Health Care Reform

It certainly has been an interesting week watching the controversial health care reform bill go thru the process it has. I had planned on writing an update on the health care reform after the vote in the house, but didn’t do it right away. Since I delayed writing the update so much has happened. The bill is back in the Senate but looks like it might get sent back to the House. It’s beginning to look like a ping pong match. From a medical billing business standpoint I have been asked many times how we think the health care reform will affect the medical billing industry. I feel that the health care reform bill won’t really affect the medical billing industry all that much. If anything it will strengthen the industry. If it passes, providers will need help more than ever dealing with insurance carriers and making sure they are reimbursed for EVERYTHING that they should be. They will not be able to afford to lose any money. On a personal note, I hope the reform does not pass. I believe it would be a HUGE mistake. I am absolutely opposed to the fact that so many votes had to be bought with bribes and that so much of the bill was done behind closed doors when we were promised transparency. I feel that my children and grandchildren would pay and pay horribly. When Nancy Pelosi stood up and said they will get this bill passed no matter what, even if they had to do it against the people’s wishes and by using dirty tactics, I was amazed. I personally feel that they need to scrap this whole bill and start over. There is too much bad blood in this bill to repair it. Time to get off my soap box and get back to work!

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Update on 21% Medicare Cuts for Physicians

On March 17th, Congress has passed legislation that delays the 21% Medicare cuts until May 1, 2010. Originally the senate had passed legislation on March 10th that would have delayed the cuts until September 30th, but the house only extended it for 30 days. I guess we will just have to keep watching to see if this cuts continue to be delayed, or if they eventually are put into effect.

Dealing With a Difficult Provider Part 2

It may come as a surprise to the beginning medical billing service but many providers do not pay their own bills on time. This can be a huge problem. The new medical billing service generally waits several months before they are even able to find, start working for, and bill a new client. You have invested time and money into getting this account started. You anxiously await the first payment to see your efforts come to fruition. Each day you go to the mailbox watching for that illusive check. What should you do when it doesn’t come?

Some doctors are great about paying. Some send the check as soon as they receive their bill. They appreciate the work you do and show it by paying you on time. You will quickly learn that the ones who are not willing to pay on time do not appreciate your work and will give you all sorts of excuses for not paying on time.

As you grow, the problem can grow too. You need to set up policies early to know what to do or you will spend a lot of time worrying about getting paid and how you are going to collect it. We send our bills to our doctors on the first of the month and payment is due by the tenth. We send friendly reminder notices on the twentieth of the month. If the bill is not paid by the first of the next month, we add a finance charge to the next bill.

If a client goes two months without paying, they definitely need a phone call. You need to try to keep your emotions out of the call even if you can’t pay the rent until you get paid. You need to ask if there is a problem with your bill and when can you expect payment. We ask our clients who are slow payers if they are willing to let us put their payments on a credit card. We have many providers who are thrilled to pay this way. They get points on their credit cards and don’t have to remember to write a check. Although it costs us a little, we can depend on getting paid on time.

We also have a policy that if a client goes three months without paying they get a letter from us stating that we have to cancel our contract if we do not receive payment within ten days. It’s a good idea to not let things go this far, but unfortunately it happens. At any rate make sure you decide how you are going to handle this type of problem and put a system in place.

Huge Medicare Cuts to Providers Delayed Again

Medicare Cuts

The 21.2% Medicare cuts to all providers have been put off again. The new deadline is now March 31st. CMS is mandated to adjust the physician’s Medicare fee schedule annually. In the past, adjustments have been either cuts or increases of less than 5%. However, in early 2009 the Obama Administration released a budget for 2010 which eliminated the SGR or sustainable growth rate formula which is used to determine the physicians pay rates for Medicare part B.

There is much controversy over the SGR. Many don’t like the formula which has calculated cuts every year since 2002. Congress has usually stepped in each year to try to intervene. However, this year, by eliminating the SGR we are faced with cuts of originally 21.5%. After some political jockeying it is down to 21.2%. Personally, I don’t think many physicians are impressed with the .3% that they’ve managed to save.

Since there is so much talk about this extremely large cut, the Senate voted on December 18th to delay the cuts to February 28th, buying time for Congress to intervene. However, nothing was done to avert the cuts. They have now voted again to delay the cuts to March 31st.

There are always those out there who think “Drs make enough money! They can afford the cuts!” What they don’t realize is that doctors do not get reimbursed outrageous amounts for their services and they have a lot of expenses involved in running an office.

I think this can be a catastrophe for the older population. Doctors are already fed up with the cuts from the past 8 yrs. They are getting tired of the rules and hoops. With a cut as big as 21.2% many providers have already expressed that they will not be able to continue treating Medicare patients, and new providers will not enroll in Medicare. Some providers have already began the process of opting out of the Medicare and others will follow out of fear.

