Some Accounts Are Not Worth Taking

When you are first starting your medical billing business, it is difficult to imagine but unfortunately it is true. Some accounts are just not worth taking. When starting out most billers wait with great anticipation for that first account. There is great excitement when that account is found and the contract is signed. We rejoice and celebrate. It may take a couple months for the stark reality to set in or you may start to see that it's not working as expected right from the start.

You may find that as you start your first account you just are not getting all the required information when you need it. Maybe the office was supposed to have the claims ready for your first pick up last week and you still haven't seen them yet. Sometimes you get a packet of claims with 25% of them missing ID#s, dates of birth, or diagnosis.

You may expect a large packet of billing and set aside a certain amount of time to complete that work to find that nothing is sent or a very small packet. Sometimes provider offices neglect to send you the eobs on time and you make needless claim status inquiries.

When we first started our billing services, we took on a couple small accounts that amounted to so little that it certainly was not worth the trouble. At that time it was still beneficial to us as it gave us needed experience in submitting these claims and practice with our software. We set up systems that we would develop as the years went by. The important thing to recognize is that when you get to a point where these accounts are not worth the work that they cause you, it is time to give them up.

Other accounts are not worth the work they present right from the beginning. They may never seem to be able to get everything together to send to you or they make unusual requests and demands that create an extra work load for you. You need to learn to recognize these and see them for what they are. Work with any office before you give them up. See if improvements can't be made to make the situation work for both of you. Check out Solutions Medical Billing for more information on dealing with providers.

Medical Billing in a Box

We have released our newest package for medical billing services just starting out. It contains 5 books, 5 special reports, 50 blank CMS 1500 forms, our completed package of CMS 1500 forms for mental health billing, workbook, and for a limited time we are offering a free 15 minute consultation with either Michele or myself. The five special reports are not available elsewhere. We wrote them special for this package.

The five special reports are:

"Insurance Denials - Learn How the Pros Handle Them to Get Your Claims Paid"
"The Secrets of Authorizations and Referrals, What You Need to Know to Prevent Denials"
"How Participation With Insurance Carriers Affects Your Billing Business"
"How to Choose the Best Practice Management System for Your Business"
"Learn the most effective marketing technique we’ve ever used"

The books are:

"How to Start Your Own Successful Medical Billing Business"
"12 Marketing Strategies To Grow Your Medical Billing Business"
"How To Complete a CMS 1500 (HCFA 1500) Completely and Correctly - Line By Line Box By Box"
"Secrets to Signing Up Your First Doctor"
"Basics of Medical Billing"

For more information on this brand new package visit Medical Billing Live

Training New Employees

One of the most difficult tasks in the medical office is training new employees. Even when an employee comes to you with lots of experience, it does not mean that the new employee will be able or willing to do things the way you want them done. We find that some of the people we have hired who come to us with experience tend to do things the way they learned in a previous office. That is not always a good thing.

Some new employees learn much quicker than others. When we hire a new person, we try to establish what their strong and weak points are as soon as possible. We find some people are natural at making and answering phone calls and some hate talking on the phone and do not do as good a job. Sometimes when we hire a person for a job we find that they are better suited for a different one than what we intended. We try to work around the employees strong points as long as it works for us. But if we hire someone for a specific job and they are no good at it we find it best to let them go before we waste any extra time in training. If we can use them in another position that they are good at, that is great but if it isn't working, we let them go.

Training a new worker is a huge time consuming job which keeps others from getting their own work completed. If you don't watch all the work they do to make sure it is being done the way you want it done you may find yourself redoing it. This can take longer than it would have taken to do it yourself. Generally speaking we find it takes months to a year before a worker is trained well enough to stop checking their work.

When first starting to train a new employee it is crucial that you check everything they do. As the new employee gets more experience we've learned to spot check the areas we feel were potential problem areas for them. With all the things there are to learn in the medical billing field it takes time to develop a great employee. Once we have a great employee we do everything we can to keep them happy so they stay on. It's so much easier to keep a great happy worker than it is to train a new one.

