Promise BIG - Deliver BIGGER!

As a medical biller, on thing that can QUICKLY become a nightmare is if you OVER promise and UNDER deliver.
You will be resigned QUICKLY.

Promise ONLY what you ARE ABLE to deliver. Then, go over and above from there.

Your service is safe from becoming a regret, or ultimately a nightmare!

Medical Billing Invoicing and YOU

One thing that can turn into a nightmare and make you look REALLY bad?

Your very own INACCURATE invoice.
Don't make mistakes on your own bills.
HUGE RED FLAG.

If you are making errors in your own invoices, what mistakes are you making on behalf of your clients and their billing?

When in doubt SOURCE IT OUT!

Medical Billing Hurdles, 101

Earning a Provider's trust is THE MOST challenging hurdle to overcome, NO matter WHAT miracles your medical billing service makes happen.

Ask yourself WHAT tools you have (or should have) in your bag of tricks?
1. Do you offer a "share-able" software platform so that the Provider is granted a window into your billing world?
2. How long HAVE you been in business VS. What experience do you bring to the industry?
3. Why SHOULD a provider "hand over" their receivables, aka PAYcheck??

These are all very real / very valid challenges!
Share what you do.
Share what you say.
Share how you overcome such hurdles.
How do you prevent the loss of an account due to these challenges, therefore PREVENTING nightmares?

The Set Up of Your Medical Billing Firm

As a succesful medical biller, you have a choice in terms of the set up of your company.
In the very beginning, we have ALL found ourselves doing all duties and wearing ALL hats. This is to be expected as there is normally a period of limited to no income.
There are basically two models to consider, once you have been up and running for a year or so.
Both CAN be nightmares if NOT set up effectively.
And, not ALL of your prospects will like the set up that you chose, BUT you need to do what is best for you for optimum results and optimum return.

The first way to set up your medical billing firm is to assign each of your employees accounts to manage. They do EVERYTHING for that account from start to finish. This includes any/all phone, appeals, corrections, patient statement generation, claim data entering, review, payment posting from EOB's, clearing house follow up, report generation, client communications and follow up and any/all special projects. This system is very trackable as a client's entire account is monitored by one single account manager. This is helpful as you receive compliments AND concerns.

The second way is to divide your company into departments. You would have a data intake and sorting person, a couple of people only entering claims. Another couple generating patient statements and posting payments and that is all that they do. You would have a couple of people totally dedicated to phone follow up with the carriers and appeals processors.

The message is to know that you can organize according to your style, your client demands, and your personnel. The first option offers a one-stop account manager that is able to answer all questions regarding a given account. The second option offers a departmental one-stop shop per duty.

Consider all of the pro's and con's as you establish and grow your business - go with your own feelings on this, as one person's dream can become your nightmare and vice versa.

Medical Billing Nightmares... such thing??

YUP!
You bet 'ya.

Well, nothing is too messed up NOT to correct or make up for.
Even if you "fat-finger" a DOS (Date of Service) when entering your claims for your client, there is ALWAYS a way to correct it!

Now, it may not be the most easy way, but it's possible.
The best thing to do is to own up to your error.

1. Call the insurance carrier and explain what you did. They will more than likely direct you to their web site, where you can log in and download certain forms to complete. You will have to mail those forms along with a cover letter and a CORRECTED HCFA to correct. This process is a pain, but a necessary evil to this business.

2. Make sure that you have a software provider that offers you to leave claims in a "review status". The importance of the review status is that it allows you to complete your work and to TEMPORARILY move onto another project. Then, later in the day, you can pull up those claims in review and give them another eye-ball before you actually send.

3. Finally, Tell your client, for example, that you inadvertently entered the DOS as 5/16/07 instead of the ACTUAL DOS of 5/6/07. Tell them that you are all over it and that you've sent in the appropriate change request forms to the carrier and explain when they will see the CORRECTED date. Many insurance carriers ask for a minimum of 30 days from time of receipt to offer a change.

4. COMMUNICATE, COMMUNICATE, COMMUNICATE.

So, the NIGHTMARE in this situation is the actual pain of completing the correction request forms. Making the error and telling your client should NOT be the nightmare part. Just be sure to stay up-front and honest at ALL times, even if your mistakes are worse.

Otherwise, your relationship with your client will be negatively affected AND you may find yourself resigned.

Medical Billing Nightmares... such thing??

Medical Billing Nightmares - "Oops. Wrong Kidney."

