Billing Tips and Tricks

What do medical billers do? medical billing news!

2009-06-16T07:41:00.000-04:00

Medical Billing Specialist Duties
Medical Billing Specialist work with physicians, medical centers. clinics, insurance companies and other medical professionals who require a professional billing service. The main function of many medical billing specialists is to prepare medical claims for processing and send them to a private insurance company or medi-care agency for evaluation and payment. Other duties might include:

Following up on rejected claims
Billing patients for deductibles
Compiling data
Posting data
Billing patients for co-payments
General maintenance of patient records
Medical Billing Specialist Skills

These are the basic skills needed to enter this field:

Excellent word processing skills
Familiar with medical billing rules
Know medical regulations to process medical forms
Know medical coding system
Know medical terminology
Know electronic billing procedures
Know insurance processing procedures
Managed a medical office
Courses in managing a medical office
Medical Billing Specialist Equipment

http://smallhomebusiness.suite101.com/article.cfm/medical_billing_specialist#ixzz0IanRdPTC&D

Accounting for your own business - medical billing news!

2009-06-03T07:59:00.002-04:00

There will be a point where you get too many clients to manage your own books. It happened to me. BUT, I thought of my need to outsource MY bookkeeping and acounting made sense for me for a couple of reasons; 1. it freed up my time to concentrate on my business and 2. I AM AN OUTSOURCED SOLUTION, so outsourcing MY bookkeeping made sense. I wasn't afraid. Imagine if no one outsourced? WE WOULDN'T HAVE JOBS AS MEDICAL BILLERS, so remember this as you review and work your own books. It is extremely time- consuming and takes away from your core responsibilities. Something to think about... My bookkeeper and my accountant are worth every penny!

More than one location per provider - medical billing news!

2009-05-12T15:16:00.001-04:00

Several of your providers MAY work in different locations throughout their typical work week. Some have multiple office locations, or they work rounds at the hospital. In this case it is required that these additional locations be added in the Facilities section of your software or database. Without this information, claims will go out with the incorrect Place of Service causing billing complications and/or denials.

Medicare Re-enrollment - medical billing news!

2009-05-09T09:12:00.000-04:00

Re-Enrollment has changed quite drastically from 27 months to 30 days, so something to be aware of. Also, if a change of address or location is not made within 30 days, there’s the risk of being expelled for 2 years. This comes at a time when many physicians are actually dropping many Medicare and Medicaid patients. The changes must be registered with the Medicare contractor.

One large concern is the paper flow as a physician could go to work before the initial process is completed for enrollment. The AMA is pushing to get the deadline extended for such changes to 90 days. Practices are not holding off on purpose, it’s just that there’s some real big mountains of administrative work that pile up today.

If the contractor denies enrollment instead of rejecting there’s a 30 day window for the physician and contractor to rectify the initial errors, so this could also offer some relief. Guidelines state that internet enrollments should be within 45 days, while 60 days is the expected time frame for those enrolling with paper.

Don't just get software; GET A BUSINESS PARTNER!

2009-05-04T18:35:00.002-04:00

It is all too easy to select a software provider, as a medical biller.
At least it sounds easy...
Well, it's not.
What should you look for?
1. Customer service and availability
2. Ease of use
3. Technical support and their availability
4. Clearing house information and workings
5. Company size
6. Country of origin
7. What they do when you are in a bind for help
8. Staff turnover
9. News and press
10. References

Align yourself with an internship program - Medical Billing News!

2009-04-30T16:43:00.003-04:00

One of the most important parts to any medical billing program is the opportunity for students to get real experience by working in an externship. Externships allow students to leave the classroom setting, and to work in an actual medical billing office. This not only provides great experience, but it also might provide a job recommendation when you start looking for a billing and coding job after graduation. Vocational schools can never promise you a job, but they can help you get experience in an externship - which is a step toward getting a real job. Check with the medical billing program near you to find out if they offer an externship or internship program for students and/or graduates.

As a medical billing business owner, aligning yourself with an externship program can be one of the smartest decisions that you can make. These folks are fresh out of school and are extremely eager to learn and to help out. Importantly, this relationship or arrangement can help the medical billing business owner tremendously. After all, it is free labor which is every business owner's dream especially in the business building stages - obvioulsy as long as the externs are honest and capable.

Get an attorney - don't go it alone!

2009-04-21T15:11:00.003-04:00

I cannot stress enough the importance of having an attorney review all of your documents, especially your contract or agreement.
It is so important to protect yourself as the medical biller.
Also, do NOT ever change the language on your own. If a potential client requests a change in terms or in the language, take that request immediately to your attorney to discuss and review.
Many people have been hurt by "inocently" editing their contract. It ALWAYS bites you in the end. So, tread lightly.

Chosing a medical billing software - medical billing news!

2009-04-20T09:19:00.000-04:00

Prior to purchasing medical billing software and making thousands of dollars investment please read reviews listed regarding the various Medical Billing software programs available. Some practices we've seen have not asked the right questions. The salesman in general will only cover the most common features of their medical billing software, and is not in it to train on how it works.
This of course would be a bit counter productive as some experienced billers are the toughest to train. Experienced billers are experienced in their current software and requires an open mind and patience while learning a new way i.e. online or web-based medical billing. Ironically, some trainings I've attended have included an inpatient experienced biller that was challenging the software and how it should work i.e. like their old medical billing software. The trick is asking the right questions and making sure the salesman puts it in writing so you can back up promises made.

How to create a medical billing contract - medical billing news!

2009-04-17T12:37:00.001-04:00

Creating a contract to be used for medical billing is a total necessity, but can get expensive.
Your contract should consider BOTH parties.
Not only a business agreement and strategy, but an EXIT clause needs to be included.
Always be certain to check with your attorney before using ANY medical billing contracts. Most of those out on the internet, even for purchase, are guidelines and/or samples.
Don't make a mistake by purchasing and immediately using such a contract without consulting an attorney. Remember terms change according to circumstance and state, so check your requirements!