Secrets to Signing Up Your First Doctor

We recently completed our latest medical billing e-book and added it to our e-books for sale on our website Medical Billing Live. We wrote this book because so many people starting this business don't understand why doctors hire billing services or how to approach these doctors to get their business. We offered some marketing suggestions as well and explained how important your marketing efforts are, especially at the beginning of your carreer.

When we started our business in 1994 we really did not understand what our worth could be to a medical office. It took years of experience to fully understand why a medical billing service could do a much better job at bringing in the money than many offices can do in-house. Our efforts in this book were to shorten the learning curve for those who want to get started in this business.

ICD10 Codes Go Into Effect in 2011

Many of us have heard about ICD10 codes but don't understand what the effect of use of the ICD10 codes will mean to individual billers. Well the Department of Health and Human Services has announced a proposal to change ICD9 codes to ICD10 codes effective October 1, 2011. What are the differences and how will this affect all of us in the medical billing field?

ICD10 codes are an important part of the effort to develop nationwide electronic health records. The current ICD9 codes which were developed 30 years ago are expected to run out of available codes next year. ICD9 codes are limited to 17000 codes where ICD10 codes will allow for 155000 codes.

The new codes will help identify specific health conditions and help with the implementation of electronic medical records. As with all changes to the medical billing industry, it will be interesting to see what challenges arise as a result. If it is anything like NPI numbers and new CMS 1500 forms, we will all be in for a surprise.

Dealing With Insurance Denials

One of the most difficult tasks in the medical office for the billing department is dealing with insurance denials. Unfortunately many claims are denied for a variety of reasons and if not handled properly no payment will ever be made on that service. Most offices are extremely busy and it can be difficult to find the time to take care of these problems. If your office does not have the time and resources to take care of these denials, your receivables will greatly suffer.

Denials can range from no coverage to treatment notes needed. Each individual denial needs to be looked into to determine how you will get paid for that date of service. Many times it will take only a phone call to fix the problem, but that phone call can take as long as 45 minutes to accomplish the preferred outcome. Some denials will entail the resubmission of the claim. An incorrect diagnosis code is an example of this. Some denials will result in billing the patient for the service but it may still take a 30 minute phone call to be sure that you are doing the right thing.

The secret to handling denials effectively is to act as soon as possible on the denial. Many denials have a time frame that must be adhered to. Then, you need a good system in place for dealing with the denial. When a claim is denied find what works best for that problem and use the same method each time you get that denial. Find the most effective solution to each denial and use that solution as soon as you receive the denial.

For instance, when we get a denial for medical records or treatment notes, we immediately type up a note and fax it to the providers office to let them know that we need the records. We then put the denial in the front flap of the folder designated for that provider. As soon as the notes are sent to us we go to the provider's folder and retrieve the denial. We print out a new claim form and attach a copy of the denial and the notes and note the computer that the records were sent with that claim.

Sometimes denials are completely incorrect. Usually a phone call to the insurance company can resolve the problem. We sometimes have claims rejected at the edit stage of an electronic submission for no insurance coverage. A call to the insurance company or sometimes checking their website may tell us that the prefix of the identification number has changed. We change the prefix and resubmit the claim. Or we may have made a typo in the ID# that needs to be corrected.

We have had claims that were accepted, but applied to the deductible. After the patient was billed we received a call from the patient stating that they either don't have a deductible or that it has already been met. Sometimes the patient is wrong and sometimes the insurance company is wrong, but all these challenges must be dealt with if you are to receive payment. The more you delay in dealing with the problems, the better the chances are that you will not be paid.

Letter to an Anonymous Medical Billing Service

We’re sorry. You lost a client today and they signed up with us. We don’t like to see any billing service struggle to survive. We sincerely don’t like to take a client away from another billing service. There are plenty of new doctors and offices that decide they can’t handle in-house billing any more to try to take a client from another service. But one of your clients called me and asked how I would handle a certain situation.

