Ten Commandments for Successful Medical Billing Operations

Ten Commandments for Successful Medical Billing operations:

No one disputes that health-care billing continues to face difficult times. Reimbursements are down, costs continue to rise.  And while there are multiple solutions to the rising costs in health-care; one fact remains sure, physician practices must meet today's challenges with strategies designed to provide excellent patient care while following often complex and confusing rules. 

Practices are under constant pressure to deliver more with less and do it in a way that also incorporates electronic solutions requiring them to spend more to comply. That may means adding EHR software to their already taxed systems.  With the looming deadline of 5010 compliance and the roll out of ICD 10, practices can become distracted from the billing process and lose focus on the one thing that can keep them solvent. 

Today more than ever, medical billing must receive constant and on-going attention to the right details.  Practices have to become more productive and that productivity must be followed by "best in class" processes to be properly paid for those efforts.  

Following are some of the best steps to successful Medical Billing functionality:

Step 1: PROVIDER CREDENTIALING/CONTRACTING:

By working closely with a provider representative; fair and proper reimbursement from carriers can be achieved.  Once that contract is in place, the practice needs a method to monitor on an on-going basis that the payment agreements are being met. At the same time, close attention needs to be paid to provider enrollment and credentialing. Failure to follow time sensitive rules and carrier requirements can cost the practice thousands of dollars.  Accountability for this process must be placed in detail orientated hands.  The purchase of soft-ware for larger practices can aid the practice in tracking and full-filling requirements. 

Step 2: INSURANCE VERIFICATION AND CAPTURE:

Interaction with the front end personnel of the practice is a critical step in this process.  They must understand the role they play in ensuring that provider productivity is paid appropriately and without delay. Capturing copies of insurance and identification data is an essential part of entering correct data into the practice management system.  Scanning products can reduce key-stroke errors that are costly. Preventing eligibility denials must be the focus of the front end personnel.  They must also verify coverage and benefits PRIOR to the appointment, thus allowing them to collect co-pays and deductibles at time of visit.  This includes secondary as well as primary insurances. Updating of practice management system with new or changed information must happen before charges go into system will ensure that changes in benefits or economic issues (i.e. layoffs, unemployment) are captured appropriately. Verification is a step the practice cannot afford to skip.   

Step 3: CONTINUOUS EDUCATION OF STAFF:

Continuing education on insurance and coding issues for all the practice staff allows everyone to stay current with the ever changing healthcare industry. As Medicare (MCR) and Medicaid (MCD) offers new options to patients; knowing where to look on card for these changes is critical. This knowledge will help the staff make correct decisions and physicians comply with coding and charting rules. The front-end must comply with appropriate verification with each visit. A mechanism to educate and offer feed-back to the front-end must be in place.

Step 4: CHARGE CAPTURE:

After the visit/procedure/surgery, an encounter form documenting the charge must be entered into the practice management system in a timely and efficient manner.  By complying with clear and standard internal rules practices will meet any time filing limits set by various insurance carriers.  At the same time, there needs to in place a method that the staff can ensure that every visit/procedure/surgery has been captured.  It is not acceptable to the provider that a service performed has not been billed.

Step 5: CLAIM SCRUBBING:

"Scrubbing" (i.e. ensuring all carrier rules for payment have been followed) is a critical step that can make a huge difference in the reduction of denied claims. Ideally, this needs to be performed prior to or at the time of charge entry to the practice management system.  This allows the practice to make corrections to the charge that would have resulted in a denied claim.  This saves valuable re-work of claim later that typically accounts for the single most costly event of the billing process. Many practice management systems have the ability to scrub a claim or a practice can purchase a standalone product that can be integrated into the practice management system. This investment pays for itself in saved time and paid claims. The job of continuously updating the claim scrubbing tool must also be maintained. New rules must be put into this product immediately.  This means that someone must be accountable for this product and the constantly changing carrier rules.  A practice should also have the ability to write internal rules into the scrubber to ensure all required fields are appropriately populated.  

