Marketing Your Medical Billing Business

When we first started our medical billing business back in 1994, we would have done anything to sign up a new provider. Our second account was a chiropractor who wanted us to submit only his workers comp claims for $3 per claim. Workers comp claims must be filed on a special claim form and were much more work than commercial insurance billing, but as I said, we would have done anything to get our business started. We took on that account even though we were well aware that we weren’t making a profit doing it.

At that time our NYS workers comp claim forms were a 4 part carbon paper form that we had to order from the workers comp board. They had to be typed each time with as few errors as possible. Of course when you are typing with carbon paper (if you are old enough to remember carbon paper) you tend to make twice as many errors as you normally would. Then we had to correct each error on 4 pages. So needless to say, this was a rather stressful job. The provider was located about 25 minutes away and we had to drive to his office each time he had claims ready. Then if we didn’t have enough blank forms available we would have to drive to the Medical Society (another 40 minute round trip in the other direction) who would give us a few forms.

The reason we took this job was to gain experience. We were green! We needed experience. We needed to submit insurance claims. We needed to learn how to talk to doctors so we first needed a doctor we could talk to. We learned lots from that experience. I’m embarrassed to say how much we learned. The first claims we sent we put one claim in each envelope. We weren’t sure you could send more than one claim in an envelope. Not only did we send one claim in an envelope to the insurance companies, but we sent the copies of all the claims to the workers comp board one claim per envelope too. But we also learned to work with workers comp claims. We learned to type with less errors. We learned to talk to doctors. We learned our value. We learned to ask for referrals. We learned much more than we would have if we didn’t take that account because we weren’t making any money doing it. All education comes at a price and doing those claims for $3 per claim gave us some priceless education.

Email Tips

We have found so many things you can do with your email that many people just don’t realize that we decided to tell you about them. It is not unusual for either one of us to get between 50 and 100 emails in a day from people looking for medical billing information. Often we would need some piece of information that we received in an email but had long since been deleted. It seemed “gone” until we realized there is more that you can do.

The first thing we did was to get better about keeping our email box cleaned out. Michele tries to keep her inbox under 10 items. I’m lucky to keep mine under 30. We accomplished this by deleting items we are sure we no longer need quicker and by building file folders to save emails you will need in the future. You can use your email just like a file cabinet by right clicking on your mouse and moving an email to a folder or subfolder. I keep folders labeled personal, credentialing, Xena, ebooks, travel, etc.

Even with all the folders I use, we still found that we had deleted some information we now needed so we started using the deleted email folder and the sent email folder. At the top of the list of emails you have the option of sorting them by date or by to or from. I can’t tell you how many times this has saved us from a potential problem. We found that by going into the deleted file or the sent file we could generally find what we needed by sorting by either date or from.

Another suggestion I would make is to check your junk email box at least once a week and permanently delete it. I can’t believe how many legitimate emails I find in my junk box. If I send out an email to our email list announcing a new book and anyone clicks reply it almost always goes in my junk email. It only takes a minute to quickly check the contents and delete them.

Dealing with a Difficult Provider – Part 1

One of the things you don’t realize yet when you first start your medical billing business is how different each provider will be from the next. You will need to learn the differences and how to deal with the difficult ones.

Some providers are very easy to work with and some can be very difficult. When you don’t yet have any experience it can be difficult to decide how to handle the problems that arise.

One of the problems medical billing services run into is the doctor’s office that doesn’t send over enough information. It may be that the initial claims lack info or that they fail to send you all the payments. We have experienced providers who fail to tell us about patient payments that have been made and we send a bill for services that have already been paid.

Each of these individual issues is a problem for both the biller and the provider. When the provider’s office sends over claims to be submitted with dates of birth missing or no insurance information, that claim cannot be submitted. This causes a delay in payment for the provider. For the billing service it causes a bunch of problems. First, the biller must notify the provider that they are lacking critical information. Second, the biller must keep this claim available so when they get the necessary information they can complete the claim and submit it. If this is a common problem for an office, you may find that after a few months you have a fat file folder of claims waiting for information that never came. Neither you or the doctor will be paid for these claims until you get the information.