Is it possible to run a medical billing business WITHOUT a computer?

2009-04-16T14:34:00.002-04:00

The answer is YES, but NOT without pain.
Without a software program or method to submit medical billing claims electronically, you would need to do the following:
1. Purchase and house the latest CMS 1500 forms.
2. Complete each claim / form by hand.
3. Mail the forms in and cross your fingers in hopes that they make it to the insurance carrier.
4. Follow up by phone beginning 4 to 6 weeks after sending to confirm receipt at the insurance carriers.
5. Call again in another 4 to 6 weeks to check the status of them being processed.

As you can sense, it is possible to run a SMALL medical billing business without a software and without technology, but it is CHALLENGING. Again, possible.
So, if funds are an issue, do a little research and go with what you have even if it's a paper and a pen to get yourself going.
Know that once you have a couple of clients, you CAN invest in your business by purchasing a software. Visit www.MedicalBillingFoundation.com for software informatin and for a no-obligation, free demonstration today!

The importance of a computer system - medical billing

2009-04-10T14:18:00.003-04:00

One of the most important and possibly the most costly purchases for today's medical practice is the office computer system. Computers are used for a variety of purposes, even if the billing aspect is outsourced, as is often the case. Large groups and small practices alike use the Internet for connectivity to other businesses, such as hospitals, pharmacies, insurers and vendors. The office staff can even order lunch via the Internet, or place their orders so their groceries will be delivered when they arrive home from work. In addition to Internet use, the office computer can be used for word processing and document creation, appointment scheduling, fax transmittals, bookkeeping and voice dictation. It does not matter whether you are buying your first or your fifth system, selecting the right setup for any size practice can be a mind-boggling experience. To those who think buying a car or house is one of life's biggest nightmares, be forewarned that by comparison choosing and purchasing a medical computer system makes those look like child's play.

Tips for submitting claims - medical billing news

2009-04-08T16:17:00.001-04:00

Helpful hints to reduce claims processing time!

Submit claims electronically. ODS processes electronic claims first each day.
Verify the patient's relationship to subscriber and plan information is correct before submitting claims.
Include all pertinent information. Date of birth, subscriber ID, valid CPT and ICD-9 codes.
If the patient is covered by more than one ODS program, submit one claim form indicating the name of the subscriber, subscriber ID, employer (if applicable), and ODS group number for both plans. If covered by another carrier, indicate the above information plus the name, address and policy number of the other carrier.

If a patient has primary insurance through another carrier other than ODS, the EOB from that insurance company will need to accompany the claim for consideration of payment.
ODS makes payment twice per month.
Please contact us before submitting duplicate claims:
Re-billing without contacting us slows our turnaround time and delays payment.
Check Benefit Tracker to see the status of a claim. If you haven't registered for this free online service, click here for more information.
If you receive a PDR indicating that your claim has already been processed before you receive a check, this indicates your re-bill was unnecessary. The claim was processed and is pending for the next scheduled payment date.
DO NOT USE HIGHLIGHTER ON PAPER CLAIMS.

Rules for Succeeding in your own business - medical billing news

2009-04-07T13:50:00.001-04:00

Ten Rules For Succeeding in Your Own Business
by Janet Attard

What does it take to start and succeed in business? That's a question I get asked a lot by startups and by owners of existing businesses that aren't living up to the owners' dreams. Although there is no one answer that fits all businesses, there are a number of practices followed by successful, happy business owners. No matter what you sell, you'll be ahead of the game if you live by these ten essential rules for succeeding in your own business.

1. Be true to yourself. No matter how much money someone else makes, if you don't enjoy the business, wouldn't be proud to show your relatives what you are doing and how you are doing it, then don't do it. If you run a business you don't like or don't believe in, even if you have temporary success, it will come back to haunt you one way or another.

2. Find a need and fill it. Yes, you've heard that a million times. But it still works. The easiest business to run is one that produces products or services that people already know they need. The reason: you don't have to spend a lot of time and money convincing prospects they need what you sell. You can focus on why you are the best source to satisfy their need. Just be sure the "need" is one people will spend money to satisfy.

3. Choose products or services that you can sell for a lot more than it costs you to make or buy them. If the difference between your cost and selling prices is too low, you will have difficulty growing the business. When profit margins are too low, you won't have enough money to hire employees, pay for rent (when you need to move the business out of the house), advertise more, and do other things needed to expand.

4. Make realistic estimates of your expenses... then double them. Most new businesses either forget about marketing, fulfillment, overhead costs, income taxes and self-employment or greatly underestimate them.

5. Be true to your customers and prospects. Don't promise what you can't deliver. Don't lie or exaggerate the benefits of what you sell and always deliver a quality product or service. Word-of-mouth marketing has always been one of the primary ways small businesses find customers. The Internet and social networking sites spread the word (good or bad) to even more potential customers.

6. Understand the importance of marketing and learn how to do it effectively. The world won't beat a path to your door just because you build a better mousetrap or write a great ebook about how to grow tomatoes or teach a child to read. To get customers you will have to market your products or services effectively and continually.

7. Treat your vendors, manufacturers and service providers with respect and let them know you appreciate them. They are an important part of your team and your success. If you speak down to them, pester them with questions you could answer yourself, imply that they don't' do a good job, nickel and dime them to death, or are an ongoing pain in the neck, they'll never go out of their way to help you -- and might drop you all together. No business needs picky, annoying, time-consuming customers.

8. Embrace the web. No matter what you sell or to whom, there's a good chance your customers will turn to the web in one way or another to make their purchase. They may turn to online yellow pages to find a florist in Florence, SC; or go to Google, MSN or Yahoo and search for a phrase like "Elder law attorney Farmington Hills MI", or "plumber weekends Astoria NY" If customers can't find you in their queries, they are likely to give their business to one of your competitors.

