Posts Tagged billing


12 Ways to Supercharge your Practice in 2012: #6 Use Remote Employees or Contractors


If you can’t find the right part-time or full-time employees, maybe you’re not looking in the right places. One of the great things about business today is that a portion of your workforce an be anywhere. Your best employees may not live in your town, your state or your time zone.


Posted in: 12 Ways to Supercharge Your Practice, Human Resources, Memes

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The Best of Manage My Practice – September, 2011 Edition

As we finish off another month here at MMP, we wanted to go back over some of our most popular posts from the month and get us ready for another busy,  productive, and meaningful month. Presenting, The Best of Manage My Practice, September 2011!

  • With the weather getting chillier, and coats and sweater getting pulled out of the closets again, it’s time once again to get ready for your patients’ flu shots! The CMS has released coding and pricing information for Flu shots given after September 1st, 2011, so bookmark the page or print it out for easy reference.
  • Did your providers get their e-Prescribing done to avoid your Medicare rate reduction? If not, you’ll probably want to apply for a CMS Hardship Exemption for 2012. Find out how here!
  • Mary Pat continued her series “Collection Basics” about Revenue Cycle Management in Physician offices with “Part II: Implementing Your Financial Policy
  • Do you dread patient complaints? Don’t! Patients with complaints are a GOLDEN opportunity to learn about your practice, gain new perspectives on your operation and connect and learn about your customers. Learn how to get everything you can from a complaint in “Why I Can’t Wait to Hear Patient Complaints“!
  • And finally, everything you always wanted to know but we’re afraid to ask about a common, but sometimes vague office routine: “The Right Way to Do Write-offs.”

We’ve started this monthly wrap-up to make sure you don’t miss any of the great stuff we post throughout the month on Manage My Practice, but we also want to hear from you! What were your favorite posts and discussions this month? Did we skip over your favorite from September? Let us know in the comments!

Posted in: A Career in Practice Management, Amazing Customer Service, Collections, Billing & Coding, Compliance, Medicare & Reimbursement

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How To Be A Billing Advocate for Your Patients

Most patients would be shocked to know that experienced medical office billing staff struggle with understanding the detailed complexities of coding, billing and insurance reimbursement.  Even though there are standards for translating services and diagnoses into codes that identify the medical event, insurance companies each have their own rules for how they accept and/or pay for those codes- rules that are subject to change with minimal notice.

I have to admit that at one time I felt strongly that patients needed to take responsibility for understanding their medical benefits plan and advocating for themselves.  Everything has become much more complex though, and I have come to believe that as the experts it is our job to understand patients’ benefits and help them receive them.  Patients have difficulties understanding their own coverage for a myriad of reasons:

Reasons Why Patients Don’t Understand Their Benefits:

  1. The benefit book is not written in a way that many subscribers can understand.
  2. Most subscribers will not take the time to read the benefit book and ask questions about the plan at the time they receive the benefit.
  3. The benefit book is usually accompanied by a sheet or two of paper that alters the verbiage in the basic book  to describe the exact information for the patient’s plan.
  4. Not all businesses have an assigned employee to translate benefit books for the staff.
  5. Many employers change their plans annually.
  6. Most plans do not send representatives to workplaces to review plans with new employees.

To be sure there is the self-serving aspect of advocating for the patient in that we have less to collect from the patient, but I believe it is our job to minimize the patient’s out-of-pocket for them.

Who Are The Stakeholders?

The employer, the insurer/payer, and the healthcare service provider each have different motivations when it comes to paying for patient’s medical service.  There is little motivation for each to communicate and collaborate for a good outcome for all.  Assuming we are taking for granted each of these entities’ desire to make sure the patient receives excellent quality care, what is the viewpoint of each of these stakeholders?

The employer is concerned with keeping monthly health insurance premiums affordable, and minimizing claims experience.  Employers try to keep premiums from increasing at a rapid rate so they can afford the coverage and satisfy employees.

The insurer/payer is concerned with paying out less money in claims than it collects in premiums.  Because most insurance companies are for-profit, there is extreme pressure to deliver dividends to shareholders and bonuses to executives.

The healthcare service provider is concerned with charging an amount that does not leave any money on the table, making up for the underpayments of Medicare and Medicaid by the charges to other insurance companies, and keeping expenses as low as possible to offset decreasing reimbursement.

The patient is the ultimate stakeholder and the one responsible for paying an average of 30% of the contracted charge.  The patient is typically the least knowledgeable and the least able to walk the maze of terminology and rules to achieve the needed outcome.

How Do Insurers Avoid Paying Claims?

  1. Pre-existing condition (if no proof of continuous coverage exists)
  2. Other payer responsible (worker’s comp, auto accident, liability)
  3. No pre-certification or pre-authorization
  4. Did not advise of emergency within 24 hours
  5. Not medically necessary
  6. Medical records must accompany claim
  7. Provider not in network
  8. Ineligible on date of service
  9. Untimely filing – did not file within deadline which is different for every insurer
  10. Non-covered service
  11. Not enrolled within timeframe (babies)
  12. Escalating premiums to the point that employers seek other coverage.

