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!!
Monday, September 24, 2007
Tuesday, August 21, 2007
Never "Fake it" Until You Make It!
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.
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.
Thursday, August 9, 2007
Medical Billing - Contracts and Necessary Documents.
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!
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!
Tuesday, August 7, 2007
Medical Billing - A Company Brochure; Is It Necessary?
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.
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.
Tuesday, July 31, 2007
Medical Billing Tips to Aviod Privacy Breaches
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.
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.
Thursday, July 26, 2007
Medical Billing - The Almighty Combo!! Yes, it's ALL YOU NEED!
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.
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.
Friday, July 13, 2007
Reduce Your Medical Billing Firm's Claims Rejection Rate!
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
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
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