9. Don't expect miracles. Yes, people do make money in their sleep or while they're away on vacation -- the Internet makes that possible. But only after they've invested a lot of time , effort, and money in building the business and building the team that keeps it going and growing.

10. Remind yourself that one is the loneliest number in business. One product, one service, one main client, and all your records stored on one computer hard drive without regular off-site backups is a recipe for failure. If you only have one product or service you're missing out on the chance to profit by selling more things to people who already know and trust you. If you have only one main client, you 're up the proverbial creek if they decide to change vendors or run into cash flow problems. And if all your records are on your computer and you don't have always up-to-date backups of your important files, a hard drive crash could destroy your business.

© 2009 Attard Communications, Inc. May not be reprinted without permission from the author.

Large medical billing firms

2009-04-05T11:30:00.001-04:00

The days of medical billing where you walked into a doctor's office and the receptionist was busy printing out the few bills she had are long gone. Today, most of the medical billing that is done is done by very large companies. While this may seem more efficient and certainly more profitable to their customers, there are many pitfalls that a large company can fall victim to. In this article, you'll read some basic tips that large medical billing companies should follow in order to get the most out of their operation. Hopefully, by following these tips, you'll save yourself a lot of grief and heartache over the course of time.

The first and probably most important thing, is for the company to set itself up in such a way as to maximize productivity and at the same time minimize the risk of running into serious problems. One way to do this is to divide the billing responsibilities up among departments. If you're representing a large client base, you'll probably want to have one section of the staff handling billing for doctors in private practice. These will probably be your smallest accounts and as a result, you'll have to dedicate the fewest resources to this section. Another section should be assigned to handle the billing for large facilities. This is where the bulk of your billing will probably come from and you're going to want to have a large enough staff to handle it.

The next thing you're going to want to do is setup your software in such a way that it allows for growth without having to worry about your network getting bogged down. This is probably the most complicated part of the process of setting up an operation. It's often very hard to look into the future and see how much volume of billing you're going to do. But if you intend on going after the facility market, there is a very good chance that your operation is going to grow at a rapid rate. How do you prepare for this?

For starters, you're going to want to do the same thing with your software as you did with your departments. You're going to want to split up your databases into departments as well. You'll have one database for each item in your software for doctor billing and another database for facility billing. You will probably want to further break down facility billing into two sections of the alphabet. Possibly have one database for patients and facilities from A to M and another database for the letters N to Z. This will need to be done for all databases in the system.

As you have broken down the databases, you're probably also going to want to break down the staff as well, having half the staff take care of all patients from A to M and the other half taking care of patients from N to Z.

The above only scratches the surface as there is also the issue of forms, networking, software updates and a number of other issues. The point is, you're going to have a large operation and breaking it down into separate parts will make your company as a whole more manageable and ultimately more profitable.

Michael Russell

Denials are not always clear cut ! The hunt is on!

2009-04-02T17:06:00.003-04:00

After being a successfull medical biller for several years, there are thing about the insurance carriers that you just figure out.
For example, insurance carriers "mistakenly" deny claims occasionally.
Yup, it is true. I know how shocked you are! LOL.
Anyway, the PAIN of this is that it is YOUR job, as a professional medical biller to follow up on those denials, offering outstanding medical billing service.
It is a painful fight, but understand that insurance carrier often deny a claim because A.) they can B.) They doubt anyone has the time to challenge it C.)they can - yes, I said that twice.
The point is that it is challenging to followup on every single denial. The good news is that MOST carriers give you one entire year to challenge a denial, so breathe.
You have a lot going on as a medical biller. This is just one more piece of the pie.
Good luck and visit www.MedicalBillingFoundation.com for more info!

Medical Billing Service for heavy PIP & WC clinics

2009-02-11T08:21:00.002-05:00

Some Medical Billers tend to shy away from medical practices or rehab centers that deal heavily in PIP and Workman's Compensation claims.
I do just the oposite.
Yes, there is more work involved and yes, there is a lot more paperwork, BUT the return from commercial insurance carriers is HIGH.
The health carriers will reimburse approximately 30% of what was BILLED.
PIP & Workaman's Comp carriers (or commercial carriers) reimburse more like 80 to 100% BILLED.
Something to think about...

Become Technologically Savvy - it's a MUST

2007-11-06T10:21:00.000-05:00

The days of a single-person, home-based small and simple billing person are quickly becoming extinct - and are nearly GONE.
It is IMPERATIVE that Professional Medical Billers in TODAY'S market are technologically savvy business owners!
If you are not, you will fall short, if not fail entirely.
Take appropriate courses.
Become active members of Medical Billing associations and / or foundations - where they ACTIVELY provide information and updates.
Try not to align yourself with stagnant sites. Partner with those that are actually run by current medical billers (like www.MedicalBillingFoundation.com).
ALSO - partner with the best software provider available.
By "best" we mean the most secure, the most convenient, the most current or coming-of-age technology.
Be as GREAT as you can be - and as ahead of your competition as possible.

How to Select a Medical Billing Vendor

2007-10-29T08:52:00.000-04:00

How to Select Medical Billing Vendor

Billing performance defines quality of billing providerThousands of billing service vendors offer solutions to poor inhouse billing performance of an average practice and increasing scrutiny of billing processes by insurance carriers. However, selection of the most suitable billing service vendor is not simple. It requires rigorous approach outlined below.
[edit] StepsScope of Services.

Scope of services may include complete practice workflow starting with appointment scheduling to electronic medical records, SOAP notes, and billing, or it may only be focused on billing.
Billing too may be limited to just electronic submission, add validation, or include payment posting, reconciliation, followup, secondary submission, and patient billing.
Each aspect mentioned above should be ranked according to specificity and coverage.
Compare Billing Models.

