MEDICAL BILLING BLOG

 With the correct set of non-traditional billing tools and programs you can drive down the initial working capital needs of a new or existing medical practice by 90% . These tools are quite unique to ClaimCare and go well beyond a pure medical billing service or an in-house billing department.

All of these tools will have a positive operational impact on how you think about staffing and/or cash flow management/financing in your practice. If these tools are implemented when the practice opens its doors it could dramatically lower working capital requirements and make the practice cash flow positive extraordinarily fast.

1. ClaimCare patient checkout tool (Bring in the bulk of the patient responsibility - about 20% of practice revenue - in the day the doors open and lower staffing requirements at the front desk) - With this tool the practice can substantially increase cash flow quickly by collecting patient balances (not just the co-pay of $20 but the co-insurance which can add up substantially more than a co-pay). This will have a huge cash flow impact, since with this tool the bulk of the patient balances can be collected before the patient leaves the office instead of 60 to 90 days after the visit. In addition, since the tool automates insurance verification it can reduce the work load requirements of the front desk (and allow you to have fewer staff members).
2. Vendor Instant Payment Program - (A free 60 day bridge loan to help minimize working capital needs for the first two months of the practice) This is another program that could help a lot with working capital needs - and best of all it is actually free. With this program all of your vendors are paid within 24 hours of an invoice being approved. As long as the practice repays ClaimCare within 60 days there is no charge for the service. If the practice pays within 30 days they actually get a discount off the bill. This works because ClaimCare negotiates a fast pay discount with the vendors. If we are paid back by the practice within 30 days we share the discount with the practice. If we are paid between 31 and 60 days we keep the discount. As you can see, in the early days of a practice this can give you a 60 day free float on vendor payments. Once you are out of the start-up mode this program will allow you to lower your vendor costs.
3. Equipment servicing contracts - (Lower the cost of maintenance contracts) As the practice buys their equipment they can save a substantial amount on the maintenance contracts through our leasing service program. This program has a great track record and basically self-insures the maintenance agreements. With this approach we are able to save about 20 to 25% off equipment maintenance agreements. This can really add up for a medical practice. This basically applies to any piece of equipment that plugs into the wall.
4. EMR -(Start paperless without the upfront investment in either an EMR or paper medical record storage system) With our EMR offering we can get a practice on an EMR right out of the gate without any upfront cost. This can save you money and improve operations since you will not need to spend the money on typically paper medical record supplies and will, of course, be able to see the benefits from an EMR with the big price tag.

Combining all of this with a world-class billing solution provides a powerful set of tools for starting a medical practice with much less working capital and lower cost.

Copyright 2008 by Carl Mays II

 No matter what technology you deploy or the strength of your process, superior medical billing ultimately relies upon a strong billing staff. There are four key elements to creating a world-class billing team:

1) Deploy a systematic approach to and dedicated resources for obtaining and developing strong employees: As was mentioned above, great medical billing requires great medical billers - no matter what system you have. Finding these individuals typically requires resources dedicated to identifying and screening potential billers for your team. The process should include multiple levels of testing and should reflect the importance of the position. These people will determine if you have cash to pay your bills and yourself.

The leading billing organizations train to develop desired quality.  Junior staff members must pass demanding training programs-junior team members are developed into billers, capable of following the measured and monitored billing process.  In addition, staff is trained throughout the year in latest payer rules, follow-up techniques and compliance guidelines.  A dedicated Compliance Officer is responsible for all additional HIPAA and OIG training.

The best staff is retained; weak staff released.  The billing organization's staff is evaluated every year to assure proper development and progress.  Evaluations are based on tangible, measurable targets and quality indicators. Best performers are properly rewarded and the lowest 10% of performers are asked to leave. This should be done methodically in an effort to continuously improve the quality of billing staff.

2) Specialize the billing team: The top billing organizations' billing team is composed of dedicated specialists in demographic data entry, charge posting, payment posting, insurance follow up, and patient collections.   Each position is designed to excel in its role and is properly supervised and incentivized.

3) Supply your billing team with strong data driven analysis: This rings back to the "You can't manage what you do not measure" message. Your team cannot systematically improve their performance or your billing without in-depth measurements of how billers behave and how the billing process is working.

4) Motivate your billing team: Utilize an OIG approved compensation system for the billing team. Aligning their interest with those of the practice is a huge source of billing improvement.

If you follow these guidelines you can assemble, develop and retain a world-call medical billing team. The results will be well worth the efforts of assembling the team.

Copyright 2008 by ClaimCare Medical Billing Services

Bad debt is on the rise according to a 2008 survey from Transunion. This survey reported that almost 80% of the hospitals responding indicated bad debt growth of between 6 and 20 percent in the past 20 months.

