Six Sigma Blogs

Medical billing is a crucial health care service that supports physicians by submitting and collecting the payments from insurance companies and patients. One needs to be an expert to ensure that the bills are collected fully and in a timely fashion. It is quite common for over 20% of a practice’s potential revenue to remain unclaimed because of improper coding and weak collection strategies.

Outsourcing medical billing is growing in popularity as an approach for addressing this tremendous loss of practice income. The range of outsourcing options runs from extremely large organizations to individual freelancers who work from home to provide medical billing services.

Although the complexity of basic medical billing is quite high, it pales in comparison to the complications that come to play for surgical billing. Successful navigation of the payers’ policies and procedures for paying surgery claims requires specialized knowledge that comes from experience with billing for surgeons.

As the cost of providing surgery related healthcare services continues to rise, medical institutions and surgical practices cannot afford to leave revenue uncollected by billing companies or freelancers that are not knowledgeable in surgical billing. It is also important to keep in mind some companies may promote themselves as large surgery billing service providers but in reality they sub-contract the surgery billing to freelancers who work from home. Hiring such companies will lead to lost revenue because of the lack of proper process, controls, and training.

Deep familiarity and comfort with surgical procedures and terminology does not come from serving one or two surgeons. Surgical billing success requires both broad and deep expertise in order to collect all of the money owed the surgeon and successful appeal claims which have been denied or answer questions the payers may have about a claim.

A company that does not encompass a wide range of surgery billing experience will find it difficult to track underpayments since multiple procedure rules and surgical procedures have significantly more complicated contractual adjustments than a typical family doctor or internist’s claims. In addition, the billing software and system design of a generalist billing company will often be insufficient for the more complicated requirements of reporting and insurance follow-up required in billing for surgeons.

The surgery-driven difficulties of medical billing encompass patient billing also. A surgeon’s patient balance process is more challenging because most of the balances are quite sizeable. Coupling this with the difficulties of explaining to a patient their complicated Explanation Of Benefits and the surgical terminology on their bills drives the need for patient collection specialists that have a strong expertise in surgical billing. If patient are not handles with care surgeons will see their patient collections fall and their patient complains rise - not a good combination.

To avoid all these billing related pitfalls surgeons need to utilize specialized surgery billing services. It is not advisable for an internist to perform surgery, similarly someone without training in surgical coding and surgical billing is not qualified to offer reliable billing services for surgeons.

Copyright 2008 by Carl Mays II

ClaimCare Medical Billing Services has interviewed countless candidates that have just graduated from a medical billing school and coding school. As a rule, we find that the courses in a medical billing school (and coding school) add little value or knowledge to the resume of an individual with no prior medical billing experience.

Typically graduates we hire from medical billing school start in our apprenticeship program alongside individuals that have not graduated from medical billing school (i.e., they start in the exact same role as folks that have not made the investment in money or time for medical billing school).

The terminology and concepts taught in medical billing school no more prepare a person to be a full fledged medical biller than reading a book on how to drive a car prepares one for the challenges of actually driving a car - it is practice behind the wheel that is required. The academic elements can be helpful - just like supplementing practice behind the wheel with a manual on safe driving makes sense. Unfortunately, however, this is only true if the academic material is accurate. I have found that often students have been damaged by medical billing schools that either teach incorrect medical billing concepts or leave the students with a sense that they have nothing left to learn.

Almost without exception, the best way to break into medical billing is to find a medical billing service or a physician practice that will allow you to execute basic medical billing tasks such as verifying insurance or calling on claims to find their status.

These tasks are critical to successful medical billing and they build a strong base of medical billing skills. In addition, you will earn an income while building a resume that can get you a more advanced medical billing job.

Most organizations do not have a formal apprenticeship program, but if you interview with the specific tasks outlined above in mind then you can find an entry level opportunity. This opportunity will pay you to learn about medical billing and build your resume.

Once you have a few years of real medical billing under your belt (not just the entry level tasks, but more advanced medical billing you move into as you master the entry level tasks) then you are ready to extract value not from medical billing school, but from coding classes. With the core knowledge in place you can make the most of the coding classes and will have credibility with potential employers.

So, if you want to break into the field of medical billing please consider pursuing an apprenticeship model it will serve you (and your future employer) much better than a medical billing school education.

Copyright 2008 by Carl Mays II

We are fast approaching the end of January and the point in the New Year when the majority of people’s New Year’s resolutions have already failed. This is, however, the time for renewed efforts to focus one’s resources on achieving the desired goal. There are two keys to reaching your goals:

1. View your failures (i.e., I have not flossed in two days) as minor set backs and not as utter failure (i.e., I might as well start saving for dentures); and

2. Create a series of intermediate goals between where you are and where you want to be (i.e., instead of “I will lose 50 pounds this year” focus on “I will lose 1 pound each week”).