With an aging population, this will be devastating. Medicare patients will not have as many options when choosing providers, and will have long waiting times in receiving care. There will be more people eligible for Medicare and fewer doctors to treat them.

We will just have to keep watching to see what Congress is going to do to avert this catastrophe.

Billing under both tax ID# and SS #

We often run into providers who are having serious issues with their billing that all stem back to billing under a tax ID# or their social security number. Most people think it’s not a big deal, and how messed up can it get. But you would be amazed at how much a provider’s income can be affected by the billing not being submitted correctly regarding the tax ID# or EIN, and the social security number. With NPI numbers now in the picture, the confusion has grown.

It was very common for a provider to have begun their practice years ago and to have started out billing under their social security number. Many did this because it was just easier. They figured they could switch over to a tax ID or EIN number later on, when their practice was bigger. The problem is that switching from a social security number to a tax ID number is not a simple tax.

When a provider changes any information regarding their practice they must notify all insurance carriers using the required method of each insurance carrier. When changing tax ID information, many commercial carriers require that new contracts be signed. Even though the provider may have been in network with an insurance carrier for years, when switching to a tax ID number it is as if it is an entirely new provider. Medicare requires that the appropriate CMS form(s) be completed. In any case, the switch must be reported using the appropriate format.

In addition to switching to a tax ID#, the provider must also obtain a group, or Type II NPI number to correspond with the tax ID number and business name. The provider keeps the individual or Type I NPI to identify themselves as the rendering provider but uses the Type II NPI for billing purposes. An individual or Type I NPI cannot be used with a tax ID# and a legal business name.

When billing they must make sure they have the correct information in the correct locations. For example, the individual NPI must be in the rendering physician box (24J on the CMS form) and the type II or group NPI must be in the provider billing information (33A on the CMS form). The tax ID must be in box 25 on the CMS form with the EIN box checked. But just having the information in the right boxes does not ensure claims will be processed that way. The insurance carriers must also have this information on their provider files this way as well.

We have had many providers who have switched from their social security number to a tax ID number somewhere along the line and cannot figure out why the are not getting payments. Many times when we look into the problem we find that they are billing under their tax ID number but they are enrolled with the insurance carrier under their social security number. When claims are submitted under the tax ID number, they are either processed out of network or denied. So if you have a provider who is receiving a lot of unexplained denials, or claims are being processed out of network when they are participating, you may want to see if they have switched to a tax ID number recently. That may be the whole problem.

Getting Past the Gatekeeper

One of the questions we get the most from medical billing services is “How do I get past the gatekeeper?” The answer is simple. You don’t.

Marketing is the hardest part of getting a medical billing business started and one of the most important. People tend to announce they are starting a Medical Billing Business and then ask “How do I get clients?” Then they call a few offices and get nowhere fast and wonder how to get past the person at the front desk to tell the provider how badly he needs them.

A much better question to ask would be “How can I get sought after and invited in by the decision maker?” When you ask how to get past the gatekeeper you are acting as just another dreaded salesman. People are resistant to salesmen, especially in this new economy. You want to be perceived as a problem solver. Problem solvers are sought out and respected.

So how is this best accomplished?

For the established Medical Billing Service this is not as big a problem as it is for the beginner as they hopefully have made a name for themselves and are receiving frequent referrals from their current clients. They have established a reputation in the community and may even be well known by area providers.

But for the new Medical Billing Service it is much different. This is where marketing comes in. The beginner needs to first find and then zero in on her prospect. This can be done in a few different ways using lead generation. You can place an ad or do a mailing but the key to this is to make it targeted and effective.

Many MBS start out on a shoestring of a budget and want to be bringing in money within 30 days. This is unrealistic. It takes time to find good clients and it can be months before you are paid for your work. So unless you have your clients lined up before you start your business, you can expect to spend a little money to find those first clients.

Now here are some ideas for getting started.

Place an ad! You can place an ad in either your local daily newspaper, a weekly paper, a trade magazine, or online. Keep you ad very simple. The headline is the most important part of the ad. Write a great headline. You want to target a specific problem you feel your potential clients have and get something into the headline that evokes emotion in the prospective client. If you don’t know what problems your potential clients have then you are in the wrong business.

You have to be unforgettable – not just another “me too.” Position yourself as an expert. You must instill trust. Know what sets you apart from all the rest.

Send a postcard! Use the same suggestions for an ad with a post card. Determine who you want to attract. Write a great headline. Target a specific problem and become unforgettable. Send out 100 postcards at a time to your target audience. You can purchase a mailing list or get names and addresses from the phone books. You can even send a letter rather than a post card, but the same rules apply. Keep it simple! Don’t get carried away writing a long letter no one will read. Write a great headline! Get their attention early.

Whatever method you choose remember the basics. Using lead generation you can get your potential clients to come to you. Take the time to come up with a great headline, keep it simple, target a specific area and be unforgettable.