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    Welcome to the ClaimCare Medical Billing Blog. We strive to provide content that improves the overall quality of medical billing efforts across the US. If you have any specific topics that you would like to see addressed in this medical billing blog please post the topic in the Medical Billing Questions & Answers Forum. If you have an article that you would like considered for publication in the medical billing blog then please email your article to resources@claimcare.net.


    What is the best medical billing fee structure for old AR clean-up?

    Posted by Carl Mays on Thu, May 27, 2010 @ 01:25 AM

    old AR clean-up, denial managementYou may be faced with multiple fee options if you are considering seeking help with your old AR clean-up and denial management. Many medical billing companies will charge a very high percentage of what they collect (over 35%). Others may offer a fixed fee approach. Which is best for your practice?

    As is so often the case, the best answer lies between these two options. One of the weaknesses of a high percentage of collections with no fixed fee is that the medical billing company doing the old AR clean-up has no incentive to pursue smaller claims. It will cost well over $20 for each old claim worked by the medical billing company. This means that any claim under $100 will not provide much profit for the company and will likely be ignored. This is an issue because many of the older AR claims are these smaller claims.

    The fixed fee option, however, has its own problems. The problem with a pure fixed fee pricing model is that the medical billing company has no real incentive to collect as much money as it can. The company is being paid a flat fee; if it can write off a claim it will cost the company less but, of course, cost the medical practice more in lost revnue. In addition, under a fixed fee model, the medical billing company has an incentive to take a long time to work the old AR - the longer they work, the more they make.

    A hybrid model of a moderate fixed fee and a moderate percentage of collections provides the best of both worlds. The fixed fee component makes it economical for the medical billing company to pursue smaller claims. The percentage of collection means the medical billing company will profit from collecting every dollar that it can (and thus does not have an incentive to just write-off claims).

    Proper alignment of incentives between the practice and the medical billing company cleaning up your Old AR is critical. A mixed pricing model provides the alignment of incentives that is required for the best overall results for the practice.


    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.

    Tags: medical billing companies, denial management, AR clean-up

    Medical billing offices need a helping hand every now and then

    Posted by Carl Mays on Sat, May 22, 2010 @ 10:37 PM

    old ar clean-up denial managementMedical billing offices / Managers often find themselves in need of extra "helping hands" for a variety of reasons including:
    • The loss of a key employee (either temporarily or permanently);
    • A backlog of old AR that has become so large that no one is quite sure how to tackle the problem;
    • Growth of the Practice, but the billing staff is the same size.
    • Expanding / opening a new office location;
    • Problems with current billing system or installing new EMR/system that causes extra work.

    In these types of situations it is critical that the medical billing office / Manager and the medical Practice become willing to seek help - even if it's just temporary, short-term help.  Trying to claw out from under these situations without outside help can be overwhelming.   And the strongest billing offices / Managers know there is no shame (in fact there is great wisdom) in asking for a temporary "helping hand" during crunch times.

    If you are considering seeking extra / temporary help, what type of help should you pursue?   You want help that meets the following important standards:

    1. The extra help can be given quickly, but does not require a long-term commitment on your part. In other words, when you are out from under the immediate crisis, you can stop using the outside resources / medical billing company.
    2. The extra help team members are true experts in the medical billing industry and they have access to the most current billing codes and requirements. In other words, don't hire "Aunt Matilda who does medical billing part-time out of her home office now and then for a little extra cash."
    3. The "extra hands" help causes minimal interruption or risk to your current cash flow and processes. For example, it is very high risk to use "pinch hitters" to do your up-front data entry work. If they fail, then your cash flow for the Practice will stop. On the other hand, applying "extra hands" on older claims and AR minimizes risk and complications because this work requires less system access, does not jeopardize the new claims that are going out daily, and requires less familiarity with the nuances of the Practice's operations.
    4. The help provides EXTRA value beyond the immediate crisis, and gives you the best bang for your buck. True medical billing Experts bring a fresh eye and state-of-the-art knowledge about the billing industry. They can give you honest feedback and keen insights about your Practice that enable you to improve collections, test out new technology to assist your staff, and provide a general level of relief that will allow the Practice to avoid future pitfalls and crises.

    The best way to achieve these objectives is to find an outside company who will work the AR that is over 60 days old.  This will:

    • Allow the Practice's current billing staff to keep getting current claims out the door fast and clean to ensure the Practice's revenue remains steady and strong;
    • Pin-point the source of much lost cash flow and give relief to the Physician's greatest point of aggravation - old AR. No medical billing Manager ever gets in trouble with the physician because all of the AR is under 60 days!! But many a medical billing office / Manager had to face the wrath of a Physician because a large backlog of old AR has started to build up in the 120+ bucket.
    • Give the Practice / Office Manager a lot of valuable feedback on the specific issues that led to the old / high AR in the first place. Are certain codes or payers causing issues? Is there a credentialing or system set-up issue? Are there denials that are not being properly pursued? Are there denials being left on the books that will never pay and are simply creating "false AR?" The feedback from the Old AR clean-up can be invaluable in helping the Practice and the medical billing Manager make changes to prevent the old AR from ever becoming a problem again after it is cleaned up.
    • Demonstrate new reports and follow-up tools to make it easier for the billing office / Manager to do their job well. Most of the medical billing companies who provide Old AR clean-up services also utilize sophisticated reports and follow-up tools that are valuable to the Practice. Seeing firsthand how these tools work may provide insights into how the Practice could leverage them to prevent future crises.

    In summary, knowing when to seek help and being strategic in the type of help you employ can turn a potential disaster in to a triumph that will delight physicians, provide immediate relief for the medical billing office / Manager and set the Practice up for on-going medical billing and collections success.

    Follow this link to see an example of an AR clean-up and denial management service that can assist medical billing offices in crisis.


    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.

    Tags: medical billing, medical billing companies, medical billing services, denial management, AR clean-up

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