Is it an aggressive or a defensive billing firm?
Which of the following functions are automated: upfront validation, submission, reconciliation, and follow-up workload allocation?
Which specific errors are handled automatically at the upfront validation level?
Compare Reporting.

Operational Report shows total claims and $ amounts submitted, paid, adjusted, written off, and failed. It allows breakdown by cpt, payer, referral, or a combination of such dimensions.
Denials Report shows a list of denied claims and a log of followup actions. By sorting it by amount paid, you can tell the smallest payment the billing service will fight for.
Reporting Frequency: What is the turnaround time for new reports? How frequently can you receive the reports? What is the method to access them?
Data Aggregation and Analysis: If web-based access is available, do the reports allow drill-into more detail? Is it possible to refine and sort reports on-line and along multiple criteria? Is it possible to export to Excel spreadsheets for further analysis?
Compare References.

What do current clients think about the quality of service? Can a client comment about any of the criteria on this list as well as cite specific improvements over time?
Compare Billing Service Quality.

What aspects of the billing process are measured? Do they include separate collections and payment delay measures? How is delay measure defined: does it measure the time elapsed from claim creation until payment by the primary payer or does it start at service delivery and measure the entire period until receiving payments from both payers and the patient? Is a histogram of payments available for client review on a periodic basis?
Compare Billing Process Quality.

Which processing quality metrics collected? Do they include coding, submission, and follow up delay metrics? Do the metrics include both claim stats as well as fiscal value statistics?
Compare Billing Transparency.

Can the candidate billing firm readily provide quality metrics and access to every step of the billing process on a continuous 24 x 7 basis over the Internet? Transparency is a critical aspect of outsourcing billing service because without transparency the service may not be reliable.
Compare Compliance Features.

Does the billing company have a compliance program in place? Is there a Code of Conduct?
Compare Communications Protocols.

Is there a formal and simple process to report problems and track their resolution? Is there a competent account manager? How often a meeting is held to review outstanding problems?
Compare Technology.

Does the firm offer access to specialized technology? Does it require software installation and maintenance or is it available on the Internet using a standard browser?
Compare Measures for Data Security and Protection.

What are data center facilities? Is the technology HIPAA compliant? Is the access to the claims secure? Is data protected? What are disaster recovery facilities? Is there a regular backup process? At what intervals? Where is the backup data stored?
Compare Data Entry Protocols.

Is Superbill available online? Can the claims be just faxed? Is there a separate form for patient and charge entry, EOB posting, and on-line claim editing? Are any of the claim validity tests available during data entry?
Compare Processes for Continuous Improvement.

How does the firm identify systemic errors? How does it ensure that previously made mistakes do not repeat?
Compare Scalability.

What billing process steps are automated? Can the firm take on another client without impairing service quality?
Compare Size.

What are the firm’s gross annual billings? How many claims does it process annually? How many practices is the firm billing for? What specialties does it currently handle?
Compare Staffing.

How large is the staff and what is the reporting structure? What is the educational background and experience of staff and management? Would adding your practice require the billing firm to hire additional staff?
Compare Responsiveness.

Consider technical systems access and problems beyond late AR or incomplete payment. How quickly does it take to respond to a technical problem notification? How quickly does it take to resolve a problem?
Compare Pricing.

Most billing firms charge for services a percentage of monthly collections. This percentage varies among specialties, depending on the average claim billing size and claim volume. Note that the lowest cost provider is not necessarily the best. It is in the physician’s interest to see that a quality billing service makes an adequate profit. Otherwise, the billing firm will be forced to reduce the amount of effort spent on supporting the practice, resulting in lower quality.

My Own Invioces as a Medical Biller

2007-10-09T07:45:00.000-04:00

One of the most difficult challenges for me and my company is staying on top of MY OWN billing to my clients or our Medical Billing services.
Here are some suggestions / tips to stay on top of your company monies;

1. Enter data into QuickBooks each week. Don't create piles or files "promising" to dedicate time once per month for entry.

2. Get yourself a GREAT CPA. One that can not only manage yoru taxes, but one that can coach you in your business along the way as well.

3. Keep your invoicing schedule to once per month. Don't send out 4 clients their bill week one and another 6 the next, etc. It is WAY TOO hard to keep track of. If you started billing like this, simply make an announcement in your next invoice explaining that you will switch your billing period to the first of every month, or the 15th of every month, etc.

4. Finally, when you can afford one, hire a book keeper. Like you try to explain to your private practice owners - outsourcing is more effective. PRACTICE WHAT YOU PREACH!

Stay on TOP of those NEW client's bills!

2007-09-24T19:01:00.000-04:00

When you are fortunate enough to earn an account and you electronically submit their very first batch of claims, MARK YOUR CALENDAR.

I CANNOT stress the importance of calling the various carriers to MAKE ABSOLUTE CERTAIN that those claims were 100% processed correctly and that they are ready for payment.

COMMUNICATE to your client that it WILL TAKE a couple of complete billing cycles to MASTER their account in your system and with the carriers. Claims WILL fail and you NEED to tell your client this. It is absolutely inevitable.

But, like we continuously say, stay HONEST. If you tell them this up front, they will NOT become upset if they receive a couple of rejections, ESPECIALLY in the beginning.

COMMUNICATE, COMMUNICATE, COMMUNICATE!!

Never "Fake it" Until You Make It!

2007-08-21T12:42:00.000-04:00

Even though, you are working hard to earn clients, you should never pretend to know answers to things that you are not certain about. It is better to jot down the question and ask permission to get back to the prospect.
DEFINATELY do not drop the ball - get the answer as soon as possible and email, call or fax the answer that is needed.
Those that Fake it FAIL.

