MEDICAL BILLING BLOG

Medical practices lose money every single day (often over 20 percent of their realizable income) because they are not utilizing medical billing specialists, technologies, processes and management that can compete with insurance companies.

As physicians are taking into consideration the use of medical billing services to stop the hemorrhaging of cash from their practices, they are faced with a broad range of options. On the diminutive end of the spectrum are home-based medical billers. On the opposite end of the spectrum are medical billing companies that employ hundreds of medical billers and have thousands of clients.

In thinking through the billing options available, it is essential to understand that medical billing is complicated and requires deep expertise and expansive experience. When a specialty is involved, such as cardiology billing, the requirements for success become even harder to realize. Success requires that the medical billing company have a team that is knowledgeable in the complex rules utilized by insurance companies to judge cardiologists' medical claims.

With cardiologists facing ever increasing costs they must insure that money is not being left on the table because they have a billing company that is not a cardiac billing expert. Cardiologists must also be aware that that many billing companies that claim cardio billing expertise actually outsource their cardiovascular billing work to at home billers. Situations like this are fraught with risk since the remote workers are not working in a controlled and monitored environment.

A key battle ground in the struggle to collect all of the money due a cardiologist is appealing denied claims and answering extremely specific and technical questions about procedures and diagnoses. Success In this arena requires significant experience, the kind that is only gained from serving many cardiologists for many years.

A company that does not encompass a wide range of cardiovascular billing experience will find it difficult to track underpayments since multiple procedure rules and cardiovascular procedures have significantly more complicated contractual adjustments than a typical family doctor or internist's claims. In addition, the billing software and system design of a generalist billing company will often be insufficient for the more complicated requirements of reporting and insurance follow-up required in billing for cardiovascular practices.

The cardiology-driven difficulties of medical billing encompass patient billing also. A cardiologist's patient balance process is more challenging because most of the balances are quite sizeable. Coupling this with the difficulties of explaining to a patient their complicated Explanation Of Benefits and the cardiovascular terminology on their bills drives the need for patient collection specialists that have a strong expertise in cardiac billing.  If patients are not handles with care then cardiologists will see their patient collections fall and their patient complains rise - not a good combination.

To avoid all these billing related pitfalls cardiologists need to utilize specialized cardiovascular billing services. It is not advisable for an internist to perform heart surgery, similarly someone without training in surgical coding and surgical billing is not qualified to offer reliable billing services for cardiologists.

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

Everyone hears about the fact that much of the cost of healthcare is driven by the expense of processing and adjudicating claims. What is often not mentioned is what is truly at the root of these expenses - payers that are attempting to withhold from physicians the money they are due. I mentioned in an earlier entry how ClaimCare Medical Billing Services constantly sees payers systematically underpaying claims. We also see claims that have been properly submitted and for which we have proof the claim was accepted simply "lost" by payers and the claims have to be resubmitted (sometimes multiple times) in order to secure payment. Now, here is a shocking fact - over 50% of claims that are "lost" or are underpaid are never pursued by physicians (and therefore the payers never have to pay the money they owe to the physician or facility). This means that payers have a powerful economic incentive to play games and make the medical billing process complicated. Here is another shocking fact - it costs the average insurance company about $25 each time a representative has to get on the phone and discuss a lost or underpaid claim with a medical billing specialist. A final key fact is that most payers "grade" each provider. The lower a provider's grade (i.e., a D versus an A) the more likely the payers are to lose or under pay the provider's claims. Why? Because these providers have no track record of catching these problems and pursuing them.

So, how do all of these fact tie into my title about Medical Billing Services fighting the rising cost of healthcare? If each and every underpaid or lost claim is pursued (which is what Medical Billing Services should do because they have the scale to have groups of people that do nothing but follow-up on such claims) then eventually payers will lose all economic incentive to play games and make the billing process complicated and expensive. Imagine if every physician pursued every claim until it was paid in full. The payers would see their cost to adjudicate the claims rise and they would see their payments to providers rise because the lost/under paid claim games would no longer prevent providers from ultimately being paid. This combination would lead to each physician ultimately being paid quickly and without fuss because the insurance companies would lose significant money by playing games ($25 per extra phone call generated by the games) and they would gain nothing since payments would only be delayed, not avoided.

There is lots of talk about the dream system where claim adjudication happens in real time and physicians immediately receive their reimbursements. Such a system will never happen until the economic incentive payers have to maintain a difficult, complicated and veiled system are removed. This, is what medical billing companies can do by doggedly pursuing each claim and insuring that every one of their clients is rated an "A" by all of their payers.

For more information visit ClaimCare Medical Billing Services or go to the Contact Us page. 

Copyright 2008 by Carl Mays II

Texas has one of the most helpful and powerful clean claim laws in the United States. The penalties for a clean claim violation can go all the way up to the payer being required to pay billed charges; that's right billed charges. The basic idea of the law is that a payer has to respond to a clean claim within 30 days (45 days if it is not submitted electronically). In order to utilize the clean claim law effectively you must have a tracking system built into your medical billing process that flags:

1. Which payers are subject to the clean a claim law (not all are),
2. When a claim was submitted,
3. When a request for information was received from the payer (if you receive one then it stops the 30 day clock until you respond),
4. When your office responded to the information request (this starts the 30 day clock again), and
5. When you received a payment or denial.

The design and implementation of the system and reporting can challenging, but it will pay huge dividends in terms of the penalties from payers and in the way in which you will make payers take notice of your claims next time. At ClaimCare Medical Billing Services we have used our clean claim tracking system extensively and have seen significant rewards for our clients - especially our Texas Medical Billing clients. We have actually received calls from managers at some of our payers that have assured us they would process our claims quickly and asked if we would please stop submitting complaints.

If you would like more information on this please fill out ClaimCare's Contact Us page.

Copyright 2008 by Carl Mays II