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.