Please let me tell you why it happened. Your client explained that she called you, her billing service, and asked why they were not receiving payments on a particular patient. You didn’t know. We told her that wouldn’t happen in our office and explained our system of tracking the claims. She told us that her billing service wouldn’t call on a claim unless she called and asked them to. Basically all your service is offering is submission of the initial claim. Anything else is extra work for you.

She went on to tell me that if the office asks the billing service for a report it is weeks before they bring it in. Weeks!! That is totally unacceptable. If the provider requires a report, you should run that report that day and fax it over. They asked for the report because they want it not so they can ask you about it again next week.

STOP!! You have to change that. You are called a billing service because you offer a service. If you offer only the service of submitting the claims, it’s not much of a service. You need to understand that other billing services are offering more than that and you need to step up to compete.

Submitting the claims is only a small part of the job you can offer your clients. Every time you find something else you can do for your clients, you solidify your relationship with them. Tracking your claims is just as important as submitting them. You must start running and working regular aging reports. You need to get a system in place for tracking your claims. You need to be reading your electronic reports and correcting any problems. You need to be reporting regularly to your clients about any problems you are encountering.

We hear enough about billing services providing poor service. Let’s all step it up a little and do a better job for our providers. We offer a valuable service when done properly. Most medical offices are much too busy to handle the billing portion of the work. Make sure you have everything under control with great systems in place for not only submitting your claims, but for tracking them, too.

If your providers are not getting the service that other billing services provide, they may not be happy. They may call me tomorrow.

Signing Up Your First Client

Signing up your first client can seem like an impossible thing when you are first starting your medical billing business. You may wonder why anyone would let you take care of their income when you haven't proven yourself yet. The first client can be the hardest to find. We have many people contact us about finding that first provider. Even though you may find it difficult, it is not impossible and you must keep working at it until you get the desired result.

In his book "Ready, Fire, Aim" by Michael Masterson, he states that a beginning entrepreneur should be spending 80% of his or her time selling or marketing and 20% on other business things. He says don't go out and buy furniture, rent office space or purchase equipment. Go out and sell. Masterson says there is no business until there are sales.

There are many ways you can look for providers to sign up with your billing service. Find a method that you can work at efficiently and go out and do it. You can go to offices and inquire, you can do a mailing, you can make phone calls, you can advertise, you can watch the ads to find new doctors opening offices, but you must do something.

A few new billing services are lucky enough to have a client before they start their business. We've talked to people who worked in a provider's office and wanted to go out on their own and convinced the doctor to sign up with them. We've talked to others who worked around providers in a hospital setting and found clients that way. Whatever your method, just keep going until you find that first provider. Remember, you don't have a business until you have a customer.

You must learn to look confident about your billing capabilities when you approach possible clients. You can reassure them with your experience even if you don't have any clients yet. Let them know that you will be trying harder than anyone else could because it is so important to you to get it right. Then make sure you do a good job at it when you get that first account. The next one will come much easier.

Timely Filing Denials - How to Get Them Paid

Isn't it annoying when you submit an insurance claim and get a denial for timely filing. Insurance companies want your claims filed quickly, some within 45 days of the date of service. If you have filed your claims on time and still get a denial for timely filing, here is the process that works for us.

First, deal with it immediately. Do not put it down someplace and think you will get back to it at a later date. Most insurance carriers give you a limited time to appeal a timely filing denial.

Second, print out a new CMS form of the claim. Make sure you print the correct claim, not a different date of service and write TIMELY FILING PROOF ATTACHED on the claim.

Third, print out a patient ledger or an insurance aging report for that claim from your practice management system. If you submitted the claim electronically, you can use a copy of your electronics report that shows the claim accepted.

If the claim was for a secondary insurance, you must also find a copy of the eob (explanation of benefits) from the primary insurance carrier for the correct date of service and attach that to the claim.