Medical Billing Nightmares effect medical billers AND patients alike.
I found the below quote and stats at http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/10ThingsYourHospitalWontTellYou.aspx

It is a great article. This piece stuck out to me... primarily because it demonstrates the likelihood of errors occuring in practices that are NOT technologically advanced. As a Medical Biller, educating the practice owners that you meet concerning these issues should be your priority. Errors are real, and MORE frequent in clinics, practices, and hospitals that are lagging behind in becoming computerized... Some Doc's need encouragement, some need a bit of coaxing, others need a solid shove to get them to change. For some reason, Doc's get "stuck" in their ways. They leave medical school or a hospital disgruntled and decide to open a private practice. They start habits - many of which are BAD habits - but, they are comfortable for that Doc and challenging to change. Get appointments and you WILL earn clients by demonstrating knowledge like this. For more information about networking, prospecting, what to do for appointments and what to bring to appointments, etc. visit www.MedicalBillingFoundation.com.
This alliance of medical billers in the US compiled a powerful manual which answers the pressing question ALL folks have when entering the billing industry; NOW WHAT DO I DO?

"Oops, wrong kidney."
In recent years, errors in treatment have become a serious problem for hospitals, ranging from operations on wrong body parts to medication mix-ups.
At least 1.5 million patients are harmed every year from being given the wrong drugs, according to the Institute of Medicine of the National Academy of Sciences. That's an average of one person per U.S. hospital per day.
One reason these mistakes persist: Only 10% of hospitals are fully computerized and have a central database to track allergies and diagnoses, says Robert Wachter, the chief of medical service at UC San Francisco Medical Center.
But signs of change are emerging. More than 3,000 U.S. hospitals, or 75% of the country's beds, have signed on for a campaign by the not-for-profit Institute for Healthcare Improvement to implement prevention measures such as multiple checks on drugs.
Though the system is improving, it still has a long way to go. Patients should always have a friend, relative or patient advocate from the hospital staff at their side to take notes and make sure the right medications are being dispensed.

Medical Billing - Earning AND Losing an Account in RECORD TIME!

WOW, what a rollercoaster ride this experience can be! I spent a total of 4 detailed meetings with a chiropractor. This gentleman had trouble with the turnover of his staff. He would hire someone and part of their job responsiblities was medical billing! Totally untrained and ill-prepared, these new employees would agree to undertake that crucial segment of the business and get into such a hole that they would end up quitting. Now, no one necessarily TOLD him that was the reason for the resignation. He just sensed this issue. So, I received a referral from someone that knows this particular chiropractor and I had an initial meeting where we exchanged basic data and all questions / concerns were addressed and I succeeded to receive an invitation to return with a price quote or proposal. I also set up a time to demo my software.

( I learned all of my understanding of the "order" of what to do to prepare for these meetings from a Business Start Up Manual created and offered by the members of The Medical Billing Foundation at http://www.MedicalBillingFoundation.com)

So, I returned and completed my demo with the assistance and expertise of my software representative. I proudly offered my proposal and THIS TIME, I was asked to leave the proposal for further review.
This, generally, is not a good sign. On occasion, depending upon the specialty and the size of the practice and if there is more than a single practitioner, than YES, of course I leave the proposal, fully understanding that it's not simply ONE person's decision. In THIS instance, however - it was just him. I have several chiropractic therapy clients, so experience and comfort was no issue. I know that I was competitive, but there was just "something missing". Some sort of missing element that he was unable to communicate and I was unable to unearth. BUMMER.

I scheduled a follow up appointment for one week out, which was fine. I returned to that appointment with a "blank" contract, so that if we needed to negotiate any points, we could do so fresh. I STILL pushed me off a bit by telling me that he has too much going on in his personal life with a divorce and he has to address his staffing issue, etc.
But, he assured me that we would work together and offered me a check for my set up costs as good will. I DID NOT deposit it, as I "felt" that something was still not quite right.

The ultimate ending of this story is that this Doctor is STILL months behind in billing, to the tune of $50,000 in claims to COLLECT (not just bill), he still has NO front staff person. He is absolutely burried in a billing nightmare and is still having personal issues. He is the same. The end all be all to this situation was that I EARNED and LOST an account in a matter of days! This was a nightmare to me. 1) I know I would totally help him. 2) it would have been a lucrative relationship for us both.

I suppose that the message here is to do your best to address ALL questions and concerns. Give 100% confidence and ALSO know that you will not "win" every account. Some will chose to stay in a difficult rutt for whatever reason.

Anyone else have similar stories???

Medical Billing - Billing The Wrong Carrier

I located this article written by Mr. Russell.
As a professional Medical Biller, I know the scary side of innocent "mistakes" gone terribly wrong...
The best protection? Document, document, document each conversation with whom at what number and extension at what time and at what location in what department and by what employee id number and so on! The more? The Better!
Yes, seriously!

