Marketing Update for end of May

April 30, 2013
This week we got 5 more leads with two phone appointments.
Both phone appointments stated they were not interested.
Called back on previous leads –
Called back one lead who wasn’t in last time we tried and she was not in this time either.  She is the doctor’s wife.
Called back another lead but couldn’t reach contact person again.  We sent an email reminder but the email failed.  Not sure what that means.
Called back three leads and were told they are not interested at this time.
Called lead where we had hand delivered the package.  Told yes she did receive package.  Will look over and let us know.
Two leads we were assured that the doctor did get the info and that he will call if interested.  On one we were told he had a stack of info to go over on his desk.
One lead we called the contact person could not come to phone as she was with a patient.
One lead we called we were told that the information was given to the administrator.
We also sent a few reminder emails.
May 6, 2013

May 16, 2013
We have heard from several others who have decided to sign up as well and so far several have gotten some leads and are following up.  If you have signed up, please keep in touch so we can all share our experiences.  On our part, we are learning lots.  Our biggest lesson so far is to make sure you sign up for the service when you have the time to do the necessary follow up work to insure success with your leads.  I am embarrassed to say that for the last two weeks we have been unable to put the work into our leads that are required.  Several unexpected things came up requiring our time and preventing us from making calls that are required.
I really don’t mean to make excuses but I know it is our own fault that I haven’t gotten any appointments yet.  We had three deaths of people close to us in the last three weeks, we had a guest here for a week and a half to study under us, my 96 year old mother and I spent one whole day in the ER after she shopped until she dropped at Wal Mart and was taken by ambulance to the hospital, Michele’s eight year old was sick and out of school all last week, we both had nasty sinus infections and we’ve had one of our three workers out all week due to her son receiving third degree burns.  Add regular doctor visits and other obligations to the mix and you may be able to see why we’ve neglected our leads.  So once again I want to make sure I get across the importance of undertaking an opportunity like this when you will have the time to follow thru.
So we are now ready to get back to business!  Calls were made for us again this week and we have 6 leads so far.  Five of the six have set up phone appointments for next week.   This is a good sign.  Although it is often difficult to get through even when you have a phone appointment scheduled there is some interest in your offer or they would not have set up the appointment.
Michele and I have talked over what has happened so far and agreed to once again tweak the materials we are sending.  Our results with the calls we have made so far have been disappointing so we really need to see where we have been going wrong.  I think we’ve had something like 23 leads so far and no meetings face to face yet so we are looking at why these leads are agreeing to receiving information from us and then not being interested in going any further.   We are not discouraged on our results as we are looking for the right account and these leads should get us to that if we handle them right.
As I’ve mentioned previously we offered a free billing analysis and we assume that this may be part of the reason the leads may be interested.  As with any marketing campaign we feel it is important to offer something of value to expect the prospect to accept any offer.  If our prospects are interested in the free billing analysis we need to build our materials that we are sending them completely around the analysis.  When we looked at it from this direction we realized that we still were not sending the right stuff.
We tried to look at it from the viewpoint of the office that may have some problems with their billing and are now offered a free analysis of their system.   They agreed to receive information on the free billing analysis so what are they looking for in this information?  We decided that they must be questioning their current situation and want to know if they could improve it.  We should be sending them information on how our billing analysis would help them, what it would identify and what they could do about it.
Most of our leads request information be sent to them by fax or by email so we wrote a few paragraphs for the fax cover that answered the questions we felt they were looking for.  The second page of our fax contained our list of frequently asked questions about the billing analysis.  The third page of our fax was a little information about our company indicating our 19 years of experience and services we provided along with the url of our websites.  This page was designed to give credibility to us and show our experience in this type of work.  Our fax is now just 3 pages.
For the email requests I decided I didn’t want to scan the pages to pdf as I wasn’t sure they would bother to open the attachment and print it out so I included all our information in the body of the email.  Instead of sending the third page of information on our company I wrote a short paragraph at the end of the email.  I wanted to keep the email as short as possible but get the important info across.

Our Advice

If you are not getting appointments to meet with prospects from your leads look at what you are sending them and determine if it is appropriate.  Don’t be afraid to tweak it to insure you are sending what they are looking for.  Try to look at it from their point of view.  Why did they agree to receive the information?  It could have been just to get the person off the phone, but some of them are genuinely interested.  If they were interested, what is the best information you can send them to encourage them to want to learn more from you?  Your main objective is to get a face to face appointment with them to see if it is a situation where your service can help them.
Don’t give up when you can’t reach someone on the phone.  Try and try again.  Eventually you will catch them when things aren’t crazy and they can talk to you.  Don’t take it personally if they can’t come to the phone even if you do have an appointment scheduled.  Quite often doctor’s offices get very busy with emergencies and your call will not be considered important then.