Medical Billing - Contracts and Necessary Documents.

2007-08-09T09:26:00.000-04:00

Yes, there are MANY documents and contracts and other "sales" tools that you will need.
Questions that I have been asked:

1. How will you know which tools and documents to use in your business?
2. Where do you begin to look for help in creating?
3. What kind of money will you expect to spend if you are starting from scratch?

Answers / Feedback:

1. You won't really know unless you become educated in what is necessary, which is VERY difficult to do. There are great courses available and great software options from which to chose, but they generally fall short. The courses educate you in billing and processes and the software is the tool that you wil need - but THEY DON'T offer the final piece, which seek the documents required. There are NOT a lot of one-stop places available where you can fill the 3rd segment of needed documentation in order to START prospecting, presenting, proposing, earning and contracting a client. In fact, we only know of one, which is The Medical Billing Foundation.

2. www. MedicalBillingFoundation.com. They offer a one-stop shop to purchase an E-Book entitled, "The Medical Billing Business Start Up Manual", where you are literally given all of the templates, tools and techniques needed to START your business.

3. If you are starting from scratch you can expect to spend anywhere from $10,000 to $60,000 creating your own documents and tools, etc. from scratch to include your attorney fees. Yes, this is a real number. Not to mention all of the time that it will take you. Statistics show that over HALF of the medical billing businesses that start FAIL because they do not know the required tools to begin the business part of medical billing. The other HALF succeed, but spend so much time and money right out of the gate, that they stay "in the red" for a lot longer than they could have, if offered a resource like The Medical Billing Foundation's E-Book. That is why the manual mentioned in answer number 2 is best AND it costs well under $1,000 for all of it!

Medical Billing - A Company Brochure; Is It Necessary?

2007-08-07T09:39:00.000-04:00

YES. YES. YES.
As a Professional Medical Biller, you will meet MANY people to discuss your business.
The question is, What will you leave with them to review once you are out of sight? A business card? A brochure?
BOTH.
A business card alone is NOT enough.
When I was starting out in my medical billing career, getting the funds together for all of these necessary pieces for my business was challenging, to say the least.
I was invited to submit some of the things that I USE day to day to an organization known as The Medical Billing Foundation.
This Foundation was created by an alliance of professional billers like me, that ALSO spent THOUSANDS putting their tools in place in order to conduct their business.
The Foundation offers a powerful manual which INCLUDES business cards and a brochure.
You can modify BOTH to add YOUR COMPANY INFORMATION and print ONLY what you need.
Printing companies and brochure design companies will cost a lot for the same thing that the Foundation offers for a fraction of the price.
The point? BOTH a business card AND a brochure are imperative as a "leave behind" whether talking about your business to family, friends, or perspective clients. GET BOTH.

Medical Billing Tips to Aviod Privacy Breaches

2007-07-31T06:49:00.000-04:00

As a Professional Medical Biller, I RARELY send ANYTHING in via paper!
It is imperative that you ally with a prominent software company that is AHEAD of today's technological and processing standards. The one that I chose to partner with is DAQBilling owned by Antek Healthware out of MD.
They offer an ASP, thin client model with mulit-server backup every hour of every day, so my data is never in jeopardy.

This article focus is on PAPER claims and the tips that go along with processing medical claims on paper.

Tips to Avoid Privacy Breaches

Protect the health information of recipients during the paper claim billing process.

It is important to protect the health information of recipients. Providers can help in this regard in the paper claim billing process. Accuracy, completeness and clarity of the form are important to ensure that the information is read correctly. Forms can be misread if information is illegible. Illegible information may be corrected manually, which results in a delay of timely processing of claims and also presents the chance of a privacy breach. To avoid protected health information being sent to the wrong providers, thus resulting in health care privacy breaches, please adhere to the following guidelines when submitting paper billing forms:

Avoid printing claim forms using a dot matrix printer. Dot matrix print is not clear and may be misread by the OCR equipment. Laser printers are strongly recommended.
Frequently change the ink cartridges on the printer to avoid light ink. Light printing is not legible and may be misread by the OCR equipment.
Use black film-type or high-quality ribbons. Ribbons should be changed regularly to ensure that a clear, distinct character is printed. The OCR equipment may misread blurred or light printing.
Whenever possible, type all information. Use 10-point font or larger (not to exceed the size of the field). The OCR equipment can only scan typed or computer-printed forms. Do not use script or italic font.
Handwritten forms should be printed neatly and accurately using black ballpoint pen only. All requirements pertaining to typed forms, such as entering data within the text space, apply to handwritten forms.
Type only in areas of the form designated as fields. Be sure the data falls completely within the text space and is properly aligned.
Verify that the billing provider number and beneficiary identification numbers are correct.
Furthermore, providers are encouraged to explore the many benefits of electronic claims submission, funds transfer, remittance and other business transactions. These electronic transactions expedite processing, minimize errors and streamline business office operation. Recent enhancements have expanded the types of electronic services available to the provider community.

Medical Billing - The Almighty Combo!! Yes, it's ALL YOU NEED!

2007-07-26T14:43:00.000-04:00

Tell me...
DO YOU Want to start off in the RIGHT FOOT in becoming a Medical Billing Business Owner?
All you need are FOUR pieces.
Ready??

1. Buy the full course (or better yet, the Success Package) at www.MedicalBillingCourse.com

2. Buy DAQBilling software

3. Buy the Mediccal Billing Business Manual and become an active member of The Medical Billing Foundation by visiting www.MedicalBillingFoundation.com

4. Excercise commitment, determination, and NETWORK!

All together, you will have a turn-key business package for WAY LESS THAN $10,000! In what other industry could you completely open your business for that little of an investment??? NONE!

Look at trying to buy a franchise - it's IMPOSSIBLE.

Reduce Your Medical Billing Firm's Claims Rejection Rate!