Step 6: CLEARING HOUSE/ELECTRONIC FILING:

After the charge has been "scrubbed" and is eligible for first time payment, electronic filing of claim through a clearing house should be scheduled multiple times during the week. This process ensures claims reach the carrier faster.  The clearing house typically supplies the practice reports that must be checked to ensure all claims went to the carrier.  Claims that did not pass clearing house rules must be addressed immediately for timely payment of claim.  Electronic filing can also provide the ability of a practice to know that a claim has reached the carrier.

Step 7: PAYMENT/DENIAL POSTING:

As the explanation of benefits (EOB) and payments come back from insurance carriers, prompt posting into the practice management system is the next crucial step in the successful billing process. As with electronic filing, electronic remittance can contribute to the successful billing process with accurate and prompt posting of monies received.  From prompt posting, claims can be followed up, secondary claims filed or patient balance billed.

Step 8: FOLLOW UP OF DENIED CLAIMS:

Knowledge of how your practice management system handles various scenarios in the life of a claim is critical knowledge. Often times, options that may help a practice automate this process are not turned on and used which results in manual effort and

over-looked denied claims.  A thorough knowledge of the practice system and the various options presented must be an on-going process.  Someone must "own" the system and continuously communicate to the management enhancements that may make this process more efficient and cost effective. Having the ability to know which claims are outstanding will allow for quick and easy follow-up with the insurance carrier.  The ability to produce workable reports for the staff is critical in staying on top of outstanding accounts receivables, thus reducing the aging of accounts. The process for who and when follow-up tasks are performed must be clear. This process should be monitored (preferably by the system) to ensure the billing office staff is meeting the expectations of the practice. A common denial by carriers is the need for additional information (i.e. documentation).  By identifying what codes will be denied for this reason and having a process to have easy access to this documentation allows the staff to promptly send this needed information back to the carrier for prompt payment.

Step 9: OTHER PRACTICE MANAGEMENT REPORTS:

The working of other practice management reports can help the practice to keep accounts receivable clean and accurate. (1) Under-payments by carriers. This report must be worked on a consistent basis to ensure the practice is being paid according to contract.  Appeal for additional payment should me made immediately upon detection. 

(2) Credit- balances.  Many times, posting and other errors are made to accounts that result in a credit balance to the account.  These errors must be corrected in order to move accounts to a final status within the system. A clear and timely process to deal with true credit balances must be followed by staff. (3) Small balance write offs. By clean-up of these balances, using well thought out parameters by management, aging can be prevented and cost of statements can be curbed.

Step 10: ACCURATE PATIENT BILLING:

Nothing destroys customer (patient) satisfaction more than an inaccurate and difficult to read statement from the practice.   Statements need to be sent to patients on a regular basis to keep them informed of the actions taking place on their account. Accuracy on the statement allows for payment of the balance that is now patient responsibility and reduces calls to the practice for explanation of that statement.

CONCLUSION:

The practice must have good reporting tools to allow the practice to monitor the success of the efforts being made.  By analyzing the progress of the practice and making appropriate changes based on findings, the practice can stay ahead of the billing curve. Often, practice management systems have standard billing reports that do not meet the practice needs for proper analysis.  By incorporating reporting tools with the practice management database, well-timed and ongoing analysis of accounts receivable can be achieved. Reports must serve a variety of purposes:  working reports for staff, summary reports (with trending data) at month end, and financial reports for accounting. Being able to meet all these reporting requirements must be a strong goal of the practice. The medical billing process is complicated; but following these above 10 steps consistently will lead to a very successful outcome for the practice. This process must involve everyone from the patient to the physician.  When everyone understands the expectations, success will be shared by all. As rules continue to change, and the road to success gets murkier, processes to deal with these changes and adapt will guarantee a successful practice.