When providers don’t send you notice of all the payments you will find that when you are working your followup reports and checking claims status many of these claims will have been paid. The problem with this is that a biller can’t be wasting their time calling on claims that have been paid. It’s funny that this is usually the same provider who will be calling you demanding to know where all their payments are. It’s difficult for you to tell because you spent 6 hours making phone calls on a 28 page report that should have been a six page report if you could have entered the payments as they actually came in. Now you’ve spent an extra four hours finding out the provider was paid last month. The other problem is that you don’t have the eobs if any of the claims have a secondary payor, you can’t submit them without a copy of that primary eob. Of course there probably were some legitimate problem claims that required attention but you are so frustrated with finding that all these payments were made but not sent to you that you really don’t care at that point. Yes, there were problem claims, but the provider made you look through a mountain of claims instead of the small pile that really had problems. These providers suck up extra time that you may not have allowed for when you originally quoted them a price.

When providers forget to let you know that patients have made a payment and you send them out a bill for that service they already paid for, the patient tends to get mad. This is not good. Not only do you have an angry patient calling you but you wasted money sending out that statement.

So what’s the answer to these problems? Good question. Usually you need to sit down with the provider and explain why this is not a good situation. I must warn you, many do not want to hear about it. Some providers do not want to know what is going on. We explain to our providers that when they don’t send us the eobs it takes us much more work to call to get the information and we have to charge them more. This usually helps the situation. We also explain that we can’t submit the secondary claims without the primary eobs.

Again, you can talk until you are blue in the face and it won’t change things in some offices. That’s when you have to make the decision if this is an acceptable situation to you or if you feel you must cancel your contract with that provider. Sometimes it is just easier to move on and let that client go.

Tips to Surviving Medicare Audits

Nobody wants to hear the word “audit” but unfortunately they are a necessary evil. Medicare uses audits both internal and external to reduce or eliminate fraud and waste. Sometimes they are looking to catch the providers who are purposefully defrauding the system, but sometimes they are looking for the providers who do not realize they are doing anything wrong. In any case, it is crucial that you are doing everything possible to make sure you (your office) are following the guidelines. The best way to do that is to understand what they are looking at and why.

One of the things that CMS is looking for is billing above the average for your specialty and patient load. They have national averages for providers and if a provider bills for E&M services and they continuously bill for the higher E&M codes without billing for any of the lower E&M codes, CMS is interested in why. For example, if a provider always bills using 99214 or 99215 and doesn’t bill any 99211, 99212 or 99213’s, this may trigger an audit. Now it may be perfectly legitimate and the provider truly meets the criteria for the higher codes, but their documentation must support that. On a national platform, the average provider billing E&M codes bills a variety, and not just the higher codes.

Another example would be a chiropractor who only bills using one of the manipulation codes. There are different manipulation codes that depend on the number of regions of the spine that are manipulated. 98940 is for 1-2 regions, 98941 is for 3-4 regions, etc. We knew a provider who just billed 98941 for any Medicare patient. Because he used the one code, it triggered an audit. After Medicare reviewed his charts, they determined that based on his documentation many of the visits should have been coded as 98940’s which is a lower reimbursement. The provider had to reimburse Medicare for the difference.

Bottom line, it is important to code exactly for the services performed, and to document the patients’ charts to support the services.

Another thing that CMS looks for is that services were medically necessary. Again, assuming you (the provider) is not ordering services or performing services that are not medically necessary this isn’t a problem. Make sure that when services are provided or ordered that all supportive information is well documented in the patient’s chart.

If Medicare informs you that they will be auditing your office, the best thing to do is to cooperate fully. When they notify you, they usually specify when they will be conducting the audit and what they will need. If you do not understand anything, give them a call and ask for explanation.

CMS and their contractors regularly educate and provide outreach to providers. They have much information available on their websites, as well as list serves (email updates) and audio conferences. Some of the contractors offer seminars throughout their area as well. Basically they are trying to help providers understand what is needed and how to accomplish it. Many times, they will give a provider an opportunity to right the mistakes as long as the offenses are not big ones. It is important that each office understand the guidelines and do all possible to make sure the office is following them.