What Can Medical Offices Do to Advocate for Patients?

  1. Provide patients with a brief handout explaining health insurance terminology.  Have this information on your website.
  2. Compile information about each insurer and each plan that your patients have.  A wiki is ideal for this, but a good old-fashioned 3 x 5 card file will do.  Yes, the patient has the agreement with the insurer so technically knowing their plan is not your job, but who loses if the insurer doesn’t pay?  Yep, you do.
  3. Use eligibility software or call the insurers to get the plan information and document this in your master file AND on the patient’s record.  Include deductible, co-pay, co-insurance, network information and non-covered services.
  4. When the patient arrives in the office, let them know you’ve checked on their plan and what you found out that will relate to this visit.  If you find out something that will alter the patient’s payment requirement, call them before the appointment to let them know about it and give them a chance to cancel or reschedule.  No surprises!
  5. Thoroughly explain any waivers or ABNs (Advance Beneficiary Notice for Medicare patients) you have patients sign for services that their insurers may not pay for.
  6. Make sure that any test or service (including lab work) that you send the patient for is provided by an entity approved by their insurer.
  7. If you are scheduling the patient for a procedure with your provider, give patients complete information on your charges.  Also give them information on estimated charges from any other provider involved in the procedure (assistant surgeon, physician assistant, radiologist, anesthesiologist, pathologist) as well as any facility charges from the hospital or ASC (ambulatory surgery center.)  Help patients to check on physician/practices to make sure they are approved for the patient’s plan.
  8. If you plan to send the patient a statement for any services, give the patient a sample bill and review how to read it.  Have the same thing on your website for patients to refer to.
  9. Encourage patients to call, email or make an appointment to talk to you face-to-face about their billing questions.  Make it clear your office is glad to help them.  Do not become defensive if a patient asks about their bill or questions if it is correct.
  10. Don’t be afraid to admit to the patient that your office made a billing mistake if indeed you did.  Everyone makes mistakes and as long as you apologize and do not try to shift the blame to the patient or the insurance company, all should be well.
  11. If need be, help the patient take the next step in filing a complaint against their insurance company if the company is not fulfilling their responsibility in paying the claim.  As the insurance companies often do, arrange a three-way call to discuss the patient’s claim and why it is not paid. Medicare patients receive a quarterly notice that lists claims for the previous 90 days and lists appeal details on the back of the notice.

Photo Credit: © Artur Gabrysiak |

Posted in: Amazing Customer Service, Medicare & Reimbursement

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Readers & Colleagues Comment on “101 Ideas for Increasing Revenue and Decreasing Expenses”

I invited readers of MMP, colleagues on LinkedIn, and Tweeps (friends on Twitter) to comment on my post “101 ideas for Increasing Revenue and Decreasing Expenses.” I’ve listed their ideas below and hope you’ll chime in on the comments with even more ideas!  Thanks to everyone for contributing.


David Kirkup 

David Kirkup

Partner at B2B CFO® – Experienced CFO for Rent. Fast, Effective, Affordable.

Consider adding a part-time CFO to the mix. Many medical offices have very weak financial capability or understanding. Assistance can range from better financial reports, capital expenditure analysis, budgeting and exit plans.



Bobby Jones

Eastern Region Sales Manager – Billing Tree

1) Build a relationship with the patient before he/she leaves the practice.
2) Make sure they know you are expecting payment on the portion they owe, and when you are expecting that payment.
3) Let them know what your process is for collecting, and when they will go to an outside agency.
4) Enable a web site to take payments 24 hours a day.
5) Set up an IVR system to take phone payments after hours.
6) Communicate your available payment acceptance methods in writing, on the phone and every time you speak with your patients.
7) Send the invoice or statement when you intend to send it.
8) Re-inforce the payment acceptance methods on the first and any subsequent invoices.
9) Adopt a plan for following up with any patients that don’t pay after 10 days.
10) Get email addresses from all of your patients and their permission to contact them in that manner.


Sukrit Tripathy

Sr. Product/Process Trainer and EDI Implementation Consultant

One suggestion would be to integrate the revenue cycle mangement function with your clearinghouse {for electronic billing} with integrated solutions like Coding database and Updates, Industry Broadcast, Performance and Audit reports for Claim Edits, Transmission and Rejects. Also, better training resources for billing staff actively into the practice management system.


Barbara Rotter

Consultant at Pacific Women’s Medical Group

I would add effective cash management (even if interest rates are so low).


Michael Glass

Michael Glass

Medical and Business Consultant at Transworld Systems

Utilize a Flat Fee Collections Agency for Non-responsive Patient Pay concerns.


Randall Shulkin

Principal Consultant – Culbert Healthcare Solutions

– Do you collect co-payments on the way in rather than on the way out?
– Does your PM/Scheduling system show the patient co-payment and outstanding patient balance in the appointment screen? If not, then can you download a listing for your front desk staff?