Anyway... this is interesting...
For this article and more, please visit http://www.ezinearticles.com

In a previous installment of medical billing goofs, we discussed what happens when you bill the wrong item to a carrier and how you can be charged with fraud, but what happens when you send a bill to the wrong carrier. What follows is a genuine story. It's kind of funny when you read it, but the truth is, it's far from funny. This is some serious stuff.

A medical billing company, we'll call them XYZ company, was sending out a claim for a patient, we'll call him John Smith, to Medicare Region A, which is in the New York area of the United States. Now in actuality, the name of the patient was a common name so there could have very well been many people with that name.

Anyway, the bill makes its way to Medicare Region A and the response from Region A is that they are not going to pay the claim because the patient that the company was billing was dead. Well, to make a long story short, the medical billing company gets on a conference call with Medicare Region A and the patient. On the one end, the patient is screaming at the carrier, "How can I be dead? I'm right here". The carrier simply responds that according to their records, the patient is dead.

Well, this back and forth goes on for quite a while with quite a few phone calls. Finally, Medicare Region A decides that they're going to go over the patient's records with the patient and the medical billing agency. So they begin the questions starting with name, address, etc. Well, when the patient gives the carrier his street address and state, the carrier responds with the following. "Sir, Texas is not in our region". Well, it turns out that the patient had the same street address as another patient in New York. Everything was exactly the same except for the state, which nobody bothered to check. So what happened was that the patient had his claim sent to Medicare Region A when it should have gone to Medicare Region C.

Everybody had a real good laugh about this, but the problem still wasn't solved. Now the claim had to be forwarded to Medicare Region C. The problem was that the medical billing agency was not licensed to bill Medicare Region C. They only had a package to bill Medicare Region A. So now they had to see if they could get Medicare Region A to forward the claim to Medicare Region C. Well, they could, but there was a charge for this. Well, the medical billing agency said no way. So what did they do?

They got a hold of another medical billing agency that did bill Medicare Region C and arranged to do a swap. They'd bill one of their patients for them, thus incurring the cost, if they'd bill Medicare Region C for them. The company agreed and sent the claim. The problem was finally solved.

You can't make this stuff up.

The Legal Risks of Boutique Medicine - and the Nightmares That Come With it.

Here is an interesting article published by an attorney concerning the trend in Medical Billing for Concierge and Boutique Medical Practices and the fact that the establishment of such practitioners and their daily practices appear to remain ahead of the laws to date. As a professional Medical Biller, the trend can prove a challenge - more and more practitioners are "joining" Boutique practices to avoid the headaches associated with running an individual practices and the nightmare billing that comes with it!

A small but growing trend in medicine is the establishment of "concierge" or "boutique" medical practices. For a fee, ranging anywhere from $900 to $20,000 per patient per year, a physician agrees to provide a range of primary care medical services to a limited number of patients.

The range of services typically focuses on wellness or preventative medicine, but can span the entire scope of a primary care practice. Often included in the services provided are amenities and preferences that are not usually associated with physician practices, including 24-hour/seven-day-a-week access to the physician, same-day or next-day-preferred appointments, private reception areas, and even such luxuries as free hotel rooms for out-of-town patients, heated towel racks, and monogrammed bathrobes. Membership is usually limited to 300 to 600 patients. Some practices cater exclusively to these patients, refusing to take any Medicare or private insurance. Others continue to provide these services and apply the membership fee only to those services that are not covered by Medicare or private insurance.

There are several high-profile examples of these types of practices throughout the country. In Florida, a company called MDVIP has been in the forefront of this movement and offers ambitious plans to recruit 1,000 physicians nationwide. In Seattle, the former team physician for the Seattle Supersonics has converted his practice into this type of arrangement. Two well-known internists in the Boston area converted their practice into a boutique arrangement. Even in Arizona, such practices have already been established and more are on the way.

Physicians who have begun these practices extol their virtues in glowing terms. They cite the financial and psychological benefits of being free from dealing with the legal requirements and billing nightmares associated with Medicare and insurance companies. Because the number of patients permitted to become members of a boutique practice is limited, physicians are able to spend much more time with each patient, which these doctors are certain increases the quality of care provided.

On the other hand, many medical ethicists, consumer advocates, and government officials express concern over the creation of a two-class system of medicine, with more services and higher quality available to those who can afford the often substantial membership fees required by these practices. They ask what will happen to the Medicare system if more doctors elect to opt out and attempt to serve an all-cash patient population only.