2007-07-13T07:59:00.000-04:00

IMPORTANT TO KNOW... Stay on top of current and changing requirements to reduce your Medical Billing Firm's claims rejection rate!

Treatment may be covered for one condition but not covered for another. For example, arthodesis may be covered for a dislocation but not covered for an anomaly. Remember, the pairing of the condition with the treatment determines which line the service is on.

Reasons For Denied or Returned Claims:

A Clean Claim means a claim that has no defect, impropriety, lack of any required substantiating documentation or particular circumstance requiring special treatment that prevents timely payment in accordance with the Member's Health Benefits Plan and the Provider - Payer Agreement.

A Clean Claim shall not include those claims which require coordination of benefits and third party liability issues until receipt of Explanation of Benefits from primary carrier or claims, which are being reviewed by the Medical Director, Medical Consultant, or Peer Review for medical necessity.

A clean claim shall accurately reflect billed Charges. “Substantiating Documentation” includes, but is not limited to:

Legible claim form—CMS UB 92, CMS 1500 or other required forms
Full Name of Patient/OHP Member
Member's Date of Birth
Member's Recipient ID Number
Date(s) of Service
Place of Service
CPT Procedure Code
Modifier(s) if applicable
Line Item and Total Charges
Quantity of Units of Service
ICD-9 CM Diagnosis Code (to the highest specificity)
Physician's Name and Address
Physician's Tax ID Number
Bill type
Admission date and time
Discharge date and time
Billing number for Facility
Revenue Center Code
Date of Service for each line item
Quantity of units of service
Line item charges
ICD-9 CM Diagnosis Code (to the highest specificity)
CPT HCPC code
Attending Provider Number
If applicable, Inpatient Nursing Facilities
Bill type
Admission date and time
Discharge date and time
Nursing Facility Billing Provider Number
Type of Admission Code
Patient Discharge Status Code
Date of Service (dates of admission through discharge)
Dates of Service through discharge except continuous stay nursing facility clients
(Use the last day of the month or the discharge date)
Revenue Center Code(s)
Line item charge(s)
Total Charge
ICD-9 CM Diagnosis Code (to the highest specificity)
ICD 9 CM Procedure Code when a procedure is performed
Attending Physician OMAP Provider Number
Written referral, if applicable

A Clean Claim shall not include those claims which require coordination of benefits and third party liability issues until receipt of Explanation of Benefits from primary carrier or claims, which are being reviewed by the Medical Director, Medical Consultant, or Peer Review for medical necessity.

Do yourself a favor and cross-check each claim that you enter to verify you have all applicalble information above.
You are a professional medical biller - do your BEST to gain the knowledge and skills required to EARN the right to call yourself such.
For help or guidance on this and more, visit www.MedicalBillingFoundation.com

Medical Billing Tip - STOP PROCRASTINATING!

2007-07-09T10:32:00.000-04:00

I found this article which can help ANY person in ANY business type, but I found that it hit home for me in my industry which is medical billing. I often work into the night, feeling that there is NEVER enough time during the day to get done all that I have to do. This can be a NASTY business practice - it invites a feeling of resentment toward's one's very own business.
Projects are a challenge and breaking a project down to reasonable pieces can be a BIGGER challenge.
Here is a list of 5 tips from an expert.
You can read more at www.ezinearticles.com
As you read this, think through these tips and how they relate to you and your duties as a professional medical biller!

Developing the skill of procrastinating over an activity that doesn’t have much impact on your business is not an issue. The problems start when you procrastinate over important and critical activities that have an impact on your productivity and increase your stress levels.

Here are five top tips to help you overcome procrastination.

1. Daily planning the night before.
People don't plan to fail; they do sometimes fail to plan. Without a plan of action in place before you arrive for work it’s too easy to get caught up in ‘stuff’. The phone rings, you get engrossed in your emails, someone pops into the office and you spend your time responding to the loudest voices rather than to the most important priorities. A plan of action, prepared the night before is like a roadmap for the next day. It focuses your brain on the important aspects of the day and creates a path of the steps you need to take to get you into productive action and away from procrastination.

2. Work with a clean desk.
Out of sight, out of mind. The reverse of that is also true. When it's in sight, it's in mind and most of us can’t help getting distracted. You’ll then create the danger of your time being directed to less important and easier tasks, causing you to put off more important activities. Working with a clean desk or clean work environment allows you to focus all your attention on the most important tasks…without other visual distractions.

3. Reduce large projects to bite-sized pieces.
How do you eat an elephant? One bite at a time!
Tomorrow you plan to work on a three-hour project. Unless you are very lucky, you won’t have three hours to work on any one activity. You have to deal with interruptions, meetings and anything else that crops up. That’s in addition to the challenge of a three-hour attention span! It’s easy to end up procrastinating on big tasks because you’ve not enough time to get it done. So, instead of scheduling the entire three-hour project for tomorrow, schedule a small bite: a step or two that might take 20 or 30 minutes. Then put the next step on the next day's ‘Action Plan’ list and the next step after that on the next day's plan. It may take you several days, but you will get that elephant eaten up, one bite at a time.

4. Plan around interruptions.
Interruptions tend to occur in identifiable patterns. You may get most of your interruptions early in the day rather than later in the day. You may get most of your interruptions early in the week rather than later in the week. So, if you plan a big project make sure it works with your normal schedule of activity. Don’t create stress for yourself before you begin. As soon as your interruptions arrive they will re-focus your attention, causing you to procrastinate what you really want to do. It’s so much easier swimming downstream with the current rather than against the tide. Therefore, plan those larger projects for quieter times of your day and week when you tend to get fewer interruptions.

