Mandino (1923-1996), author of "The Greatest Salesman in the World" and other best sellers, was an early mentor who wrote one of the first testimonials for my "A Strategy For Winning" book. We shared the speaking platform a few times, and something I recall Og saying is, "Beginning today, treat everyone you meet as if he or she is going to be dead by midnight. Extend to everyone all the care, kindness and understanding you can muster, and do it with no thought of any reward. Your life will never be the same again."
Og's words came to mind and this column was inspired by the recent death of Dave Baker, co-owner with brother-in-law Larry Cole of Five Oaks Tire and Service in Sevierville. I was behind on getting the tires on one of my vehicles rotated and balanced. Due to a heavy schedule I had been putting it off. When I finally phoned early Tuesday morning, July 14, and Larry answered, I said, "Hi, Larry, this is Carl. How's it going?" There was a pause, and then Larry replied, "Pretty good," in a manner that was rather un-Larry-like. I said, "Well, I'd like to see if it might be possible for me to bring my truck over for rotation, balance, and maybe check the alignment this morning."
There was another pause before Larry replied, "Well, Carl... here's the situation..." I thought he was going to tell me about a big work load or something like that. But Larry continued with, "Dave died Saturday..." The pause was mine this time. Larry went on to say, "We're closing today at noon, the funeral is tonight, and we won't be open tomorrow." Of course, all thoughts of tires and rotation left my mind completely and I told Larry so. We talked about Dave's sudden, truly unexpected death. (Later, I discovered it was determined to be caused by a dislodged blood clot that probably formed about 38 years ago when Dave broke his leg in an automobile accident.)
Larry and I discussed the situation for a while. Larry then said, "Dave was talking about you just last week, saying it has been a while since you were over here..." Jean and I attended the funeral that evening, both still in shock, as were many people. And I kept thinking about how I put off getting my truck serviced and had not seen Dave in a while, and how I will miss talking and laughing with him, and exchanging "war tales" that he and I enjoyed telling each other so much. Og Mandino was right. You never know.
______________
About our guest Blogger:
© Carl Mays, father of ClaimCare CEO Carl Mays II, is an author and speaker at over 3,500 events. Contact Carl at carlmays@carlmays.com or 865-436-7478. His motivational speaking and book information can be found on http://www.carlmays.com/. The Student Mentoring site MyMerlin.Net for students and others is based on his book and program, "A Strategy For Winning."
Posted by Carl Mays on Mon, Sep 21, 2009 @ 06:32 PM
Without any intention to sound like a broken record... there is yet more data indicating how critical it is for medical practices to have a solid patient collection process in place. A new survey indicates that health savings accounts are growing in popularity. Both the number of accounts and the amount of money in those accounts are growing at a significant rate. A recent study from Celent, a consulting company that works with banks, showed that the number of HSAs increased 46.1 percent between January 2008 and January 2009, and the money in HAS accounts grew by 62.6 percent. HSA accounts have an average account balance of $1,561. This number is likely significantly understated because most banks do not consistently purge inactive, zero-balance accounts.
What does this mean for medical practices? It means that they need have a solid set of tools, processes and policies in place for collecting the portion of their income that is the patient's responsibility. Some of the key elements of a world-class patient collections process are:
- A clearly communicated patient collection policy that is consistently communicated to patients before they see the doctor;
- An automated insurance verification tool that allows the front-desk to easily verify coverage and confirms the key parameters of the coverage (deductible, co-insurance percentage, and the amount of the deductible met for the current year);
- An easily used tool that allows the front-desk to inform the patient before he leaves the office how much he will likely owe after the claim is adjudicated. This allows patient to pay their portion of the healthcare bill before they ever leave the office;
- Quick claim submission and follow-up so that patients that have not paid their bill before leaving the office can be sent a patient statement as quickly as possible after the date of service;
- Well designed patient statements that eliminate many of the issues that cause patients to treat bills from physicians differently than they treat credit card or utility bills;
- Payment processing tools that automate and monitor payment plans; and
- A system for ranking patient balances for follow-up effort based upon expected collections - not simply on the magnitude of the patient balance.