These practices have not slipped under the radar screen of government officials, as numerous investigations and other efforts to stop this movement have begun. The most visible action was a letter sent in March of this year to the Inspector General for the Department of Health and Human Services by five members of Congress, including Representative Henry Waxman from California and Representative Pete Stark, the author of the Stark self-referral law. In their letter, the Congressmen raise several concerns that the boutique practices are violating federal laws, and they asked the Inspector General to take "rapid action" against these practices. Last year, Senator Bill Nelson of Florida introduced a bill in Congress to prohibit physicians from charging additional fees to Medicare patients. In addition, various state agencies have begun their own investigations. Departments of Insurance in the states of Massachusetts and Florida are reviewing the practice.

The legal risks with these practices can be briefly summarized. Most of these risks arise when a practice continues to seek reimbursement from Medicare and private health insurance companies for covered services in addition to providing these additional "boutique" services for a separate fee.

Violation of Medicare regulations. Medicare regulations prohibit charging Medicare beneficiaries for services covered by Medicare. Some argue that the services offered for the additional membership fee overlap with services that are covered by Medicare. To the extent that there is such overlap, charging for such services would constitute a clear violation. However, there is significant dispute over whether any such services would be reimbursable under Medicare.

Violation of the False Claims Act. In their letter, the five Congressmen alleged that the annual membership fee should be considered part of the charges for basic office visits, which charges are often reimbursed by Medicare or health insurance plans. As the letter itself explains:

An MDVIP patient, for example, might pay $1,500 per year in order to see his or her doctor five times for covered services, with each visit costing an additional $100 (billed to Medicare). Looking back, the true charge for each visit, including the value of the annual fee, was really $400. By failing to put the true charge on its claim to Medicare, a physician could be violating the False Claims Act. Of course, if the membership fee is for additional services provided by the doctor, then it may not be accurate to allocate that fee to office visits and other items normally covered by Medicare.

Violations of provider agreements with private insurance companies. Most private insurance company provider agreements prohibit balance billing of patients in a manner that could prevent charging any amounts to enrollees of those health plans, even for non-covered services. If these arrangements were found to violate Medicare regulations, they are likely to also violate private health insurance provider contracts in the same manner.

Violation of state insurance laws. To the extent that these practices require annual prepaid membership fees, they could be viewed as offering insurance without a license. If the physician is taking the risk of providing these services for a cost greater than the fee paid to him, insurance statutes define the offering of insurance broadly enough in many respects to encompass such an arrangement.

Violation of the anti-kickback statute or other laws prohibiting payments to induce patient referrals. To the extent that the practices offer amenities such as heated towel racks, free hotel rooms, special bathrobes, and the like, these luxuries could be viewed as improper inducements under the federal anti-kickback statute or provisions of the Health Insurance Portability And Accountability Act that prohibit such inducements. Of course, since these amenities are offered only upon payment of a fee, they could be nothing more than an exchange of fair value in return for what was paid.

Abandonment of existing patients. Often, a physician who attempts to transition an existing practice to a boutique practice which limits the number of patients will have to terminate his relationship with many existing patients. If that is not done correctly, the physician could expose himself to liability for abandonment.

In many situations, trends in the health care industry have run far ahead of the applicable law, requiring the law to be changed to catch up with what quickly becomes common industry practice. For example, the explosion of physician networks or IPAs required clarifications of the antitrust statutes in order to permit them. On the other hand, sometimes common practices are shut down once the law catches up to them, such as the widespread practice of physicians selling prescription drugs over the Internet. Clearly, boutique medical practices are ahead of the law at this point. Whether the law adapts to permit or prohibit them remains to be seen.

Medical Billing - The 13 Core Steps to Avoid Nightmares

I found this step-by-step guide published at www.MedicalBillingandCoding.net
I thought it useful to refer to as a means of staying on track to avoid falling away from general duties of a professional, full time medical biller.

See if you agree;

13 Steps Work Flow Chart:

1. Enter your patient information, adding new insurance carriers to your database as you go.
2. Enter the referral source or referring physician as well as any other information you've agreed to track for your clients.
3. Enter CPT and ICD-9 codes from the superbills and day sheets. Your software will automatically fill in the amounts charged for each procedure. Enter each charge on a separate line.
4. Transmit electronic claims directly to insurance carriers or to the clearinghouse.
5. Receive the audit report, review and correct errors on it.
6. Forward clean claims and resubmit rejected claims.
7. Print any paper claims.
8. Separate claims into your copy and the insurer's, fold and insert in envelopes.
9. Weigh envelopes that contain more than five claims to make sure you have sufficient postage.
10. Post payments to each patient's account. Most software programs include features that show which charges have been paid, how much is left on each charge and which charges are still unpaid.
11. Print aging reports so you can review each patient's account to determine which ones haven't been paid in a timely manner. Most software packages will do this for you.
12. Call insurance carriers to check on the status of delinquent claims. Most of your follow-up calls will be for paper claims.
13. Put your feet up and relax. You've earned a breather

Medical Billing Nightmares - Common Mistakes in Medical Billing

Common Mistakes in Medical Billing

Errors in the billing process can significantly reduce the profitability of a medical practice and should be avoided. By having a clear understanding of the entire coding and billing process and developing protocols for practice management, the medical office can run smoothly, efficiently and ensure maximum profitability.