It’s imperative for a practice to see seamless cash flow like how blood flow is important to our nervous system. Its all in the hands of billing team's performance and contribution that matters as a collective achievement as there is say that only if you perform you can take the provider to Penthouse else its the other way around taking providers to the Platform because bad performance.

Always give the best possible in the job you do and leave your foot prints.

Success is 10 % Hard Work and 90 % talking about it!

There is a popular saying. In this world of packaging it s crucial to market yourself well. Is hard work your winning motto? Who would know what you have done, so is marketing your skills more important? How would you strike a balance between the two?

53% - Say

No, skills are important

Marketing can be helpful in short run, but skills are there forever...

  First comes the skills that you should mold into a product so fine (i.e. You!) which in itself would be an excellent marketing tool.

Hard work is important as only marketing can give a short term gain only. Skills are very important

Without working you can not gain anything. So to acquire knowledge we must do work regarding this knowledge. Since changing is the rule of life and you can not change yourself without doing something.

 

You can’t prove yourself in market without skill, and can’t be developed without dedicated visionary handwork. These are only things which we can, and we should if we want to get success. Good luck and bad luck is only for them, who do hard work, not for those who just watch and excuse luck is everything. There is no substitute of hard work and dedicated practice with vision. Lord Krishna told, "Karmanye Vaadhikaraste Maa phaleshu Kadaachana". 

Do your duty don’t expect the reward as it will automatically come. What you sow is what you reap. 

A Happy Staff is a Productive Staff: How to Motivate Employees

A company's employees are one of its most valuable assets, and managing them can be one of the most important—yet challenging—tasks required of a small business owner.

Even businesses that have very few people listed in their employee payroll software still need to be attentive to how motivated, productive, and satisfied their employees are, because all of these things can impact the company's bottom line.

However, theories abound for how to increase staff productivity and job satisfaction, and some small business owners may be discouraged by thinking that they do not have enough money or resources to adequately meet the needs of their employees.

On the contrary, many employee motivation and recognition strategies require little to no financial investment, and may be simply a matter of adjusting management practices. Others require some investment, but that is often returned by boosting the company's productivity and, consequently, bottom line.

Invest in compensation packages
One of the most traditional and commonly used tactics for increasing employee satisfaction and retention is ramping up compensation packages.

This can involve raises, bonuses, or enhanced benefits such as matching 401(k) contributions, transportation reimbursement, health insurance, and vacation days.

However, not every business can afford to take measures like these, especially in the wake of the economic downturn. Businesses are encouraged to use their employee payroll software to see if the company can afford enhancing compensation packages.

The win-win incentive strategy
Benefits do not always have to be expensive—in fact, some may actually help a business increase its profit margins.

For example, incentives such as flexible work schedules and telecommuting can improve worker satisfaction by improving an employee's work-life balance, making employees feel happier and more productive. This is an especially attractive setup for workers that have small children at home.

At the same time as making employees happier, telecommuting and flexible work schedules can reduce overhead costs by limiting the amount of energy, supplies and office space needed. If a company offers transportation reimbursements, this can also eliminate some costs.

All work and no play…
Another way to increase employee motivation and job satisfaction is to make investments in corporate culture.

This can be as simple as recognizing employees on their birthday or instituting monthly cocktail hours, or can be as involved as creating a company softball team or putting an entertainment-filled break room in the office.

Whichever level of involvement is chosen, employees will likely appreciate the attention being paid to their job satisfaction, a factor which will often be seen in their productivity and performance.

In addition, corporate outings and events that aim to improve corporate culture can enhance collaboration by facilitating bonding between employees, which can thereby increase overall company productivity and competitiveness.

Corporate culture measures can also impact employee productivity and satisfaction on an additional level—tactics such as company sports teams, fitness incentives, and even company-wide fitness events such as participating in a charity run can improve employee health as well as facilitate corporate bonding. After all, healthy employees are not just happier employees—they tend to have fewer sick days and can be more focused.