If you medical practices has not invested in developing a world-class patient collection process then you are likely losing at least 10% of your practice's potential revenue.
_____________
Copyright 2009 by Carl Mays II. Carl is President and CEO of ClaimCare Medical Billing Service, one of the largest medical billing companies in the United States.
Posted by Carl Mays on Sat, Sep 19, 2009 @ 02:59 PM
When this true story appeared in a Florida newspaper and was sent to me a few weeks ago, I filed it away and said, "This is definitely something I must share with my readers."
On his patio, a man was working on his motorcycle with the engine running. When the motorcycle slipped into gear, it dragged the man through the glass patio door and into the dining room. He lay bleeding on the floor as his wife called paramedics. They inspected him, determined he needed some treatment and transported him to the hospital for stitches. The wife then went into the dining room, pushed the motorcycle back outside and used some paper towels to blot up the gasoline that spilled onto the floor. She threw the towels into the toilet and went to the hospital to check on her husband.
His stitches done, the man was released to come home. Upon arrival home, he looked at his shattered patio door and damaged motorcycle, became despondent, went into the bathroom, sat down, and smoked a cigarette. He then threw the cigarette into the toilet where the gasoline-soaked towels were. The toilet exploded, blowing the man's trousers away and burning his backside. His wife again ran to the telephone to call for an ambulance.
The same paramedics came to the house again. As they were carrying the man on a stretcher down the stairs to the ambulance, one of them asked the wife how her husband had burned himself. She told the inquisitor, and the paramedics started laughing so hard that one of them tipped the stretcher and dumped the man out. He tumbled down the remaining stair steps and broke his arm.
I pulled the Florida man's story from my files when I thought I was going through a rather challenging time this week. Then I confirmed to myself that maybe my week hasn't been so rough after all. What about you? Sure, some of us may have had experiences this week that possibly top what the Florida man encountered, but I would dare say that most of us probably haven't surpassed him so far.
As you may sympathize or even empathize with the motorcycle victim, let me remind you of a popular song from years ago recorded by Jerry Vale. Titled "Even The Bad Times Are Good," the essence of the song is that the singer was so much in love with his sweetheart that when he was with her she turned even the bad times into good. Syrupy, huh? I'm sure it would be very difficult for the Florida man and his wife to sing that song - but, at least they can build on some mistakes and continue on - just as we all can do most of the time when we suffer from negative experiences.
Lessons from the motorcycle episode include: be extremely careful when working on an engine that's running, find a safe and secure work location, seek counsel when you feel despondent or depressed, realize that smoking can be very dangerous, and always flush.
______________
About our guest Blogger:
© Carl Mays, father of ClaimCare CEO Carl Mays II, is an author and speaker at over 3,500 events. Contact Carl at carlmays@carlmays.com or 865-436-7478. His motivational speaking and book information can be found on http://www.carlmays.com/. The Student Mentoring site MyMerlin.Net for students and others is based on his book and program, "A Strategy For Winning."
Posted by Carl Mays on Sun, Sep 13, 2009 @ 12:52 PM
Are you average? Could it be you are above average? Or, is it possible you are in a category labeled as below average? Now, before you think too seriously about responding to these questions, you need to ask in return, "Am I average, above average or below average in WHAT? Ahhh... therein lies the important question.
This column was triggered when I read an article by Jacquelyn Mitchard titled "The Search for the Perfect Apple." I've written a couple of columns about apples and for a long time have been intrigued by the many varieties now available. Mitchard said, "As this apple-picking season begins, the bustle to breed the best bushel is as brisk as the race to create the perfect hybrid car." I don't know exactly how many different kinds of apples are out there, but Cornell University's Experimental Research Station has bred and named 62 varieties.
But, let's get back to the "average" question. Something that jumped out from Mitchard's article is, "The average American eats 17.8 pounds of apples each year." Now, first of all, how in the world do you go about determining an "average American," especially during this day and time? Secondly, if we could agree upon what an average American is, this figure of 17.8 pounds reveals to me that many average Americans never touch an apple. I say this because for many years I have eaten at least one apple a day. The "average" apple from my apple bowl weighs 5.4 ounces. According to my math (in which I am sure I am not above average), this means I eat approximately 123 pounds of apples annually. This doesn't count the dishes we sometimes have, such as fried apples, fruit salad and the apple pies Jean is coerced into making every now and then.