5. Assign deadlines.
Have you ever failed to achieve a New Year's resolution? If so, that probably happened because you didn’t set a deadline. Deadlines will move you to action. Without a deadline, activities will end up in your ‘soon as possible’ pile, a never never land where items might get attended to some day, when you get the time. Create a deadline and you’ll be moved to action.

Now go do those sales and marketing activities you know will generate business for you!

Medical Billing - Web Presence; Is it Necessary?

2007-07-04T09:20:00.002-04:00

YES. YES. YES!!!

As a medical billing professional, I purchased a web site immediately! I did not have much money, so I purchased a basic template that had several pages about what I do. As I mentioned, it was a template - quite generic, but it offered me a lot. It offered me the appearance of having more experience than I really had. Also, a few days after meeting with a practice owner, handing them my business card and "First Appointment Folder", they would review the provided information and visit my site to confirm all that I promised them. Medical Billing companies that do not own a web site do NOT do as well as those that own one.

Again, starting off is difficult and costly, so just get a VERY basic site that describes your talents and details exactly what you do. Templates are available to you for very little cost at www.MedicalBillingFoundation.com. I am confident that the sites available there are under $500! That is "CHEAP"! (pardon the expression)

As a medical biller, a web presence is a necessity! Mark my words!

So the tip for today is to get yourself a web site - no matter how basic. Your company will be "Googled"! I promise you!

Medical Billing - You DO NOT Need to Earn a Coding Degree! Suprised??

2007-07-03T09:12:00.000-04:00

Many individuals considering a career in Medical Billing have ZERO knowledge about the industry and the requirements to open a Medical Billing Firm. MOST will speak to friends and family, call local colleges, and search the web looking for information on HOW to begin. A COMMON misconception is the necessity of becoming a certified coder.
I own and operate a successful medical billing company. I am NOT a certified coder, nor do I pretend to be. I HIRED a certified coder as a member of my staff. This young woman attended a medical coding course for 1.5 years and was referred to me for work. What people don't realize is after you spend $5,000 to $15,000 on a coding certification course, you complete the course with one MAJOR QUESTION - "Now what do I do?" Many of these medical coding institutions CLAIM that the employment market offers a LONG list of coding jobs. This is simply NOT the case. A certified medical coder MAY find work at a hospital or major clinic. That's it. I know MANY coders that finish their education and CANNOT find work - they don't fulfill a need.
Medical Billing is a different animal all together. What I recommend is the following;

1. Go to www.MedicalCourse.com and buy the 9-chapter course on medical BILLING. Tammy Harlan is the owner of this course and it's offerings. I took the course and I cannot tell you the value and understanding of billing that I learned. It walks you through ALL aspects from start to finish - from the point of receiving a superbill and patient info sheet all the way through posting payments and aging. It also educates the student on industry rules and language. It is a VERY cost effective course being offered for UNDER $1000, start to finish. ALSO, it is taken at your own pace. Some finish the course in two weeks, some in two months - depends upon the student's employment status, commitment and personal obligations to study around.

2.Align yourself with a powerful, accredited medical billing software provider. My favorite? DAQBilling, by Antek Healthware out of Maryland. This company is phenomenal. Their tech support is top notch and their SALES assistance is key to your success in this industry!

3. Go to www.MedicalBillingFoundation.com. This site was created by an alliance of members who ARE successful medical billers. They recognized that new Medical Billers still have a VOID even if they complete steps one and two (indicated above). New Medical Billers are HUNGRY for help in the STREET portion of really applying their new knowledge to practical application - LIVE on the street, meeting private practice owners and doctors. They offer networking advise, effective marketing tools, a modifiable brochure and business card template, presentation documents, proposal ideas and documents, contracts and agreements relating to confidentiality and HIPAA compliance. THE WORKS. They also offer monthly webinars, conference calls and regional seminars. Why REINVENT THE WHEEL? Rub elbows with fellow medical billers - successful ones. Their package is ALSO under $1,000! AND, the webinars, conference calls and seminars are VERY reasonable prices d too.

With the three steps COMPLETED above YOU WILL BECOME A SUCCESSFULL MEDICAL BILLER.
Tip for today?
DO NOT WASTE YOUR MONEY ON A MEDICAL CODING DEGREE - UNLESS you would like to work in a hospital.
If you are looking to STARTING a Medical Billing Firm - DO THE COURSE, GET DAQBilling, Get the tools for success.
This, my friend, is ALL YOU NEED.
This is one heck of a tip.
The only thing that I cannot offer you IS THE DRIVE for success.
I suspect that you have it if you are willing to invest (LESS THAN) $7,000 on your business.
I am not down playing the amount of money $7,000 is - BUT, NO OTHER BUSINESS OPORTUNITY IS AVAILABLE FOR THAT LITTLE MONEY.
GO FOR IT!

Medical Billing - The Truth About this Industry & It's Potential

2007-07-02T08:33:00.000-04:00

"Medical Billing Home/Office Business
The health care industry is predicted to add nearly 3.5 million new jobs between 2002 and 2012, an increase of 30%. (U.S. Bureau of Labor Statistics). Taking advantage of this growth by beginning a Medical Billing Business now is a smart move!"

The quote above was provided by Tammy Harlan of www.MedicalBillingCourse.com, a nationally recognized course offered for VERY reasonable costs.

This medical billing business is NOT seasonal and it IS recession-proof. Doctors need to bill for patients that saw them on Valentine's Day, Christmas day, during Hanukah, Thanksgiving, etc.

So, TODAY's tip is to GET INVOLVED IN ONE OF THE ONLY GROWING INDUSTRIES IN THIS COUNTRY!

Medical Billing - Getting answers to the RIGHT questions the first time!

