The End of a Season

Ecclesiastes 3:1 To everything there is a season, and a time to every purpose unto Heaven.

I wanted to start this off by saying “Nobody said this was going to be easy” but actually when we started our business bask in 1994 people did tell us it would be easy. But they were not the right people to be listening to. When people ask me about starting a medical billing business I never tell them that it will be easy. I tell them that it can be a very rewarding and profitable career but you work for your money. And you work hard!

The past five weeks has been very trying for us. That’s where Ecclesiastes 3:1 comes in. Sometimes we need to recognize that some relationships aren’t meant to be forever, but are only meant for a season. It may be a relationship with a provider, an employee or a partner. Whatever it is, it is better to recognize that the season is over than to try to keep the relationship going past it’s season.

The important thing in this business is to maintain your level of standards in everything you do, and surround yourself by people who either help you to achieve this or encourage you to achieve this. I have heard that people either sustain you or drain you. You can’t afford to be around the ones that drain you too much. If you want to be successful, you need to surround yourself by people that are going to allow you to be successful. You should find a mentor (or two). Just make sure you are seeking advice from people that are going to give you good, solid, honest advice. Getting advice from the wrong people can be a real setback.

I began to wonder why I was even writing this, but then I thought, I am writing this to encourage others. You may experience times in your business that are very trying, downright difficult. But sometimes it is necessary to go thru these times to get where you want to go. I’m not talking about doing anything to get there, or stepping on anybody to get there. I’m talking about just doing your business as you should do your business. It is not always going to be smooth sailing, but if you just keep your head up, your eyes focused on the goal, and keep your standards where you set them, you will get thru and there will be a new season.

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Discouraged in Your Progress?

I have gotten several emails lately from medical billing service owners who have started their businesses but are not happy with where they are in their businesses. This is very common in this type of business. Some people have unrealistic ideas about starting a medical billing service. Some think that it will be easy. Some think that they will get rich. Some start their businesses only wanting to hire others to do the work and not really having to get involved at all. Many start their businesses with the right idea but have no idea how they will find clients and don’t work hard enough on this important part of the business.
Many of these people come to me for advice. We are where they want to be. We started where they are. They want to know how to get the accounts they need and how to get systems in place to make it profitable. Mostly they just want to talk to someone who might be able to help them but there aren’t many places to go for that. What I find is that most of them just need encouragement. There is no quick easy way to become successful in this business. It is one client at a time. One system at a time. One small victory after another.
I remember when Michele and I started our business. It was hard. It took a long time to start making a profit and be able to get a paycheck. We got discouraged. Fortunately we got discouraged at different times. When I got discouraged, Michele would talk to me and when Michele got discouraged I would talk to her. It worked well. We could usually bring each other out of the disappointment and get fired up again about finding a new client or getting an account running better. It took many many small victories to get to where we are now.
I am sure it is difficult when you work alone to get past the disappointments and continue building your business but that is what you must do to make this business work for you. After I get through encouraging a new biller they are usually very grateful and ready to go forward and work on their business. I try to make a few suggestions as to what to try next and they are excited to get some fresh ideas. So when you get discouraged in your business, maybe you just need someone to talk to. Find someone with a positive attitude who you can trust and see if you can’t get some inspiration.

Increase Your Income With a Clearing house

Most people doing medical billing now are submitting at least some of their claims electronically if not most. Of course there are still a few small insurance carriers that do not accept electronic submissions yet but they are becoming obsolete. For the few billers that are still doing everything on paper, it is only a matter of time before you will be submitting electronically.

Most electronic claims are submitted thru a clearing house. Maybe you think all clearing houses are alike, but that is not true. They actually vary quite a bit in both cost and function. It is important to find the one that will work well for your needs.

We recently began using a new clearing house and we were amazed at the different functionality. The system we were using was working fine and we didn’t feel there were any problems. But when we began using the new clearing house, we realized how much more we could be doing. We have now switched almost all our claims submissions to the new clearing house.