So, this is interesting, but how does it apply to medical billing? Well, if you keep these ideas in mind you can use them to achieve lofty improvements in medical billing performance. How? Start with a powerful and straight forward goal: Make sure your claims are clean before you submit them. This will help your medical billing in several ways:

- You can only achieve it by having a laser focus on the front end elements of medical billing. This is where the medical billing “game” is won or lost;

- This goal can be easily broken down into smaller goals such as “I will improve my acceptance rate by 2% per month or I will implement a claim scrubber by the end of March;

- This goal has many ways in which failure provides powerful learning opportunities. You can set aside time to analyze rejected claims to determine the source of the rejection and then focus on eliminating the problem area.

- Technology can be a powerful ally in achieving this goal. The use of coding tools, automated demographic verification tools and scrubbing claims will eliminate many sources of up-front errors that lead to claim rejections.

Use the end of January as the time for a more informed New Year’s resolution for your medical practice. Today is the time for you to:

- Measure your current performance level;

- Write down a powerful and meaningful performance improvement goal (my practice will have over 95% of its claims accepted on the initial transmission);

- Create a “goal ladder” where each rung of the ladder represents an incremental, achievable goal on the way toward your ultimate goal. For instance your may set incremental goals of improving your clean claim performance by 1 percent each month; and

- Create a plan for how you will learn from rejected claims.

This approach and focus can allow your medical billing efforts to reach new standards of excellence in 2009.

Copyright 2009 by Carl Mays II

Medical billing is a critical service that supports healthcare providers by submitting claims and collecting payments from insurance companies and patients. Medical billing specialists need to be experts to guarantee that the bills are in full and in a speedy manner. It is quite common for over 20% of a practice’s collectable revenue to remain unclaimed because of improper coding and ineffective collection tactics.

As physicians are taking into consideration the use of medical billing services to stop the hemorrhaging of cash from their practices, they are faced with a broad range of options. On the diminutive end of the spectrum are home-based medical billers. On the opposite end of the spectrum are companies that employ hundreds of medical billers and have thousands of clients.

Medical billing is a highly complex area and it requires experience-based knowledge and expertise to contend with insurance companies. When it comes to cardio billing, the situation gets even more complex. Such complexity can be handled only by a company that is staffed with well trained cardiac billing professionals. The medical billing specialist must be familiar with the specific codes and rules that make up the world of cardiology billing.

With cardiologists facing ever increasing costs they must insure that money is not being left on the table because they have a billing company that is not a cardiac billing expert. Cardiologists must also be aware that that many billing companies that claim cardio billing expertise actually outsource their cardiovascular billing work to at home billers. Situations like this are fraught with risk since the remote workers are not working in a controlled and monitored environment.

Deep familiarity and comfort with cardiology procedures and terminology does not come from serving one or two cardiologists. Cardiac billing success requires both broad and deep expertise in order to collect all of the money owed the cardiologist and successfully appeal claims which have been denied or answer questions the payers may have about a claim.

A company that does not encompass a wide range of cardiovascular billing experience will find it difficult to track underpayments since multiple procedure rules and cardiovascular procedures have significantly more complicated contractual adjustments than a typical family doctor or internist’s claims. In addition, the billing software and system design of a generalist billing company will often be insufficient for the more complicated requirements of reporting and insurance follow-up required in billing for cardiovascular practices.

The cardiology-driven difficulties of medical billing encompass patient billing also. A cardiologist’s patient balance process is more challenging because most of the balances are quite sizeable. Coupling this with the difficulties of explaining to a patient their complicated Explanation Of Benefits and the cardiovascular terminology on their bills drives the need for patient collection specialists that have a strong expertise in cardiac billing. If patients are not handles with care then cardiologists will see their patient collections fall and their patient complains rise - not a good combination.

The safest way for a cardiologist to navigate the medical billing land mines outlined in this article is to travel the medical billing battlefield with a surgical billing service that has deep and proven expertise in traversing the cardio billing hazards. Family doctors should not be performing open heart surgery and generalist medical billing companies should not be providing medical billing services to cardiologists.

Copyright 2008 by Carl Mays II

Don’t worry. This article is not about a product, or a software, or an ebook, or a report that you simply must have in order to make money online. This is article about is a very simple piece of advice. It is something which I’m pretty sure that you already know but just knowing is sometimes not enough. The advice I am talking about is:

“There is no such thing as a free lunch.”

If I could get inside your head, I know what you will think. “Who is this guy trying to fool? Tell me something I don’t know.”