A well-run and profitable medical practice always has a written procedures manual for all phases of operation. Most importantly, procedures in the reimbursement process: billing and coding, insurance issues and patient accounts should be kept in easy reach. Clear guidelines on the processes to manage accurate entry of all services provided and generation of correct insurance claims and patient bills lets all staff members know the accepted protocols and provides an easy to access reference when questions arise.

Errors in the reimbursement process fall into two categories. The first kind of error is technical: errors in generating and submitting claims, and then in processing payments correctly. Technical errors include missing or inaccurate data on claim forms. The second kind of error is in customer service: mistakes in managing patients accounts and treating patients in a way that is disturbing or disrespectful. Both of these mistakes can have grave consequences in the profitability and success of a medical practice.

In addition to clearly spelling out the steps of all phases of the billing cycle, office procedures manuals should address common mistakes in the reimbursement process. Some of the most common problems are outlined below.

1.) Technical errors

Mistakes in the technical aspects billing process cost money for a practice because claims are needlessly denied or delayed. These included claims and coding errors and insurance errors. Correcting the problems requires time spent researching the problem, making corrections, and generating a duplicate claim form. Unfortunately, a problem in many medical offices is follow up on unpaid claims. Many times, poor follow up leads to unnecessary write-offs and lost revenue. Careful attention to procedures can rectify most of these kinds of errors.

2.) Claims and Coding errors

Illegible claims
Misalignment of printed claims
Coding errors
Unbundling
Upcoding
Services provided without a medical necessary
Incorrect/outdated diagnosis or procedure codes
Insurance errors

3.) Failure to obtain pre-authorization of referrals

Submission of claims to wrong insurance company or outdated address
Failure to obtain insurance information for responsible party when a dependent or spouse is being treated
Calculating co-insurance based on incorrect fee schedule
Miscalculation of deductible, copays or so-insurance
Other common mistakes in medical office reimbursement involve billing and financial policies. It’s a well know fact that the longer a bill goes unpaid, the less chance of recovering payments. That means that timely and efficient handling of accounts receivable is critical. Some common errors in this area are listed here.

4.) Billing errors

Lack of consistent billing cycle
Statements patients can’t understand
Credits not posted to patient accounts
Overcharging
Duplicate billing
Charges for services not provided
Billing for services that are not medically necessary
Exceeding time limit for filing claims
Incorrect or inappropriate Finance charges
Poor Financial Policies

5.) Rebilling charged-off balances

Denial of necessary care for financial reasons
Intimidating or threatening collection efforts
Non-compliance with insurance contracts
Verbal payment agreements
Inconsistent collection practices
Reluctance or refusal to explain billing policies and patient statements

Errors occur. It's inevitable. BUT, catch them! As a medical biller, it is your job! Pointing out errors, owning up to errors, and FIXING the errors will help you KEEP clients. The oposite practices will cause you to loose clients!
For more information about medical billing nightmares, visit www.MedicalBillingFoundation.com

Medical Billing Nightmares - This Time to The Consumer / Insurance Policy Owners

I found an article today that does a great job illustrating Medical Billing Nightmares to the CONSUMER by www.Credit.com. It does touch on processes as a Medical Biller and offers great resources at the bottom of the article. I would like to add 2 resources as a Medical Biller; www.MedicalBillingCourse.com AND www.MedicalBillingFoundation.com - VISIT THESE. You will be set up for your business by these TWO sites alone.

Medical Bill Nightmares
by Emily Davidson for Credit.com

It could happen to anyone at anytime. A trip to the emergency room or bad news from your doctor could result in thousands of dollars in medical bills. Even with medical insurance, you may end up with catastrophic debt as a result of your illness. To make matters worse, many health care providers have unfair billing practices that only add to the financial issues faced by patients. Except for a few billionaires, every American is just one major illness away from bankruptcy. In this article we outline this issue and show you what you can do to avoid medical bill nightmares.


The facts
Medical debt issues impact us all, whether you have insurance or not. Here are some startling statistics:
Uninsured patients – Over 45 million Americans (15% of the population) don’t have health insurance. Nearly half of people without medical insurance currently have outstanding medical debts, averaging $9,000 per person.

Insured patients – Over 60% of families who report having medical debt problems are covered by medical insurance. In fact, 75% of people who filed for bankruptcy because of medical debts had health insurance.