2007-06-29T10:21:00.000-04:00

As a seasoned, professional medical biller, I often think about where I AM vs. where I began in this business. After earning many private practice owners as clients, it has been quite the road n figuring out EXACTLY what is needed to begin working for these practitioners. It took me MONTHS of errors and THOUSANDS of dollars literally FAILING to really "get it". I had so many questions about what I really NEEDED to get started in this billing business. I have since met MANY people interested in developing their own medical billing firms. They generally take some sort of course, align themselves with a software vendor and "believe" they have what they need. I WAS the same. But, unlike many, I DIDN'T "FORGET" TO START! But, I may be different than others - I try and try until I figure it out. I believe in persistence and determination. BUT, I also believe in HELP. It is IMPERATIVE that you gather KEY data in order to set a practice up correctly the first time. There are many things that you require that go beyond their business name, tax id and address. I am an active member of a foundation that was created by an alliance of medical billers from all levels of experience. I have contributed to the foundation and other members selected ONE of my tools as an offering for use. My questionnaire. There are MANY additional tools available through the foundation that EVERY MEDICAL BILLER needs! Check out the foundation by visiting www.MedicalBillingFoundation.com. The membership fees are so reasonable for what you receive. The continued education that I receive, I actually pass on to my clients, which demonstrates my ever-growing knowledge in the industry. Frankly, I do not have time to conduct independent searches. The foundation gathers the updates for me and I simply share it with my clients. They even have a newsletter that I download and use as a handout to both clients and prospects alike. There are forums and blog pages available which encourages medical billers to stay connected and to share information and experiences. I am anxiously awaiting their webinars and seminars. My tip today is to BUY the help that you need AND do not "forget to start" by not having complete tools or information. Utilize what is readily available and proven to work, created by other experienced medical billers. I am COMPLETELY pleased with both their offering and their pricing. I cannot believe that I spent over $20K on what it NOW available in ONE PLACE for under $1,000. Hindsight is (unfortunately) ALWAYS 20/20.

Medical Billing Career from Home; Managing a Healthy Balance Between Work & Family Time

2007-06-28T08:38:00.000-04:00

A home-office based medical billing career can offer some flexibility in work hours. To optimize your productivity and professional drive, it is important to examine some of your working "conditions", if you will.
Do you leave the primary areas of your home and go through the excercises of "going to work" for the day?
Maintaining a normal 40 hour work schedule and dedicated routine is incredibly important in maximizing your productivity. I recognized this early on and set up my electronic claims processing firm in a completely secluded area in my home. I spend family time in the morning, get the children off to school/daycare, get dressed for the day and technically "get to work" by 8:30 each day. I have a dedicated area, PC, phone line and other medical billing-specific office supplies in my work area. Having such a space set up effectively helped me tremendously in becoming successful. When I began my medical billing career, I found myself working very early in the morning (often in my PJ's) through really late into the evenings (back in my PJ's). During sleep, I would often dream about processing claims and meeting doctors at networking events. This is not necessarily healthy, especially if those dreams go beyond the initial excitement period of opening a business. I cannot stress enough the NEED to end my day at a normal time - 5 or 5:30 pm. It is imperative to have the space and TIME for client contact, business processes, and administrative duties. Also, allotted space and time for home life, family events and simply "being" with family. During the first month of opening my business, the cable television service in our main family living area was broken for an entire week and I did not know it - this was a quick awakening for me! I wasn't even watching the occasional news program to stay abreast in today's stories! I was rushing through dinner and NOT spending quality time with my family - all to jam-pack as much as humanly possible into a day - or in this case, night. These types of habits can prove detrimental as a medical biller. Our tasks can be daunting enough without the added stress of extra-long days and having "not enough time" to get done what needs to be done. One can "burn out" rapidly trying to maintain such a demanding schedule, which is utterly impossible to keep! Once I recognized the habit that could have potentially soured my taste to this most lucrative industry, I got some help and some guidance. The end-all message to you is to operate in an official and productive office, do your best to keep a normal 8 hour schedule, and don't be afraid to ask for and PAY for quality help.

The one place that I found that truly helps answer the "Now What?" questions about running my business was a foundation totally dedicated to medical billing success; http://www.MedicalBillingFoundation.com. This site not only offered documents, tips, plans, proposal samples, as well as advise on networking, effective marketing, an more - it also offered a detailed (down to the HOUR) plan of what exactly to do during the first full month in business as a medical biller! The membership costs are VERY reasonable and the information that comes from the foundation is invaluable. The reason? The data was collectively provided by successful medical billers from all over the country so that a NEW medical biller like me didn't have to waste time reinventing the wheel! I chose to purchase the tools made available to me ONCE instead of spending thousands on attorney fees alone creating my own, individual necessary documents and marketing tools.

Medical Billing Tips and Tricks

2007-06-27T11:45:00.000-04:00

There is MUCH to do once you have decided to open your own medical billing firm. Here is an important Tip. Considering that this industry is MOSTLY run by women in small business - do yourself a favor, DO NOT put your home address on your business cards or other business publications! First of all, how do you think "178 Cherry Hill Estates" will be viewed by healthcare professionals? No doubt, they will think you are SMALL time! You need to walk the walk and talk the talk and have a PROFESSIONAL front for your business. Granted, MOST of us that run a medical billing business do so from our home offices - but, your clients don't necessarily need to know that! Go to your local UPS store or Postal Center and lease a mail box. These facilities are located in busy mall strips or on major roads that don't contain words like "cherry" or "estates" AND you can call that box a "unit" OR "suite"! You do not HAVE to list that address as a "PO Box". A "home" address appears too small and a real "PO Box" only offers a front that looks AND sounds like one! Not only will this demostrate that you are an established professional in the medical field, it also offers you protection. Be street smart! Most of us in the medical billing industry are women; all ages and backgrounds, but MANY single with children. You wouldn't want some strange doctor or disgruntled office manager to show up at your home! Besides, it is YOUR job to visit with them at THEIR practice and/or location! Hope that this helps! Look for more "Medical Billing Tips and Tricks"!