So, if you ask me if I am "above average," I can truthfully answer, "I am way above average. I eat 123 pounds of apples annually!" In turn, you may say that is not the type of average to which you are referring. Then when I ask you to explain your definition of average you may have some difficulty in doing so. That's one of the reasons I dislike hearing phrases that declare someone as an average, above average or below average teenager, student, athlete, musician, employee, patient, customer, boss... You get the idea. I dislike declaring an individual's "averagability" in very broad categories.
And that is the whole point of this column - people are individuals. When I presented "A Strategy For Winning" at the East Tennessee Human Resource Agency (ETHRA) leadership conference for at-risk students in July, I emphasized, "Everyone in this room has strengths and weaknesses. The challenge is to discover, develop and wisely use what we have. While cultivating and building on our strengths, we can also use them to help us improve in our areas of weakness. And that is what today's seminar is all about."
One of the students (a very good apple, if I may say so) stood at the podium, looked the attendees in the eyes, and challenged everyone to not mess around, to get with the program, to overcome obstacles (she didn't know her father, and her mother is a prosecuted drug addict). She closed her challenge, as I close this column, sharing a short poem from my "Winning Thoughts" book titled Be You:
"Drama, music, sports? Maybe business, math or art? What are your talents, likes - dislikes? How can you do your part? Teaching, writing, medicine? Helping others who have lost the way? Finding a niche and doing your thing... This makes a happy day!"
______________
About our guest Blogger:
© Carl Mays, father of ClaimCare CEO Carl Mays II, is an author and speaker at over 3,500 events. Contact Carl at carlmays@carlmays.com or 865-436-7478. His motivational speaking and book information can be found on http://www.carlmays.com/. The Student Mentoring site MyMerlin.Net for students and others is based on his book and program, "A Strategy For Winning."
Posted by Carl Mays on Sat, Sep 12, 2009 @ 10:11 AM
The U.S. Census Bureau recently released a report revealing that the number of people without health coverage in the U.S. grew to 46.3 million in 2008, compared with 45.7 million in 2007.
According to the report, the number of citizens covered by private health insurance fell from 202 million to 201 million, and those with employment-based health insurance fell from 177.4 million to 176.3 million. The uninsured rate for native- and foreign-born people stayed about the same, with native-born persons at 12.9 percent, and foreign-born people at 33.5 percent. The number of uninsured non-citizens remained at approximately the same level, 44.7 percent uninsured. Meanwhile, the number covered by government health insurance jumped from 83 million to 87.4 million.
These finding reinforce the importance of good patient collections and bad debt management for medical practices. The expected collection levels from patients drops dramatically over time. Given this and the high rates of patient responsibility mean that a medical practice can easily lose 10% of its expected revenue to a bad patient collection processes.
The following articles can help you learn more about how to improve your patient collection efforts:
Improving Patient Collections
Patient Collection Tools
2009 copyright by Carl Mays II
Posted by Link Grader on Fri, Sep 11, 2009 @ 02:54 AM
Scale is key when selecting a medical billing company. By scale I mean that the medical billing company should have tens and hundreds of providers across whom large, necessary investments can be spread.
For instance, If a $150,000 per year billing system administrator is required, then a medical claims billing company with 200 clients only needs each of its client to carry $750 per year of that person's cost. If a practice of four providers employed this person, then each provider would need to carry $37,500 per year of that person's cost; this is the value of scale. A medical practice can achieve significant advantages by leveraging the superior scale of a mid- to large-sized medical insurance billing company.
A medical billing company should be deploying technologies and resources that a typical medical practice simply cannot afford or support. Examples of technologies and processes that lend themselves to scale include:
- Advanced (and expensive) billing systems that offer state-of-the-art claim management and reporting abilities.
- Pre-submission claim scrubbers that deal with the different rules for adjudication that every unique payer has.