More employers are starting to see the benefit of corporate culture, sometimes even more so than with compensation packages—a recent survey from human resources firm TriNet found that 36 percent of small business owners believe company culture and reputation were the most important factors in employee morale, ranking higher than compensation at 9 percent and benefits at 5 percent.

Be a cheerleader
Encouraging high performance can sometimes be as simple as rewarding it. Programs such as employee-of-the-month or other initiatives that recognize and reward high-performing employees not only make the worker feel more satisfied with his or her job, but they also set an example for other employees and encourage them to work harder.

Listen up
Some employee motivation and morale programs require no investments whatsoever. Many small business owners, faced with less money for formal incentive and recognition programs, have simply increased their communication with employees.

More face time with workers can make them feel more comfortable approaching bosses and managers with problems, which will not only increase their job satisfaction but can also cut down on errors.

Being upfront and honest with employees has become even more crucial during tough economic times, as employees that are worried about their job safety can be distracted, unproductive, and not entirely committed to their work. They may also search for other employment on the side—and even leave the job if another offer comes in—if they feel their job is threatened.

The ROI of happy employees
Whatever the strategy, small business owners are encouraged to pay attention to the happiness, well-being, and motivation of their staff. Productive and satisfied employees represent more than just good management practices—they are a crucial element to a successful business.
Taken from(http://smallbusiness.intuit.com/news/Achieving-sales-&-profitability/19439231/A-Happy-Staff-is-a-Productive-Staff:-How-to-Motivate-Employees.jsp)

BOOST YOUR PRACTICE REVENUE

BOOST YOUR PRACTICE REVENUE

Is your practice suffering from cash-flow deficiency anemia? Maybe it's time to go back to the fundamentals. Here are nine tips for achieving and maintaining a healthy inflow of cash.

GETTING PAID

How to Stop Hemorrhaging Red Ink

These nine tips will help you restore your practice’s financial health.

If you’re working harder and smarter but your revenue still seems anemic, your practice may be suffering from some internal bleeding of red ink. You may be losing money in silent, unseen ways that adversely affect the health of your practice. Here are some suggested therapies.

1. Don’t give anything away. Some practices have the unfortunate habit of neglecting to claim everything they legally can. For example, a practice will bill for a vaccine but fail to claim the corresponding vaccine administration code or bill for administering an injection but fail to bill for the substance injected. Failing to charge for services provided is like handing out money to your patients and their insurers.
2. Code appropriately. For the services you are claiming, make sure you’re claiming exactly what you did. For example, if you code a 99213 when you actually provided and documented a 99214, you’ll have given Medicare a 36 percent discount on your services. Likewise, coding an established patient office visit, rather than a consultation, for a pre-operative evaluation requested by a surgeon will minimize your reimbursement.
3. Learn to use modifiers. Modifiers can make a big difference in your reimbursement for those insurers that recognize them. Learning to use modifier –25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is especially important. It can allow you to be paid for two E/M services done on the same day.
4. Use an up-to-date and accurate superbill. Also known as encounter forms and charge sheets, superbills serve the purpose of capturing all the charges that a practice provides and is legally entitled to. If the form is using outdated CPT and ICD-9 codes, you’re inviting claims denials and billing inefficiencies, both of which can cost your practice. Likewise, if your superbill doesn’t include commonly provided services, a place for modifiers, etc., it may be contributing to your problems.
5. Track your superbills. Does your practice have a process to ensure all superbills are accounted for each day? Superbills represent money, so losing one is losing money. Consider numbering your superbills or instituting some other method to track all superbills generated each day.
6. Keep a current CPT and ICD-9 book. A superbill, of necessity, cannot cover everything. Having access to current key references, like the CPT and ICD-9 books, is essential. The cost ($100-$150 to purchase the pair) is minimal compared to what it will cost you in denied claims if you’re using old editions. You wouldn’t dream of vaccinating your patients using an outdated immunization schedule; you shouldn’t treat the financial health of your practice any differently.
7. Don’t forget to bill the patient, especially at the time of service. This may seem obvious, but some practices simply fail to ask the patient for his or her portion of the bill. Most insurance plans have a patient cost-sharing feature, and if you don’t ask or bill the patient for it, you are unlikely to collect it. You should ask for co-payments when the patient checks in at the front desk. This approach is infinitely more cost-effective than generating and mailing a bill after the fact and will probably increase your likelihood of collecting. An added bonus of doing this is that your practice earns interest on the income in the meantime.
8. Look at your Explanations of Benefits (EOBs) before you file them. When an insurance company sends you an EOB, make sure someone takes the time to review it before it’s filed. Were all the claims paid? Were all the claims paid appropriately? If the answer to either question is no, some follow-up may be in order. Otherwise, you may be letting the insurer keep money that belongs to you.
9. Hire the best you can afford. Too many practices hire office managers and billing staff with too little experience and education in the areas for which they are responsible. The money the practice saves in salaries in the short run costs the practice far more in lost revenue in the long run.
Hopefully, your practice is financially healthy, wealthy and wise enough to be doing all of these things already. If not, consider a little self-assessment along the lines suggested. The results should pay dividends to you and your practice.