The issues
A recent report from the National Consumer Law Center highlighted the growing problem of abusive medical debt collection practices. According to their report, hospitals use the following tactics:
Not offering charity care – Hospital are often officially registered as non-profits on the basis that they provide free or discounted health services to qualified patients. However, it has been shown that more than 70% of patients with medical debts are never offered financial assistance from their providers. In fact, uninsured and poor patients are routinely charged much higher prices for their treatment than others.

Suing patients and their spouses – Health care providers can send medical debts to collections, file judgments, garnish wages, obtain home liens, and even take patients to court over medical bills that they cannot afford to pay. In many cases, the spouses of patients are pursued for payment even if they don’t live in a common law state.

Offering expensive credit to patients – If you have medical bills you are unable to pay, health care providers may offer you expensive credit cards or loans as a solution. For example, Kaiser offers a credit card with a 9.9% introductory rate that quickly increases to 24.24%. Some of these accounts are so expensive that your debt will actually increase as you pay each month.

Using collections and credit to coerce patients – Debt issues can lead to serious credit score damage. When health care providers sell debts to collections, file judgments, and obtain liens, they are damaging the patient’s credit profile. According to the Federal Reserve, over 50% of collection records and 20% of lawsuits that appear on credit reports are related to medical debts.

Denying future care to debtors– Some health care providers have strict policies in place that deny health care to patients who owe money for previous treatments. In rural areas, there may be few health care alternatives available for people who are ill and unable to pay their debts.

All together, these abusive debt practices can lead consumers with health problems to destroy their credit, lose their homes, or file for bankruptcy. Without an understanding of their rights, a secure financial standing, and a willingness to negotiate, many patients are stuck facing a financial crisis at the same time as a health crisis.


The options
If you find yourself unable to repay medical bills or in the hospital without insurance, there are a few things you can do to avoid being stuck with an unmanageable amount of debt.
Know your options – Evaluate all the insurance, Medicaid, and charity options available to you. The time it takes to investigate possible alternatives to high medical bills is well worth it. Don’t be afraid to ask the medical billing office questions about your options. Keep asking if there is something you don’t understand about your insurance or financing choices.

Review your bills closely – It’s is very common to find double billings and errors on health care invoices. Take the time to closely review each of your bills and challenge any costs that you feel are incorrect. When you are challenging bills, however, be sure that the medical office is not selling your debts to collections while they are in dispute.

Pay with credit card– Use your own low APR credit card to pay for medical bills instead of opening a new account through the hospital. If possible, choose a credit card with a long 0% introductory rate and a low APR after that period expires.

Avoid financial traps – Pay your most important bills (such as your mortgage) first, before you pay medical bills. Never use a home equity loan to pay expensive medical bills. This type of loan can put your home at risk if you are unable to pay.


The solutions
Increased attention has recently been paid to the issue of unfair medical billing practices. With recent reports by The Access Fund, Harvard University, and the NCLC, the dramatic issues that patients face are coming to light. The following regulations are recommended in order to improve patient’s rights and control abusive medical billings:
Regulate charity care programs – Health care providers should have clear standards to follow in regards to providing free or reduced care to patients. Patients should be given a full disclosure of their financing and assistance options.

Set clear income discount policies – Sliding scale billing should be instituted to ensure that the poorest patients aren’t paying the most for their health care. The same discounts that insurance companies receive on medical bills should be applied to consumers.

Establish reasonable payment programs – Medical offices could actually increase their billing returns by establishing longer repayment periods with monthly minimums tied to the patient’s income. Just as student loans are set with low interest rates and low monthly payments, medical debt repayment should be affordable.

Restrict the sale of debts to collections – Medical debts should not be sold to collection agencies until payment negotiations have been completed and a set amount of time has passed. Also, the use of wage garnishment, property liens, and judgments for medical bill collection should be restricted.

Cap medical prices for low income patients – Health care providers should not collect more than the actual costs of services from patients who are low-income or uninsured. Currently, these patients often pay inflated “sticker prices” for their medical care.

Protect spouses from medical debts – Restrict health care providers from using common law doctrines to collect medical debts from spouses of patients, especially when these spouses are elderly or low-income.

Some of these reforms are already in place in certain areas. For example, California, Massachusetts and Texas require health care providers to account for their charity care spending. Connecticut currently has laws in place that prohibit charity care hospitals from suing a patient for debts until it is determined that the debtor is not eligible for free or reduced costs services.