Next, staple the claim, aging report, and if necessary the eob together with the claim on top. If the insurance carrier you are appealing the claim to requires an adjustment form, you must also complete the adjustment form.

Mail the claim. That's it.

Starting Your Own Medical Billing Service

We hear from many readers who are just starting or wanting to start their own medical billing business and have many questions to ask. Last week we heard from someone who has a start up behavioral health billing service and was asking about practice management software. She is trying to work with fill and print software and a separate insurance tracker and finding it not filling her needs.

When you are first starting your medical billing business, most of us don't have a lot of money to invest and we try to skimp where we can. The problem is that there are many things that you absolutely require to get your business going. A practice management system is one of them. A good fill and print software can be great for a small office where there aren't a lot of claims being sent to the insurance companies. But when you need to track the claims to make sure they are all paid, you need a good practice management system.

The practice management system allows you to run reports to let you know what claims are outstanding. It can also total everything for you at the end of the month which may be necessary, depending on how you charge, to bill your clients. Each claim is saved in the software and the payments are entered into the corresponding claim when they are paid. It is really a necessary tool to keep track of all your work.

Practice management software is available in a wide range of prices with a variety of options. If you are shopping for a good software, you first need to know how many computers you want to install the program on.

Multi user and multi practice systems can be confusing, but here's what you need to know. If you are the only person who will be using the software, you can get a single user. If there will be more than one person using the software at a particular time, you need a multiple user or both of you won't be able to use it at the same time.

You will need a multi practice practice management software if you plan on billing for more than one office which most billing services do. This will allow you to separate the offices so you don't have to print Dr. Smith's claims in with Dr. Jones. A good multi user, multi practice software will cost you a minimum of a few thousand dollars. Research this purchase really well because you don't want to try to change systems down the road.

Some of the other things that you will require are a fax machine and a photocopier. You will be making photocopies of any secondary and tiertary claims you file on paper. It can become expensive if you have to make very many copies on your fax machine. You will need some file cabinets to keep track of claims and eobs.

You will also have to plan on keeping your computers up to date. We try to replace one of our computers each year to make sure they will work at optimal performance.

Medical Billing Newsletter Released

The April issue of our free monthly medical billing newsletter was released yesterday. We've written an article on medical credentialing, on par vs non par and accepting assignment, some info on billing for vision insurance claims, and we've announced the release of our newest e-book "Mental Health Billing Made Easy". You can sign up for our free monthly newsletter here.

Mental Health Billing Made Easy

I'm happy to announce that our latest book will be released in April. We are finishing up "Mental Health Billing Made Easy". It covers everything a person in the mental health field needs to know to effectively bill insurances and patients. I'll have more info about it in April's newsletter. Make sure you check out all the other books on medical billing we offer.

New CMS 1500 Fill and Print Software

We've had several people ask and have finally found a "fill and print" software for CMS 1500 forms that we think is an answer to many requests we've gotten from our readers. Speedy Soft offers this for only $99 and it not only fills in your CMS forms just as if you were typing them onto a CMS form, but it also stores the patient info so you don't have to type a repeat patient's demographics in all over again.

It also stores the practice info and diagnosis and prints them on the claims. This type of software is great for the small office that is still handwriting claims or typing them. It is a huge timesaver and very easy to use. The company offers free support and an option to send the claims electronically. They will soon be releasing a version for UB04 forms, also.

Medical Billing Forum

We've been working hard to put together our new medical billing forum. I've been taking some of the "Ask the Biller" questions that we've gotten over the last year and been moving them to the new forum with the answers we gave. Now the questions are all organized into categories to make it easier to find what you are interested in.

The interest this has generated has been amazing. There are lots of us medical billers out there with questions and answers to other's questions and now we've got a place to share them.

We've had lots of new people signing up and helping us answer the questions with their experiences and knowledge. Thanks to everyone. It can't help but benefit all of us if we can share our problems and challenges and resolutions.