- A good billing system manager that stays updated with constantly changing claim submission rules from different payers. Sometimes claims can go several weeks before getting submitted, simply because many payers change their formatting rules so often. Medical billing companies are less susceptible to such tactics.
- Advanced collection tools, such as predicting payment yields from patients (such as the amount the patient owes times the likelihood they'll pay).
- A well-defined and managed billing process that will not grind to halt because a single employee is lost and eliminates errors before they propagate through the system.
- A dedicated group of individuals that follow-up on claims that have not had a response from the payer within a reasonable time frame.
These and other advantages show that most medical practices can't afford the personnel and technology to match the services that a good, properly scaled medical billing company provides.
Most of the costs associated with the processes and technologies are fixed, and medical billing services spread these costs over their entire client base. A medical billing company that serves a few hundred physicians is more likely to provide better services than one that serves only a few practitioners. What's more, smaller medical billing companies struggle just to use processes and technology that is equivalent of what most practices already deploy.
The bottom line is that it's always a good idea to check the scale of your medical claims billing company. The bigger ones are better able to collect from insurance companies and payers, who tend to do whatever they can to keep their money.
Copyright 2009 by Carl Mays II
Posted by Carl Mays on Fri, Aug 07, 2009 @ 11:54 PM
Like many of you, I am continuing to discover that more and more business is being conducted over the Internet and, specifically, by way of e-mail. When I first began speaking professionally, I never imagined I would ever book engagements without communicating with the meeting planner on the telephone and through traditional mail. Along came the popularity of the fax, which changed procedures somewhat, but nothing like the changes instigated by the Internet explosion about 10 years ago that began noticeably affecting the manner in which my speaking engagements were booked and continues to become more common.
Recently, I spoke for the first time with a meeting planner when she met me as I arrived at a conference in Arizona for which she had booked me as the keynote speaker. Up until then, all communication with her had been via e-mail, except for the signed letter of agreement and deposit check I received through the postal service. Even the questionnaire I require to be completed as I customize presentation preparations was handled through e-mail and never discussed on the phone. To top that, however, I had another engagement where even the letter of agreement was taken care of over the Internet and the speaking deposit was made via Internet transfer.
All of this is being shared in this column because it is hot on my mind as a result of a recent conversation with some other speakers who have been in the business for a long time like I have. And the thing about it is, no matter the profession in which you are involved, if you have been around for very long then you know what the changes have been like in your specialty - and how things continue to change.
As many businesses can attest, the Internet affects all services and products. In my case, selling books and other materials through my Web site has replaced flyers, brochures and various traditional methods. And I'm sure that many readers of this column agree with me when I say that letters received through traditional mail are becoming few and far between (except for bills - and even the billing companies are emphasizing more and more that consumers receive and pay bills via Internet). In response to my columns, e-mails arrive weekly. On the other hand, I can't remember the last time I received a column-response letter through the post office, which used to come frequently.
And with the introduction of MyMerlin.net, our new mentoring Web site for students and others, I am receiving some e-mail responses and questions that at first glance appear to be written in hieroglyphics or some alien language. It's a continually-changing writing style that is popular with contemporary texters, tweeters and other such communicators. In discussing this with school teachers, I am told that some students are trying to merge this communication style into text written for school projects. Based on their frames of reference, experience and ages, teachers are dealing with this in various ways.
I received a recent e-mail regarding MyMerlin.net that began with: "?4U" (Question for you). Following the question that dealt with the disposition quiz I developed for the site, the e-mail concluded with: "TIA" (Thanks in advance). Now, I will tell you, I am not into texting, but I did rather easily recognize the "?4U" part and deciphered the "TIA" closing. I struggled through the question enough to comprehend its essence. Maybe next week I will share with you the question and my reply to it. It is something of interest to just about anyone, and I think of special interest to readers of my weekly column.
TAFN (That's all for now).
______________
About our guest Blogger:
© Carl Mays, father of ClaimCare CEO Carl Mays II, is an author and speaker at over 3,500 events. Contact carlmays@carlmays.com or 865-436-7478. His motivational speaking and book information can be found on http://www.carlmays.com/. The Student Mentoring site MyMerlin.Net for students and others is based on his book and program, "A Strategy For Winning."