Denise Price Thomas

Denise Price Thomas

DPT Healthcare Consulting & Training

I’d like to add “acknowledge the patient with eye contact” and offer “polished customer service” and they will WANT to return = return on your $ $


Stacy Mays

Managing Partner, Dynamic Grape Companies

One other thought… don’t be afraid to try new technology. For example, one of my clients has developed a kiosk that allows patients to take their own weight and bp and electronically feeds the data into their EMR. The whole set up costs about $3500 and can save a ton of staff time. Tele-health in general should also be considered.


Angela Short

VP at Operations

If you select a reasonably priced EMR and you implement enhancements then you more than save on staff cost. Keep in mind that my practice rolled out the EMR five years ago, so we have had time to get it right. Here are some of the savings/revenue opportunities:1. We utilize our electronic technology to send text messages and emails to our patients to remind them of their appointments. This function alone saves my practice one FTE. Not only do we save with staff time we improve patient satisfaction, as our Blackberry users loves the email or text that they can directly add to their calendars. The revenue enhancement to this function, we decrease no shows and lag time in our physician’s schedules.

2. The robust reporting within the EMR allows the organization to assemble important quality measures that we use in contract negotiations. Without the EMR this would be a labor intensive task.

3. We are able to push a secure message to our patients regarding their pathology results saving staff time on the telephone and increasing patient satisfaction by eliminating a visit just to obtain a normal result.

4. No more chasing charts for a phone message. My call center takes ALL clinical messages. This is attached to the patient’s electronic chart and routed to either a nurse to respond or a physician. This process greatly reduces staff time, decreases the time it takes to respond to the patient’s issue and provides a legal record of the telephone call which is often missed in a paper environment.

5. We receive a discount on our mal-practice insurance because in an electronic environment it is guarantee that your notes are legible.

6. The formulary function built into most EMR’s provides the physician will a real time snapshot if a prescription that he/she is about to write is covered by the patient’s health plan and provides alternatives if available.

I have just highlighted only a couple examples of the administrative benefits. There are many more. It is tough to imagine going back to a paper chart.

I have done the math and we could cover our current EMR with the incentives offered through the government initiative.

I will comment that physicians need to be trained on how to use the EMR. You can lose site of the patient and focus the entire visit on the computer versus the patient, however, we teach our physicians that the patient first and then chart completion. We conduct patient satisfaction surveys and I rarely receive a complaint regarding the physician’s time at the computer. I do however, receive praises from patients regarding the ePrescribe as it decreases their wait times when the arrive at the pharmacy, the prescription is ready.


Okay Readers, it’s your turn – what’s your secret weapon for increasing revenue or decreasing expenses?

Mary Pat

Posted in: Collections, Billing & Coding, Day-to-Day Operations, Electronic Medical Records, Finance, Innovation, Medicare & Reimbursement

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What Does a Medical Practice Manager Do?

clockWhether the title is manager, medical practice manager, physician practice manager, administrator, practice administrator, executive director, office manager, CEO, COO, director, division manager, department manager, or any combination thereof, with some exceptions, people who manage physician practices do some combination of the responsibilities listed here or manage people who do.

Human Resources: Hire, fire, counsel, discipline, evaluate, train, orient, coach, mentor and schedule staff. Shop, negotiate and administer benefits. (more…)

Posted in: A Career in Practice Management, Leadership

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What Saves Money, Time and Is Green All Over?

An article authored by Kurt Cagle, online editor for O’Reilly Media, does a great job exploring telework which he defines as

employees and contract workers performing their work out of the office – from home, from distributed work centers, from coffee-shops, indeed, from wherever those workers may happen to be at the time.

Probably the job most commonly performed off site for medical practices is transcription, with billing a close second.  More recently I’ve heard of triage nurses and registrars teleworking and if you  think about it, any job that can currently be filled by outsourcing (appointment reminders, appointment scheduling, switchboard, etc.) could be performed by your own employees offsite.

If you’re like me, you may have considered teleworkers for your practice, but worried about managing off site employees and keeping them bonded to the team.  Cagle discusses the ever-growing list of technologies available to stay connected, but does not underestimate other problems historically associated with telework.

Telework requires a certain degree of self-starting and responsibility. Ironically, a number of studies, including one performed by Sun in 2007 showed that one of the older stereotypes of teleworkers as people who would tend to do a little work then skip to some other activity, watch TV or surf the web actually proved to be something of a myth – for the most part most teleworkers actually tend to put in longer days working than they would in the office …


Other benefits of teleworking for employees:

  • Savings on gas, parking and wardrobe
  • Ability to self-schedule
  • Gain personal time eliminating commute
  • Customized workspace for each person: temperature, light, sound
  • Reduction of the carbon footprint

Other benefits of teleworking for employers:

  • Saves on expensive medical office square footage
  • Fewer distractions could increase productivity
  • Allows practice to grow without physical expansion
  • Expands employee pool – employees can live anywhere
  • Reduction of the carbon footprint


Read the entire article here.


Posted in: Human Resources, Innovation, Memes

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