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.
Tuesday, November 6, 2007
Monday, October 29, 2007
How to Select a Medical Billing Vendor
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.
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.
Tuesday, October 9, 2007
My Own Invioces as a Medical Biller
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!
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!
Monday, September 24, 2007
Stay on TOP of those NEW client's bills!
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!!
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!!
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.
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