The resources
If you are interested in learning more about this issue, you can visit the following consumer agencies and organizations that are campaigning against abusive medical billing practices:
National Consumer Law Coalition – www.consumerlaw.org
Access Project – www.accessproject.org
Bill Advocates – www.billadvocates.com
Consumers Union – www.consumersunion.org
Hospital Debt Justice – www.hospitaldebtjustice.org

Medical Billing - Improving Cash Flow: Start with Denials & Missing Information…

Often, a practice CAN BE "on the fence" in their decision to hire you as their Medical Billing Firm. If that is the case, ask them to "test" your services by giving you the "junk" or denied claims. I own and operate a successful Medical Billing company and YES; I too occasionally have to "prove" my services. It's not often, but it does come up. When their hesitation is clear, I offer to take on their most difficult claims and/or insurance carrier fact-finding work, which takes their staff member too much time. Now, of course I ask for a per-hour fee and a higher percentage for working these denied or old claims. They are a lot more work than the fresh ones and often need to go through an appeals process. This process has earned me SEVERAL accounts. After reaping the rewards of my diligent work on these old claims (a.k.a. income), they hire me immediately and WITHOUT hesitation. For more information and true guidance as a medical biller, visit www.MedicalBillingFoundation.com. This is the ONLY institution available that offers this level of counseling, instruction, ideas and support concerning these types of scenarios that you, as a biller, can undertake to ultimately earn ALL business opportunities that are offered up to you. Try to NEVER walk away. Below is information about medical bills "missing' crucial information for processing...

It might seem impossible that a patient would undergo hip-replacement surgery without anesthesia, but it’s been known to happen. Likewise, there have been cases of surgery to implant a pacemaker without the actual pacemaker. Or at least that’s the impression you might have upon noticing such items glaringly missing on the bills sent by the healthcare provider!
The situation is almost humorous, if it were not so serious. Doctors across the country lose millions of dollars every year due to mismanagement of the billing process. The reasons range from inaccurate charging, such as undercharging for a service or procedure or missing a charge altogether, to sending out claims that are for various reasons deemed inaccurate by the insurance carrier and therefore denied.
These service and item omissions and claims denials generally stem from an unhealthy mixture of unwieldy process, improperly trained employees, and inadequate technology. Fixing the problem, therefore, means determining the underlying causes and then directing resources toward those areas.
Whether the solution involves instituting new procedures and technology, or outsourcing the billing altogether, the benefit should be obvious.
Accurate charge capture and claims denial management processes mean not only improving cash flow, but also protects revenue that the provider is entitled to – and that adds up to a healthier bottom line.
No matter the size of the organization, billing inconsistencies affect all healthcare facilities to some degree – even those that are on top of the problem.
On average, providers lose 5 percent of gross revenues, and that can translate into millions of dollars for a single organization – yes, even the smaller practices over time.
With reams of regulatory rules, disparate software systems, and frequently high employee turnover, opportunities for mistakes to occur in the billing process are many.
At the worst point in the health system’s billing problems, the actual denied claims were measured in yards and feet and inches, depending on the size of the practice.
If you are hesitant in getting help from an outsourced solution on a full time basis, reach out for help on a project-to-project basis. A good Medical Billing Company should leap at the oportunity.
-HFMA, Mar. ‘07

Medical Billing - To Both the Firm and the Outsider; Yes, it is a Nightmare!

To many outsiders, the medical billing world appears as a nice, neat little package. The truth is, the world of medical billing is ANYTHING but neat. Sometimes, many pieces have to be brought together before a bill can even be sent, depending on what you have done. Some procedures are simple. Then there are those that can turn into total NIGHTMARES. What follows is a true story to show you how complicated this can get. THE BELOW EXAMPLE WAS WRITTEN BY A GENTLEMAN NAMED Michael Russell:

A patient goes to the doctor for a routine checkup. During the checkout, it is discovered that the patient has some calcium buildup. The doctor explains to the patient all the things that this could possibly be including, most unlikely, TB. But just to make sure, the doctor gives the patient a TB test. Well, low and behold, the test comes back positive for TB. Now, it turns out that the patient works with a lot of immigrants who are probably in the country illegally and therefor there is a real possibility that the patient has TB, though it could be a false positive.

The next step is that the patient has to get a chest x-ray to determine if it is a false positive or if the patient really has TB. So, the patient is then sent from the doctor's office to an imaging center to get a chest x-ray. After the patient gets the chest x-ray, which turns out to be negative, the patient then has to go and get a blood test to determine if there are any blood and/or liver problems that would prevent the patient from getting a pill for the next nine months to keep the patient from actually getting TB. The patient is then sent to a lab to get a blood test.

So, let's review where we've been. We've been to the doctor for a checkup, covered by insurance, an imaging center for a chest x-ray, also covered by insurance and finally a lab for a blood test, which is also covered by insurance. Turns out that the x-ray is not covered by the patient's primary insurance but is covered by the secondary insurance.