There are a couple of things that make the clearing house work well for us. First of all, most of our claims are submitted for free. As long as we submit more than 50% of claims to commercial carriers, vs government plans, we don’t have to pay for any of our claims. Many clearing houses charge a per claim fee. For the volume that we submit, this is a huge savings. The system we were using didn’t charge a per claim fee because we actually acted as our own clearing house, but we did have to buy an expensive software and then pay for updates and support every year.

But the part that I’m most excited about is the reports that we get. We got reports from our old system but they were not as detailed and they were difficult to read. We had to sort thru the accepted claims to find the rejected claims. The new clearing house notifies us immediately when a batch is received and within an hour or two if the claims were accepted or rejected and they notify us by email. The email system works a lot better for us than having to go in and download the reports. The email comes in and you can quickly check to see if the claims were accepted or rejected. If there are rejections, you simply log on to the clearing house web site to view the rejections. There is also a place where you can go into the claim right from the website, make any changes or corrections, and resubmit right from there. It is not necessary to completely resubmit the claim from your practice management system.

Thru the website it is very easy to quickly check the status of all batches, or individual claims submitted. A claim that is initially accepted can be rejected by the insurance carrier for reasons such as insurance plan not in effect at time of service, or patient not covered under plan. The claim was originally accepted because there were no claim level errors, but the claim will not be paid for other reasons. If a claim that was initially accepted is rejected at the insurance carrier level, another email is generated, and the status of that claim is changed from accepted to rejected and the reason is displayed. This makes it very easy to check and act on rejections as they are listed very clearly.

This system allows you to be aware of claims that are not going to be paid within hours or days of the services. There are many systems that do notify you of rejections, but not all do it as clearly and quickly. Add that to no charge per claim and it’s really starting to sound pretty. Now if you are taking care of these rejections quickly, then your aging reports will be much more manageable.

Most offices lose a lot of money because they do not work their aging reports, or they do not work them well. With a good clearing house that provides detailed and fast reports, you can reduce the aging reports greatly, making them easier to work. They take less time and are not so cumbersome. You are not making unnecessary phone calls to find out about denials that can be found in the electronic reports. In our office, the aging reports are not the most desired job so reducing them is greatly appreciated.

A lot of insurance carriers have an online claim system that will let you submit claims directly thru their web site. This can be nice, but it requires double entry of the claims. You have to enter them into your practice management system to track them, then enter them into the web system. We don’t find this is very cost efficient in most cases, but there are a few that we do this with. They have something called “real time submission” that allows you to see immediately if payment is going to be made and how much will be paid. If it is going to be denied, the reason is there instantaneously.

Whatever system you decide to use what is important is that it works for you. Recognize that they are not all the same, investigate what they offer and what they charge and make sure that they submit to the carriers that you will need. It is important to make sure that you are checking your reports and fixing the denials. This will save you a lot in the long run. It is also important to learn the system you are using so that you get the most out of it.

The proctologist report is in – New NYS Medicaid Cut Sticks it to Doctor

It seems that when the government needs money, they take a look around to see where they can take it from, and New York State has hit the medical profession again.

New York State has implemented an across the board Medicaid payment reduction of 1.1%. The reduction started on all checks issued after September 15, 2010 and will continue until March 31, 2011. This reduction is due to the 2010-2011 State Budget and it was enacted to address financial plan deficiencies relating to reductions to the FMAP or Federal Medical Assistance Percentage authorized by Congress.
Providers have been trying to fight this reduction but up thru last week have been unsuccessful. They have appealed to Albany lawmakers with no luck, so they have taken their fight to Washington.

These cuts come on top of previous state cuts to the Medicaid program and come at a time where providers are already operating at a break-even level or even at a loss. Many fear that these cuts may push providers who are on the fence to stop participating in the Medicaid program which will make it difficult for patients to get medical care.

So now what does this really mean? In my opinion it means that our state government desperately needs money so they decided to take it from medical providers. What they are doing is figuring out what Medicaid should pay, putting it all down in black and white on the EOB, then subtracting 1.1% to keep for themselves. I guess they thought that such a low percent might go unnoticed, but I think they are wrong. At a time when providers are already facing high expenses and lower reimbursements, they are just cutting more. How much will the providers take? What state is next?