What job interviewers and recruiters are really assessing

Some people love going on interviews, others hate it. Some people are comfortable disclosing information about themselves, others are not. Which- ever category you fit into, interviewers/recruiters are paying attention. True, some are looking for dirt and gossip, but mostly they want you to succeed so they can hire/refer you and get on with their busy lives.

In preparing yourself for the interview stage of a work search, be sure you have done all your venting and released all your anger and negative energy of your past employer before you even begin to put yourself in front of a hiring manager or recruiter.

Have an agenda when you go into an interview. Prepare specific points you want to make and don’t allow yourself to get derailed. If the tables get turned in an interview with poor questioning be prepared to highlight your strengths and bring the conversation back to what you can do for the company.

“In an interview, the focus is about you, not the organization you just came from,” says experts. “You should have control over your search, not your search have control over you,” they both declare.

You theme yourself. Identify your accomplishments and achievements, but also leave the interviewer with the correct image and perception of who you are and what you can bring to the position. You pick one of 12 themes such as creativity, people skills, innovation or problem solving and then help you thread it through all your responses. This common thread, this continuity, should leave an impression which is of importance to the company and their value system or work ethic.

Know what a recruiter wants to see when you meet them for the first time:

    1. A candidate has to know the company directives and their values. If possible, network within the company to come up an insider’s perspective of the business. Ask the interviewer what the company’s values are and make the connection between your values and theirs. Don’t expect an interviewer to make the co-relation, you need to do it for them.

    2. Illustrate that you have a sense of purpose, a goal for your career path. Know the answer to where you want to be in 5 and 10 years from now.

    3. Show an interest in the job, that this is the job you want.

    4. Express yourself in such a way as to sell your passion without using passion words. Smile, use positive verbiage, use your hands when you talk, ask questions and show enthusiasm.

    5. Last but not least, be yourself, and be honest.

And what behaviours turn off recruiters/hiring managers:

    Poor eye contact
    Poor grooming, dressing and posture
    Swearing/slang/poor grammar
    Not listening and inappropriate reactions to questions
    Taking too many notes
    Cockiness or chit chatty
    Inappropriate use of personal physical space
    Not staying focused

Getting too familiar with an interviewer is to your disadvantage. Keep a comfortable guard up, remember this is a total stranger and they don’t need to know you intimately at this point in time. There are some smooth operators out there whose sole purpose is to get you to relax, trust them and dish the dirt. Stay alert in an interview, be cautious but warm and discerning and you’ll be sure to leave a positive impression and hopefully a call back.

Working with your Team

When you reach certain position not necessarily departmental head you may have to lead at least a small group of people. To achieve performance you are also depending on their performance. Therefore it is also a must that the group of subordinates working under you as your team must be molded to suit your style of working and achieve performance or complete the work or task in time and quality. For the above you may have to take some initiatives.

