End of the Year Thoughts

It’s the end of November and I was thinking about what our accomplishments were over the year and how that stacked up to what I expect to get done next year. I kind of surprised myself as when I first started the list I couldn’t think of much. But then I remembered that we published our first book on Medicare enrollment in March and revised and added 40% more information to our Basics of Medical Billing in June. We went to a seminar in Ohio in July that inspired us to write our book on contracts in August which has quickly become a best seller. We brought in a new manager in September and changed many systems and processes in the medical billing department. We revised and added lots more info to our Chiropractic book in November and are doing the same to our Mental Health book for December. We emailed eleven free copies of newsletters Michele and I wrote. We started a new training program for medical billing services. And we very recently shot some video for sales videos for our ebooks. We will be posting them on Medical Billing Live soon. I guess that was a lot to accomplish over the course of the year but it’s not nothing compared to what we have in store for next year. We can’t wait to share with you some of the exciting projects we have been working on. We’ve got some goals for January we’ll be feverishly working at. Tell you about them soon.

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Marketing Seminar in Baltimore

Alice and I just spent the last few days in Baltimore, MD at a seminar. It was a beautiful time of year to visit. Our hotel room had an awesome view of the inner harbor. One of the areas we see a need for in medical billing businesses is marketing. Alice and I are working on a whole line of new marketing
materials and techniques that we are very excited about and the seminar was very helpful to us. The seminar had some great speakers and vendors and we came away with some exciting stuff that we will be sharing with you guys over the next couple of weeks.

Coming from a very rural area in upstate NY, it was an eye opening visit in some ways. We had to walk anywhere we wanted to go. In our area, there are very very few homeless people and the few that we do have, aren’t seen. Walking around Baltimore we saw many homeless people. I have been to other cities with homeless people but the homeless people in Baltimore seemed different,
more friendly. Friendly is a wierd way to put it, but that is really the best way to describe it.

We were in a restaurant eating dinner on the second night and a homeless man came in, sat down at a table where a family had just left, and began grabbing handfuls of food from the plates they had just eaten off of. It didn’t take long for a manager to escort him out. I can’t imagine being so hungry that I would be able to eat off of someone else’s plate that was left on a table. Being a bit of a germ freak I can’t even let my husband eat off of my plate! Get your germy fork out of here! Well, that was quite eye opening
for us. Actually neither of us could finish our dinner. So for the rest of our stay we would get ‘to go’ boxes for any food we didn’t eat. On our walk back to the hotel we would offer it to any homeless person we ran into who asked for money.

It was still culture shock to us, someone willing to take our left overs, but they were so grateful and couldn’t believe we were offering food. But there is one funny story. Alice and I ate at the Cheesecake Factory. It was a first time for us. The food was amazing but they gave us so much food it was unreal! Perfect though for our plan for feeding the homeless. But who can visit the Cheesecake Factory without getting a piece of cheesecake right? After the super sized portions we were stuffed! So being intelligent businesswomen, we got two pieces to go. Ready to head out on the street with our leftovers for the homeless I wanted to make sure we didn’t mix up the cheesecake with the leftovers. We felt for the homeless, but we wanted the cheesecake. So I stuffed both pieces of cheesecake in my bag, and we carried the leftovers in our hands. We started off down the street and we’re talking about the seminar and what we had learned, etc. Then we came across our first homeless person. He asked if we have any money and Alice said “no, but are you hungry?” He replied “I’m always hungry ma’am” to which Alice explained to him that we had just eaten and we had leftovers if he wanted them. He was very grateful, but for some reason Alice just kept explaining that we had leftovers but didn’t give him her bag. She looked at me so finally I offered him my left overs.

As we walked away I said to Alice “so why did you keep offering the guy chicken, but you didn’t give him your bag?” She said “This isn’t chicken, it’s
cheesecake.” I’m like “no I put the cheesecake away remember? You’re carrying your chicken!”
It doesn’t seem as funny as I’ve typed it all out, but if you can just picture her standing there with leftovers in her hands, asking the homeless guy if he wants them, but refusing to hand them over. We laughed all the way back to the hotel.

(Alice here) – In my defense we were deeply involved in discussing some very exciting new marketing ideas we had just learned and I thought she had the chicken. I didn’t know why she wouldn’t give it to him. I’m sure all you city people think we are nuts but we really never deal with homeless people here in Floyd, NY.

Well our new found Australian friend Rebecca (who is very familiar with homeless people) summed it up by calling us “rookies!”

Anyway we had a great time in Baltimore, learned a lot of things, and we’re looking forward to sharing them with you soon!