Medical Billing Errors – Common Causes and Prevention

Author: Gina Wysor

Medical Billing claim errors can be a real pain to deal with because of the time it takes to determine what went wrong, correct it, and resubmit a claim. Many providers have a significant amount of money stranded in unpaid or rejected claims that never get addressed because no one in the office has the time or desire to work on it.

I’ve seen estimates that as many as 10% of claims are initially denied or rejected. Of these only about half are typically resolved in favor or the provider. From my own experience I’ve received calls from physicians that are seeing much higher rejections than this because their billing practices are such a mess. Or they have someone trying to do the billing who has never done it before.

Once the doctor has provided their services, the claim is then coded, entered, and submitted. The next step is getting paid. But then you receive the EOB (Explanation of Benefits) that the claim has been denied – or rejected – sometimes with a bunch of cryptic denial codes.

These denials can be prevented or minimized by using good billing practices and addressing problems promptly. The longer an unpaid claim sits around, the less likely it is to be corrected and resubmitted – which becomes lost revenue for the provider. I’ve found it takes a lot more time and effort to find out why a claim was denied or rejected, than it would have taken to catch it when the claim and patient info was being entered and submitted. In some cases there’s not much you can do because the insurance payer questions whether a procedure is necessary. In those cases an appeal letter has to be submitted for reconsideration.

Most Common Reasons for Rejected Claims
Some of the most common causes of claim rejections are:

●    Errors to patient demographics such as age, address, date of birth, sex, etc.
●    Errors in provider information.
●    Incorrect patient insurance ID number.
●    Patient is no longer covered by policy or insurance info is not up to date.
●    Incorrect, omitted, or invalid ICD or CPT codes.
●    Treatment code is not consistent with diagnosis code or visa-versa.
●    Incorrect modifiers.
●    No pre-authorization (More common with certain specialties).
●    Place of service code incorrect.
●    Medical necessity questioned.
●    No referring provider ID or NPI number.
●    Upcoding or Unbundling codes.
Fortunately these are some of the easiest issues to fix and resubmit the claim assuming the patient notes are readily available. This is where having a good EMR (Electronic Medical Records) system is helpful to the billing specialist.
Denied Claim Verses Rejected Claim
A denied claim is not the same as a rejected claim, however both terms are many times used interchangeably. A rejected claim has not been processed due to problems detected before the claim is processed. Claims are typically rejected for an incorrect patient name, date of birth, insurance ID, address, etc. Since rejected claims have not been processed yet, there is no appeal – the claim just has to be corrected and resubmitted in order to be paid.

A denied claim is one that has been through claim processing and is determined by the insurance payer that it cannot be paid. These claims usually require an appeal by submitting the required information or correcting and resubmitting the claim.

Common Causes of Billing Errors

Patient Info
A frequent cause of rejected claims is incorrect or out-of-date patient info. When the patient checks in, that’s the time to ask if there are any insurance changes, address changes, etc. The front desk employees play an important role in the reimbursement process and making sure to ask if a patient’s info is still up to date. People move, change jobs, and change insurance all the time.

Insurance Verification
As mentioned above, peoples insurance changes all the time. That’s why it’s important for a provider to verify insurance before treatment. We frequently see claims rejected because the date of service is after the patient’s insurance coverage ends. There are also situations where the service or procedure is not covered by their plan. This is especially important for certain specialty practices such as mental health.

Documentation Legibility
Another common cause is superbills that are difficult or impossible for the biller/coder to read which can lead to errors when the information is entered. We all know that sometimes a physician’s handwriting can be difficult to read or interpret. When a claim is rejected or denied, it can be very time consuming for both the biller and the provider to pull the patients record and figure out what the problem is – especially if it’s a coding issue.

Employee Training or Experience
Untrained or inexperienced employees can contribute to billing errors. We all have to learn somewhere. Many providers don’t see the need to pay well for the billing and coding functions. This can lead to hiring untrained and inexperienced employees who are not knowledgeable of the claim process or proficient using practice management software. Hiring experienced staff or investing in their training may cost a little more, but believe me it’s money well spent.