Bosses like people who show the inclination to be future leaders. By taking initiative you will be doing just that. People who come up with new ideas or take new ventures are deemed to possess leadership or management skills, which is viewed favorably by top bosses.

When you take an initiative you understand your office environment. If your boss and colleagues support you wholeheartedly you’re in the right place, otherwise you might have to think about shifting offices. As a rule, organizations that support new initiatives have more successful and happier employees.

Taking initiative helps us not only in our professional life but also in our personal and social life. And, at times even a small step can do wonders.

When you take the initiative to do something new you step out of your comfort zone and challenge yourself. This is a very important for both personal and professional development. The entire exercise of attempting something new and executing it helps you grow faster, which is the key to success.

Sometimes you run out of ideas to advise your team as to how to go about further in completing a task. At such   juncture, taking an initiative can help you revive interest in your job. You can start off by taking a small initiative, say by organizing an office picnic and move on to bigger things. By doing this, you will soon finding yourself getting out of the rut and thinking anew.

You can go on and on about the successful team building. After all, there’s no fixed rule to what makes a group of people click together.

It’s very important for a team leader to be honest to his / her team. S/he should tell them exactly where they stand within the organization. A team leader should convey the right information in a positive manner. Once your team members know they are positive in the organization they will take your instructions in a better manner.

Be consistent about your communication with your team members. You will lose credibility with your team members if you communicate differently with different team members about same situation. If you project a professional behavior whatever the situation your team will surely respect you.

Always be open with your team members if there is some bad news coming for your team or the organization. Employees find out about the bad news. They can handle bad news as long as their managers are concerned about them.

Your team members work hard, and by giving feedback you show that you appreciate their efforts and the difference they make to the team. A team leader should also make it safe for team members to give feedback. Let them know that you value their inputs.

The solidarity of a team is an important indicator of how much influence the group has over its individual members. The more cohesive the group the more strongly members feel about belonging to it the greater is its influence. If the members of a group feel strongly attached to it, they are not likely to do anything against the group or team.

Team cohesiveness also plays a role in small companies. Team cohesiveness is critical in helping the individual feel good about his or her contribution to the effort. They also made sure that all employees understood that no improvement is too small. Over a period of time, they can make a major difference.

Highly cohesive teams often have less tension than less cohesive groups do. Additionally studies have found that cohesive groups tend to produce more uniform output than less cohesive groups, which often have problems with communication and cooperation.

Some talented individuals cannot flourish in a team oriented environment. If team cohesion is not to be eroded, management must recognize such a mismatch and address the problem before team goals go haywire.

Managers can improve solidarity of a team by introduction of competition, increasing interpersonal respect in the team, increasing interaction and create common goals for employees.

Be careful in what you plant to reap

If you plant honesty, you will reap trust.
If you plant goodness, you will reap friends.
If you plant humility, you will reap greatness.
If you plant perseverance, you will reap victory.
If you plant consideration, you will reap harmony.
If you plant hard work, you will reap success.
If you plant forgiveness, you will reap reconciliation.
If you plant openness, you will reap intimacy.
If you plant patience, you will reap improvements.
If you plant faith, you will reap miracles.

But

If you plant dishonesty, you will reap distrust.
If you plant selfishness, you will reap loneliness.
If you plant pride, you will reap destruction.
If you plant envy, you will reap trouble.
If you plant laziness, you will reap stagnation.
If you plant bitterness, you will reap isolation.
If you plant greed, you will reap loss.
If you plant gossip, you will reap enemies.
If you plant worries, you will reap wrinkles.
If you plant sin, you will reap guilt.

So be careful what you plant now, It will determine what you will reap tomorrow, The seeds you now scatter, Will make life worse or better, your life or the ones who will come after. Yes, someday, you will enjoy the fruits, or you will pay for the choices you plant today.