We're excited!! Make sure you visit the Medical Billing Forum and ask any questions you may have or answer any questions you've had experience with.

Diagnosis Codes - ICD10 and DSM IV Codes

Here's another question from our "Ask the Biller" page.

Hi again! I'm just wondering whether Diagnostic Codes, Line 21 on CMS 1500 are to be exclusively ICD 10 codes or are DSM IV codes also accepted?

Thank you, Carol

We answered:

You can use either ICD or DSM codes in box 21, as long as the codes are recognized by the individual insurance carrier that you are billing.

Question on Billing Sick Child Visit

Here's another question we received

I am the billing manager for a pediatric office. When we see a sick child for wheezing and/or tightness in the chest we usually bill 99213 for office visit and give them a inhalation breathing treatment under procedure code 94664 but we never get reimbursed for the treatment only the office visit. How do I get insurance companies to consider procedure 94664 am I billing this correctly?

Michele's answer

When you see the patient for the wheezing/tightness and you do the 94664, I would recommend trying a 25 modifier on the E&M code indicating that the E&M was a Significant, Separately Identifiable E&M Service by the Same Physician on
the Same Day of the Procedure or Other Service.

Also, if you have more than one diagnosis and if it is appropriate to use a different diagnosis for the E&M than you use for the 94664 that may help.
For example, if a child comes in with an upper respiratory infection, and you give him a breathing treatment for the wheezing/tightness, then you could bill the 99213 with dx URI and the 94664 with the wheezing/tightness diagnosis.

Hope that helps.

Question on Locum

We recently received this question

We have an anesthesia group and a pain clinic. We have two anesthesiologist on staff, one is permanent, the other is according to the permanent doctor, a locum. My dilemma is that the pain clinic is in the same building as the O/R, which means they are both in the same building, so is he actually covering for the permanent doctor while he is in the pain clinic, which would make him a locum, or is that not within locum guidelines. Both companies have seperate tax id's and NPI's but are on the same property.

Michele's response

I’m not completely sure I understand your question. Do both anesthesiologists (the perm & the locum) work in both the pain clinic & in the OR? A locum physician is just a temporary physician usually filling in for a permanent physician’s position. Some practices use locums more as a permanent position though. Since a locum is a licensed physician they do not have to work under a physician’s supervision, like a NP or PA. If this doesn’t answer your question, please email me with more details.

Can Your Business Get Too Big?

If you are a struggling new business I'm sure you wish your problem was that you were growing too large. But the reality is that when you are a growing business it can be difficult to see when you are growing too quickly.

For either the medical office or the medical billing service the same thing applies. When you grow too fast you risk not being able to take care of your customers the best possible way. We found an interesting example of this today.

We signed up a new account today. It was a small account, but his billing was important to him. He had signed up with a billing service in April 2007 and now in January 2008 had not yet received $.01 from an insurance company.

He inquired regularly to his service as to the status of his claims and was assured that everything was in place. Now nine months later he is questioning if he can stay in business.

How can you let nine months go by without a payment and not do something? That can only happen if you grow too quickly and can't take care of the details of your business. The details are critical.

Patients who must wait hours in a waiting room for the doctor are not happy patients. If this is happening in your office, you need to make changes and make them quickly before your practice suffers
If paperwork is required for patients to receive their workers comp checks, this paperwork needs to be completed asap. It is very important to this patient. These are the details I'm talking about.

If you already have too many patients to take care of the ones you have effectively, it is time to stop taking on new patients. If you don't, you will find you are loosing old patients as fast as you are gaining new ones.

This is also true of medical billing businesses. You must do a good job with the accounts you have. The details are critical. If you are too busy posting the payments to work your aging reports, you aren't paying attention to the details.

It's important to remember that whether it is a medical office or a billing service, it's still a business and needs to show a profit. So if you get too busy to take care of the details, you've grown too fast.