Other key survey findings include:

• Consumer Directed Healthcare Plans are a source of concern for hospital administrators. Almost 80% believe they will be a significant source of additional bad debt by the end of 2010.
• Hospital executives are spending a lot of time worrying about patient collection issues. Improving patient collections was the number one priority for over 40% of executives. Close to 20% have focusing on lowering bad debt as their top goal.

It is there therefore supremely important to collect well from the patients.  Clinics and practices need every tool available (basic and advanced) to streamline what is otherwise a very labor-intensive task:

• Better use of on-line electronic payment tools. The latest tools can make it easy for you to accept practically any form of payment on-line and for patients to pay in a self-serve manner.
• Have more than one credit-card reader if you're processing a lot of patients at the same time. If possible, install a card reader with a built-in check scanner to convert a paper check into an electronic one, debiting the patient's account that much faster.
• Develop and rigorously follow a policy concerning patients that cannot pay co-pays (and other prearranged payments) on the day of service. Will you tell them they need to reschedule? Will you call and collect payments before they arrive? If you see patients that cannot pay on the day of service then make it easy for them to pay you after the fact. Do not wait for the claim to adjudicate to ask for them to send the co-pay. Give them a patient statement showing the co-pay balance due before they leave the office. Include a pre-addressed payment envelope.
• Use a tiered approach to patient collections and match the collection effort not with the patient balance but with the expected payment. Credit Cards use this technique through the use of credit score. They know that a $2,000 balance on a consumer with a credit score with 720 is worth more to them than a $3,000 balance on a consumer with a score of 600. You can use this approach by looking at patients past payment patterns, healthcare credit scores (there are services that provide these) and/or employment status.
• Use a monthly bonus system for employees that collect patient payments in the office. Make the amount meaningful and the metrics clear and easy to track.

The tips and techniques above can help protect you from the growing specter of bad debt.

Copyright 2008. Carl Mays II

Revenue Cycle Denial Management has become a universal and often abused term in medical billing. Some use the term to describe a means of addressing claims denied for medical necessity. Others use the term to describe how some information is tracked for a specific payer, set of procedures or a place of service.  Still others try to use it to describe what they do daily in the physician's office.

If you were to ask your billing department or a current medical billing company (1) what is their Revenue Cycle Denial Management strategy; (2) what process do they use to methodically measure it and (3) what are the quantifiable results of it, you would most likely get a lot of blank stares.

Few billing departments appreciate the value a good Revenue Cycle Denial Management system can bring to a medical practice. A robust Revenue Cycle Denial Management system provides methodical management data for the billing process; the data are then used to (a) increase and (b) accelerate cash flow. The system accomplishes this needed service by tracking, quantifying, and reporting on every claim billed for which any payer denied the service. The reporting should be comprehensive, tracking all denials (not just selected denials). If used properly, the system can reduce first-time claim denials by over 50 percent. In our experience we've come across many practices with no way of monitoring if the payer is denying their claims at excessive or unwarranted rates, or even for what reason. These practices are probably losing 10-20 percent of their total revenue.

What is typically missing from troubled billing operations is the lack of the management-reporting expertise needed to extract the data in a concise and meaningful way coupled with a lack of methodical, measured billing process needed to correct mistakes.

ClaimCare Medical Billing Services' comprehensive Revenue Cycle Denial Management system has two main purposes. First, to provide feedback on why and how many claims are not being paid on the first submission to the respective payers. The second is to fix these issues. ClaimCare Medical Billing Services' Revenue Cycle Denial Management software databases have been designed to track, quantify, and report on all denials for all payers. The standard output tracks, by payer, the number of claims denied and the reason for the denials. This is coupled with our Dashboard reporting for a quick visual management. With these unique reports our team can easily identify which payers are inappropriately denying claims; we can also compare these payers to their peers for proper trending and follow-up. The unique output for each practice allows us to refine the payer specific rules and build our own rules to prevent future payer denials. Payers that are chronic violators are pursued to resolve how and when they intend to process and pay outstanding claims. If the issues persist, there may be grounds to charge penalties stipulated by the Clean Claim Law (to the extent it exists in the state). Only by quantifying and analyzing the problem can you discover how to improve on the process. A real Revenue Cycle Denial Management system gives you a way to optimize and accelerate cash flow. ClaimCare Medical Billing Services' system has a proven track record of improving revenues between 5-20 percent.

You can take advantage of ClaimCare's Denial Management success with our Old AR Recovery service.

Copyright 2007 by Carl Mays II