New Marketing Program for Medical Billing

Michele and I got some great new marketing tips at our seminar are excited about sharing them with you. From the posts in our forum it seems as if this is where many of our readers need help. We are in the process of putting together a whole marketing package where we will work directly with you with specific techniques where we can all share our experiences. We will supply the materials and walk you through the whole process. We will be letting you know more about it soon. If you want to be sure you hear about this new service, you can email me at alice-solutions@cnymail.com and I’ll be sure to include you.

Get In Front of the Ball

Whether you are a medical billing service, an employee in a doctor’s office, a provider or doctor, or some other worker in the medical billing field, it is so much better if you are proactive instead of reactive. We find that most offices operate in a reactive mode, including ours at one time. If you or your office is reactive, most of the day is spent putting out fires and dealing with what comes up. The day cannot be planned out and regular work usually falls behind. Something or things that needed to get done – didn’t. Basically your business or office is operating out of your control.

Not only are you operating out of control but your clients (if you are a billing service) are not as happy or satisfied as they should be. And if they are not happy there is a risk that they will stop using your service. If you are in a providers office your accounts receivable is probably not in control because the jobs required to keep them in control cannot be done because you are too busy putting out fires. You barely have time to get the billing done, let alone run and work aging reports (work being the operative word), file appeals, handle denials, and all the other things needed to keep the accounts receivable under control.

It is so much better to be handling the issues or jobs that if not handled will cause fires before they even get a chance to start to smolder. So how do you make the switch from fire fighter to fire prevention? It’s actually not as difficult of a switch as one might think. You must be determined that you are going to change things and then get the systems in place to prevent the fires. Instead of being reactive you need to learn to be proactive. Once you have switched your mindset, you need to get your actions to line up with your new mindset.

This is done by identifying what is causing the fires in your office. Is it providers calling because their receivables are down or because they are wondering why a certain claim or claims were not paid? This is a preventable fire. Think about it. If you were not so busy putting out fires the electronic reports and the follow up reports would be being worked regularly keeping the accounts receivable in check. Any unpaid claims would be resubmitted, appealed or acted upon in some appropriate way. This will eliminate many of the provider calls for these reasons. Some will still call, but you will have answers for them on the first call not even allowing a spark, let alone a fire. Everyone remains calm and the provider is reassured that you are in control and on top of their account. This method is so much better than “FIRE!”

Sometimes it is actually a person in your office that is causing the fires. An employee that just enjoys drama or cannot operate unless there is total chaos. It seems unreal, but it is actually quite common. Personally I hate drama and chaos and cannot understand how anyone would want to create them. Unfortunately I have seen it first hand so I know these people exist. If you have someone in your office like this most likely they will have to go in order for you to turn things around. It is very unlikely that you can get them to change.

What else is causing fires in your office? If you take a step back and determine how the fires are starting there is almost always a way that they could have been prevented. Take immediate action and you will see big changes very quickly. It will be well worth the effort it will take you to make the changes.

Medicare Audits for Chiropractors

National Government Services implemented a pre-edit audit that affects all chiropractors in New York and Connecticut effective 10/14/2010. This pre-audit causes notes to be requested for all claims submitted with CPT codes 98940 and 98941. We do not bill for all the chiropractors in New York and Ct, but the ones we do bill are are outraged.

Many of our chiropractors have a large Medicare patient load so this really affects their income. National Government Services states the reason for the pre-edit audit is due to previous audits done in both states indicating the codes were being billed improperly 11% of the time. Bottom line is that the 98940 is for 1 – 2 body regions, the 98941 covers the manipulation of 3 – 4 body regions and 98942 is for the manipulation of 5 or more body regions.

Medicare only pays for treatment of acute conditions therefore the notes and the diagnosis must reflect the number of regions you are billing for and it has to be an acute condition.

We completely understand that many chiropractors treat the whole spine and that most patients benefit from this treatment. Without the treatment many would become acute very quickly. However that type of treatment does not meet Medicare guidelines. Medicare will not pay for the treatment of a condition that will not improve or be corrected by the treatment. They also do not cover what they deem to be considered maintenance.

We had a humorous conversation with one of the customer service reps. We called for details on the pre-edit audits and we asked if this was on all claims for all chiropractors in New York and Ct. and were told “No not all claims – just the 98940s and 98941s.” We responded stating that there are only 3 codes reimbursable by Medicare. He replied “Really?” We also inquired as to how long the pre-edit audits would be in place. NGS informed us there is no set time frame for this audit. It could go on for a week, a month, or who knows.

In the meantime chiropractors will receive letters requesting notes for all claims received after 10/14/2010 for codes 98940 and 98941. The notes must be mailed with the letter to Medicare or the notes can be placed on a disk with a sheet attached to the disk with a list of all patient notes included. Our question is how long will it take for Medicare to handle this onslaught of notes and pay or deny the claims.

Currently we are only aware of this affecting N Y & Ct. chiropractors, however, who knows if other states will follow.