Charges Not Posted
Many providers don’t realize the importance of posting insurance and patient payments for successful claim processing. If insurance payments do not get posted, the patient can’t be billed for the remaining eligible charges, copays, or coinsurance. Secondary claims also require primary insurance processing before they can be submitted. This can add up to significant revenue for a practice.

It’s also important to promptly post payments so the practice can understand how it is performing financially. Without posted charges, those managing the practice don’t have the reporting info that shows accounts receivable, unpaid claims, payments by insurance carrier, payments by procedure, patient payments, etc.

Good Billing Practices to Prevent Errors
1    Submit a clean claim the first time without any errors. When information is difficult to read or doesn’t look right, go back to the original documents such as the superbill or patient insurance card when they are readily available. It’s much easier to do this up front than when the claim is denied or rejected.
2    Ask each patient when signing in if there are any changes to their insurance or patient info. Trying to get this info after the claim has been rejected is a lot more time consuming and difficult.
3    Double check claims when they are being entered. Many clearinghouses or claim software can catch obvious errors such as missing or invalid information but don’t have the ability to catch coding errors.
4    Understand the EOB’s. This takes experience. Many billers and coders may not know what the cryptic codes and messages mean that the insurance company lists on the EOB for denied or unpaid claims.
5    Use the reporting features of your practice management software. Most all practice management software has reporting features that allow you to analyze your accounts receivables. Look for trends in claims that are being denied. What are the most common reasons are for denial? What insurance companies are denying the most? A lot of $ can be saved by looking at the data and asking some simple questions.
6    Follow up promptly. The sooner you follow up on an unpaid or rejected claim, the more likely it is to be paid. In claim processing, time is the biggest enemy for resolution. Also most insurance payers have timely filing requirements.
Claim Appeals
Some denied claims will require an appeal letter to be submitted. The letter should clearly communicate to the insurance payer why the denied charges should be reconsidered. It should include all the specific claim data and documentation. The more relevant info the more likely it will be favorably considered. This could include any supporting notes, lab results, etc. Also try calling the insurance company first. Many insurance payers have a representative that can be very helpful for resolving these types of claims. Our local Blue Cross/Blue Shield has a provider contact that’s really helpful in identifying what’s wrong with the claim and what we need to do to resolve.

Before filing an appeal with the insurance carrier, check out the contract your provider has with them to have a good understanding of their appeals process. Many insurance payers have specific criteria and time periods for appealing claims. If you need to submit a corrected claim, make a note on the claim that it is a corrected claim when sending via paper, or attach a letter stating what corrections were made to the claim.

Errors by Insurance Carriers
Believe it or not it’s not always the providers or the medical billing specialist’s fault.
Even when “clean” claim makes it to the insurance payer, that doesn’t always guarantee they are going to get paid. The American Medical Association has estimated that an insurer’s electronic claim processing accuracy ranges from 88% to 73% depending on the payer. This is most likely due to a lack of claim processing standard requirements – they vary with each insuror. Some practices and cumbersome appeals processes the insurance payers use also contribute to reduced provider payments. The AMA also estimates that a physician can spend up to 14% of their income dealing with the insurer’s requirements. Unfortunately there’s not much the billing specialist can do about these issues other than to challenge the insurance company when claims are denied.

In summary medical billing and claim processing errors are a part of process due to the complexity of the claim process and all the players involved. Adhering to good billing practices and dealing with issues promptly can lead to a much more efficient billing process and save the provider stranded or lost revenue.

For more information on medical billing topics visit

Results of marketing campaign

The first week of our calls started 4/1/2013. 