I agree. When that husband of yours willing takes out the trash without being told, you know he’s going to drop a bombshell. Within the next 24 hours, he is going to start a conversation that will begin with, “Honey, remember when you said that we should tell each other everything? Even the not so nice things? Well,….” At least you enjoyed not having to tell him to take out the trash.
However, when we go online, many of us forget to bring the skepticism that serves us so well in the offline world.

You are bombarded with get-rich-quick sites on the Internet. You require no professional training, you don’t need to spend a lot of time, and the financial investment needed is minimal. Just join their site as a member and, after a month or two, you will be making more than a doctor does.

Such websites do well because it seems that when we come online, we lose our healthy skepticism.

And with their promise of early retirement and having more free time, who won’t be tempted? Some might actually be skeptical but wanted to try their luck. After all, it’s just a few dollars.

And I won’t think too much about the money lost when you decide to take a chance with these type of sites. But I would be very mindful of the time wasted on such sites. Money lost can be earned again, but time lost is gone forever.

These sites are on every single corner of the web.

Do yourself a favor and click the back button the next time you come across such a site. Making very good money on the Internet is a very real possibility, but only if you spend your time and energy productively, and not on offers or sites that are too good to be true.

Who among us has never procrastinated? The first time you procrastinated was probably in school when you did a project or paper at the last minute or tried to cram for an exam. It’s not easy to overcome procrastination, but it is a habit you can unlearn, just like you learned it.

If you’re going to solve your procrastination problem, first you have to admit you have a problem. Then you have to commit to solve the problem at any cost. All procrastinators should repeat this, “I chronically procrastinate. I’m willing to do what it takes to rid myself of this habit.” That’s great! You’re on your way to a “do it now” lifestyle.

Generally, there are three reasons we procrastinate. One, we just don’t like to do unpleasant things. Two, we’d rather do what we’d rather do. Finally, we put off and jobs or tasks that seem overwhelming.

You may be able to justify your procrastination a thousand different ways. Leaning on these excuses for procrastination may have become normal for you. It’s time to find a way to get around the reasons you procrastinate.

If there is something you absolutely do not want to do, then you need to give yourself some motivation to get the job done. Plan a reward for yourself. In other words, if you make it to the dentist promise yourself a shopping trip. Another solution to this problem is to find someone who will nag you to death until you get the job done.

If there is something else you prefer doing make that your reward. If you would rather have a manicure than go to the dentist, schedule a manicure right after your dental appointment. Immediate gratification is a great way to overcome procrastination.

When a task overwhelms you, try to break it down into smaller jobs or tasks. It will help you overcome procrastination when the job seems doable. Breaking the task into smaller jobs makes each of them achievable. Pretty soon, the entire task will be done.

Procrastination seems like a never-ending battle, but you can overcome it. Here are a few more tips you can use.

Plan your day and practice good management and organizational skills. Once you establish a schedule stick to it. If a job runs over its allotted time stop and add it to your list for the next day. Don’t expect a miracle. Take small steps and you will begin to procrastinate less and less.

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We’re all trying to get more out of life, but there’s often a disconnect between the actions we take and the goals we’re aiming for. The reason for this is that we treat ourselves like workers instead of treating ourselves like the boss. When you’re an employee you basically do what you’re told without asking many questions simply because that’s your job. You may goof around and you may take your time because, generally, you have little personal interest in the job before you.

By acting more like a manager you give yourself a deeper stake in the outcome of your behavior and you feel as though you’re working for yourself instead of someone else. To act more like a boss you simply have to treat yourself like a factory instead of a person. You get to call the shots and you get to say what goes.

Managing Your Money: We all have some control over how we spend our money, but we also have control over how we generate money. Sure, you know you have control over how you spend your money, but you also have control over how you make your money. You’ll start out as the worker bee but after time you’ll end up as the uncomplicated boss that everyone loves.

Managing Your Wellness: You control not only what you eat, but the actions you take. By taking charge and treating your body like a factory you can begin managing it as a manager might control an assembly line. The more good food you eat and the more you exercise, the more efficient and powerful your body is. If you’re having a difficult time being motivated, try to imagine yourself a little cartoon manager who literally controls how your body moves and acts.

Manage Your Time: We all want more time and we all complain about not having enough. The key to time management is a little bit of planning mixed with a little bit of flexibility Again, just doing things for the sake of doing them is not good enough. You need to treat your schedule as a manager would: prioritize the things that have to get done and the things that need to get done. Once your gain control over your time everything else will fall into place.

Becoming a manager of your finances, your wellness and your time will pay you back a million fold as you improve your management skills. Stop being a worker and give yourself a promotion - right to the manager’s office!