Marketing Advice for Medical Billing Services

Marketing can be the hardest part of starting/running a medical billing business.  Recently on our forum someone asked a question about marketing their medical billing business.  Their question was regarding cold calling and they were asking for any tips/suggestions.  Another forum member responded in what some might consider a negative way but in reality, they gave medical billing owners a great insight into what the cold call looks like from the provider’s office.  She stated the following:

“This is probably not what you are going to want to hear, but here goes…

I am the office manager for a solo practitioner, and I have always done her billing. The very last thing I want is unsolicited phone calls during office hours when we are busy with patients. And I get quite a few in one week. We don’t need a billing service, we don’t need a debt collection agency, we don’t need a new copy machine, etc. In fact, if I were in the market for any of those services, and numerous others I didn’t mention, I would find one on my own, by asking for referrals from other practices, by going online and looking at websites for various companies, contacting the local Chamber of Commerce, etc.

There is truly nothing more annoying than having to put a patient on hold on the phone, or have to leave a patient in a room during a history taking to answer the phone, and find out it is a cold caller. So my suggestion is if you are going to cold call, do so after hours, when you can leave a message on the practice voice mail. That way, you are not interrupting the doctor/staff during valuable patient hours, when what we want to focus on is the patients. It really is the equivalent of how people hate getting telemarketing calls when they are at home.

As far as obtaining a list goes, I have no idea where you could get something like that. What you can do is research the practices you are thinking of calling by looking at their websites, and see if they appear to be truly solo, or are part of a hospital, etc. Probably it is even better if they DON’T have a website, and are solo/smaller, because that means they are more “old school” about things, and have not signed on with a larger entity. Using the phone book, you can probably figure out who is solo/smaller, and who is not.
Finally, and this is just from MY experience, I work for three billing companies(two small ones, one large one) doing remote billing in addition to my full time job. Not one of those billing companies has ever gotten a client from cold calling. It has all been from knowing someone who needs a biller, then onto referrals from satisfied clients, and also from actually stopping in offices and dropping off information about their services. They all gave up cold calling early on, it just didn’t get results.”

My response was:

“Actually, Kristin gave some good advice.  It was interesting to hear her viewpoint too.  But don’t take it as ‘what you don’t want to hear.’  She actually gave you great insight into what you are up against.  And after 20 years at this I would say that is what we have found to be true as well.  The only time we cold called on the phone is to smaller mental health practices who don’t usually have a receptionist/secretary and who are known for having an answer phone.  We would create a short, to the point message letting them know about us and asking them to call us if they were interested in hearing more.  That got good results.  If we were targeting larger medical offices (not the big ones, but ones that had staff – solo MD w/an NP, etc.) we would physically go in to the office usually bringing a handout with information about a current issue.  Also candy is a huge hit.  Even some of the hardest office manager’s will soften at the sight of chocolate.     When we brought info it would be something like:

“Did you know that Excellus BCBS is now requiring taxonomy codes on all claims?  They started it on Monday (they really did in our area!).  Here is some information regarding that.”  Then hand them a flyer telling them about the problem and of course your information is on the form as well explaining what you do and that you can help them if they are having a problem with this new requirement or any other billing issue.”

(Note:  We have a free medical billing forum where you can post any questions or just read others questions and responses.)

The Truth About Co-pays – Is the Dr. Breaking the Law

Most people in the medical billing industry are aware that there are compliance issues with professional courtesies or the waiving of patient responsibilities but there still seems to be a lot of confusion surrounding the issue.  What they are not aware of is that the practice of waiving the patient responsibility may actually be breaking the law.

Many providers do not understand why they cannot decide to extend a break for services rendered to a family member or friend.  They feel that they have a right to choose if they want to collect the money that the insurance carrier deems to be the patient’s share.

The insurance carriers feel differently about the situation.  They feel that by waiving the patient responsibility the provider is intentionally charging a different price for the same service.  For example, a provider charges $100 for a level 3 established patient office visit and the patient’s insurance carrier pays $80 and the patient has a $20 copay.  If the provider waives the $20 copay the insurance carrier feels that the provider is willing to accept $80 for the level 3 established patient office visit.  Based on that they feel that they overpaid the provider $20.  They should  have paid $60 and the patient should have paid $20.

Why does the insurance carrier feel this way?  Basically all of these concepts, deductible, co-pay and co-insurance, are cost share obligations.  The rules of managed care state that the patient CANNOT see the doctor until they make their co-payment. Managed care is governed by federal law and is not open to interpretation. To “write-off” a co-pay, or to allow a patient in to see the doctor without collecting the co-payment, is against federal law.

Federal law never allows waivers of patient responsibility to be offered as part of any advertisement or solicitation.  Basically a provider cannot use the enticement of waving the patient’s responsibility to get a patient in the door.  A provider may think that they can advertise a special where they will waive the patient’s co-pay for a new patient consultation to try to get more patient’s into their practice but this is illegal.

Most managed care contracts that providers sign when enrolling to be participating with an insurance carrier forbid waiving patient responsibility.  They consider such waivers to constitute insurance fraud, misrepresentation and unfair competition.  If an insurance carrier discovers a provider is waiving co-payments the insurance carrier has the right to stop payments on a claim and/or recover amounts already paid on claims.

Professional courtesies must be distinguished from waiving patient responsibilities.  A professional courtesy is when the provider waives the entire fee for a physician, or the dependent of a physician.  A professional courtesy may also be a discount such as 50% for such an individual or the provider may choose to waive only the patient’s out of pocket expenses as well.  This is known as accepting “insurance only” as payment in full.  The issue is that this professional courtesy is often extended to many others such as staff, family of staff, friends, etc.

Generally if the professional courtesy is the waiving of the entire fee or a percentage of the entire fee it is considered legal.  However, if the professional courtesy is waiving the co-pay or the patient responsibility it is generally considered illegal especially if the patient has a federal insurance plan such as Medicare.  This is true even if the patient is a physician.

It would also be considered illegal if the professional courtesy was extended to a patient who is in a position to refer business to the provider.  This could be considered fraud and abuse, especially in the case of Medicare patients.  Waiving patient responsibility for Medicare patients violates a federal statute that states that the provider knows that waiving the patient responsibility is likely to influence the patient to seek care from that provider.

Some individual states agree with the insurance carrier’s perception and have declared the insurance only courtesy is insurance fraud.  If the provider accepts insurance only then the state feels that they are misrepresenting their fees by charging insurance carriers a fee that is higher than the fee that they actually intend to collect.

There are many situations where waiving the patient’s responsibility either in the form of a deductible, co-pay or coinsurance is deemed illegal.  Federal plans and managed care plans are covered under federal law and most commercial plans, depending on the state, are covered under state laws.  If not illegal, it is most likely a violation of the provider’s contract with the insurance carrier.  Violating the contract may result in the provider being removed from the insurance carrier panel.

Basically, providers are not supposed to ‘forgive’ patient responsibilities without proof of financial hardship.  Such financial hardship cases must be consistent and not provided routinely and the hardship should be documented in the patient’s chart.  Therefore, the best course is to avoid waiving the patient responsibility unless a financial hardship has been established.  Office policies should be reviewed regarding any courtesy discounts to make sure that they are compliant.