We offered a free billing analysis to any of the providers contacted.  We look at it like this.  The leads we get from this marketing efforts are warm leads.  They are not signups. They are offices that may be having some problems and considering other billing options.  They have some interest in what we are offering.  They may be offices just looking for the free analysis of their billing.  That’s fine too.  If they have good systems in place that work, we don’t want their business.  We are looking for offices that need our help.  We are good at what we do and what we do takes time.  From our experience in returning calls to these people the one thing they do not have is time.  So we can help them.  We will call on denials and get them reversed.  We will do appeals when necessary.  We will get their billing done on time.  We will get the patient statements out on time.  We do the extra work that they don’t have time to get done.  Know your strong points and use them when you talk to these leads.
The reasons we were willing to try this company
Many of these leads may amount to nothing and that’s alright.  We don’t want 6 new accounts this week.  We want one good one that is a good fit for us.  Quite some time ago we paid a girl who worked at the front desk of an office we really wanted to get in to talk to the doctor to get us in.  She got us an appointment and we signed up the doctor and paid her several hundred dollars which was money well spent.  That office brought us in between $4000 and $7000 every month.  We will gladly pay for a lead like that so if we have to sort thru these leads for two or three months to find that good account again, it is well worth it to us.
Many years ago when we first started our billing service we ran into a similar marketing company who did cold calls like this.  The difference was that they charged a lot more, actually set up appointments and sent an experienced person with us to the appointments.  That turned out good for us.  We signed up a good account and learned a lot.  So having had some experience in the past with this sort of situation we decided to give it a try.
Here’s what happened the first week of calls
We received 6 leads from first 100 calls week of 4/1 (we thought was pretty good response)
We emailed or faxed info to offices same day or next we received lead.  We sent the six pages we have printed up in our presentation package and the front and back of our brochure with a short cover letter.  Contents of our presentation package contain

  • A page of info on our company and a list of services offered
  • A list of benefits of outsourcing
  • A list of what we will do for you
  • Our compliance plan
  • A page of testimonials for current providers we are working with
  • Our brochure

Two of the leads requested phone appointments the following Wednesday.

4/10 made scheduled phone calls – results
1st phone call – didn’t have time to look over materials yet
2nd phone call – couldn’t come to phone – with patient – very busy

What we learned:

These offices know that they need help or they probably wouldn’t have agreed to receive the info but they are very busy.  They have trouble taking the time to change anything in their systems.  They certainly aren’t going to call us back saying yes, please come in for our free analysis.  We need to talk to them further to explain how we can help.  We need to do some follow-up now.

4/15 Second round of 100 calls started.
We got 8 more leads that day and 4 more during the rest of the week. (we felt this was an amazing amount of leads for 100 calls) We faxed and emailed info.  One office of the 12 set up a phone call meeting for Monday 4/29
4/16 we sent bank bags with a letter to first batch of leads asking if they were taking enough money to the bank and telling a little about our service and reminded them of the info we had previously sent.  (Read more information about sending “lumpy mail” and “shock and awe” packages in our ebook “Advanced Medical Billing Marketing for the New Economy”.)  We included a list of frequently asked questions about the offer for the free analysis, a business card, a brochure and a post card size offer which expires on 5/10/13 for the free analysis.   One office sent a fax back saying they were not interested.
On 4/23 we called the office back that set up appointment and couldn’t talk when we called.  This time we found out that the billing manager we were to speak to was no longer there.  We spoke to the office manager who asked that we send the info to her to review.  We forwarded email to her.
We also called one of the other leads and found the doctor’s wife who is the office manager was away until Monday.  Call back next week.  Another of those leads said he was not interested.  The final lead never answered the phone, it was always voice mail.  Tried several times with no success.
What we learned:
We waited too long to follow up.  They had forgotten that we sent info by then so we needed to act quicker.  Calls must be made by the following week.  Also realized that the reason they were accepting the info from us was for the free analysis but the initial info we were sending didn’t have anything in it about the free analysis except reminding them of the offer on the cover page.  We decided that we needed to send the frequently asked questions on the top of any other info we sent and decided to eliminate sending the brochure in a fax or email for a couple reasons.  It was redundant.  All the info in the brochure was included in the sales info on the four pages.  It was printed sideways and intended to fold into thirds.  It was too much info to expect them to look at as we were faxing 9 pages.
The office where the billing manager is no longer there may be a good lead.  Need to call back the office manager.

Our Advice
Make sure your calls are made with an offer of something of value to the provider.
Send the right info – related to the offer – don’t send too much info
Don’t wait too long to follow-up
Don’t expect 12 leads in a week – that was amazing!  Don’t know why we had such good results that week but I don’t want to be disappointed next time when only 4 leads come in.  A lead is a valuable thing.
Don’t take it personal when you can’t reach the person you want to speak to in the office.  Sometimes these offices get extremely busy with sick or injured people who must be dealt with.  Just be polite and keep trying until you are told they are not interested.  Then move on to the next good lead.
It may take a few months to find the right great account you are looking for.  I can’t believe that with this many leads coming in that if we do a good job of following up on them that we won’t find the account we are looking for.  What is it worth to you to find the account you are looking for?  How many warm leads do you have if you don’t try the program?  For those of you who can’t afford the program make the calls yourself.  At least you will have some warm leads to follow up on.