Okay, ready for the billing procedure for this nightmare? The doctor submits a bill to the primary carrier. The lab submits a bill to the primary carrier. The imaging center also sends a bill to the primary carrier who rejects the claim. The imaging center notifies the patient who then has to submit the bill himself to the secondary carrier. The secondary carrier then sends requests to the doctor and the lab to see what other things were billed for this condition before they finally pay on the secondary claim.

If this had been handled by a medical billing agency, they would have sent all the bills at once on behalf of each place and the paying of the claims would have been handled automatically by the various carriers, including the secondary insurance.

So, if you think medical billing agencies don't perform a valuable service, this is one example where they save the patient and medical facilities a lot of grief. (Michael Russell)

For medical billing news, articles, help and more visit www.MedicalBillingFoundation.com. The Foundation is committed to continuously providing it's members with the required tools for success through practical application.

Medical Billing Costs to Consider

I was SO excited to earn my first medical billing account that I practically paid THEM to get started with me! I provided them with OUTSTANDING service as I hoped that they would become a valuable reference source for me over time. They eventually became my PRIMARY reference source due to my extra care and attention. What people fail to remember is that there are legitimate costs to a medical billing firm - even sole-practicing firms! You will have overall operation costs, but what I'm writing about today actually has to do with software fees or costs incurred due to non-payment of claims by the carriers. We can all agree that software fees are unavoidable. The trick is to PROTECT yourself when it comes to costs incurred by errors that are OUT of your control. For example; upon earning my first client, I took all of the applicable data necessary to set up this provider, to include provider numbers per insurance carrier. As a medical biller, I rely HEAVILY on the information given to me directly by the provider. How else would I learn their Medicare-specific Provider Identifier, for example? Well, after my very FIRST batch of claims submitted, I received a copy of an EOB from an insurance carrier that denied my claims due to an inaccurate provider ID. Naturally, after examining this with my client, I learned that they weren't even credentialed with that carrier! I sent 57 claims on this provider's behalf only to have all 57 deny payment. Because I did not have a "(RE)submit fee" in my contract, I did NOT get covered monitarily by that provider for the original submissions. This was a lesson that I learned the hard way. So, my tip for today is to include a (RE)submit fee in YOUR contract that covers your costs to the software provider and your labor at a PER claim rate. After my painful lesson, I now have this type of protection in my contracts with all of my providers.

Medical Billing Nightmares can Become a REALITY!

When I decided to begin a career in Medical Billing, I was so anxious and excited to just "get out there" and start doing it! I took a medical billing course, I acquired some marketing materials, I named my business, I ordered business cards, etc. As far as I was concerned, I was READY! After weeks of effort to get in front of doctors and practice owners, I FINALLY earned an appointment with a podiatrist - a very BUSY podiatrist! I was so excited. We held our first meeting. I asked the questions that I needed answers to, we got along brilliantly and I left with an appointment to return the following week to present my proposal. When I returned with my proposal, that doctor liked everything that he saw. He liked my service guarantee and my pricing, and most importantly, he liked ME! Then he asked the nightmare question, "Can you show me what you do - or what system you use to enter my medical claims?" Um... UH-OH. I was stumped! I HAD purchased a medical billing software, but NEVER saw it. I couldn't ever get someone LIVE to demonstrate the software, I couldn't afford to pay for a provider set up, which would allow me use of my software WITHOUT an actual doctor client because I hadn't generated any income yet! I knew it was there, and I SIMPLY assumed that I would "use it" once I had my first client. Boy was I wrong! I knew that I was NOT the only medical biller that this doctor was interviewing. None-the-less, one of the OTHER billers earned his business and I know why... I could not demonstrate my product. This was MY NIGHTMARE. I got all the way here, earned the trust that is needed, priced everything perfectly, and then I fell - I FELL HARD. I share this with you only to encourage you to align yourself with the BEST possible medical billing software available in todays market. Since that experience, I learned a lot! I bit the bullet and spent a lot of time interviewing and actually VIEWING demonstrations by various software providers. The one that I chose to buy has HELPED in my ability to earn clients. Now, when I provide a proposal for a doctor and we get to the point where they like my service offering, my pricing and ME - I OFFER to demonstrate my software and what I will be doing for them. My software provider will dial in remotely and run the demo, while we listen to that representative on speaker phone. Now, I sit back and enjoy the show along with the doctor. Because of this powerful relationship, I RARELY lose an opportunity. If I do, it is CERTAINLY NOT due to my lack of knowledge when it comes to my software any longer! I made sure of that. Do yourself a favor - CHOSE A SOFTWARE CAREFULLY!