Six Sigma Blogs

Time management really is a problem for a lot of entrepreneurs. They have so much they do themselves ” everything from the mundane to the important and it can simply overwhelm you.

Make the most of your business hours, using these 7 fast time management tips to help you manage your business day:

1. Create an action list that goes one step further.

Make a task list for that day. You can do this the night before or first thing in the morning. Prioritize the tasks by categorizing things that are essential and things that can wait. Then, rank those actions by numbering them in order of importance.

2. Bundle your tasks.

You can bundle certain chores together. For example, set aside a time block to return and make all your calls will help you avoid task jumping

3. Bundle your tasks.

Do like activities at the same time: answer all your calls, return all emails, do all your web work. Avoid task jumping that eats up time you could use for more productive efforts.

4. Just do it.

If you work at home with small children, include them in your plan. You can care for your children and operate your business if write the kids into your task list.

5. Bring a file or notebook along to take advantage of time gaps.

If you have your file with you, you can make notes or plan while you wait for an appointment. You can punch out a quick thank-you note to a customer on your laptop or blackberry, or even update the status of all your current projects.

6. Carry work with you to take advantage of time gaps.

Bring materials with you. If you need to wait 10 minutes before an appointment, you can punch out a quick thank-you note to a customer on your laptop, or even just update the status of all your current projects.

7. Give yourself a break.

Superman is just a comic book figure. Hes not real. And hes not you. No one can run wide open from daybreak to dusk. Breaks are critical to your success. Include down time in your time management strategy. Lean back in your chair and close your eyes. Prop your feet up for 5 minutes. Recharge your batteries, and you’ll be amazed at how much more you’ll get done.

Time management in reality is activity management. How you manage your activities makes all the difference.

The 80-20 Rule of Pareto states that 20% of what you do will make 80% of your results. This goes against traditional time management layouts.

The 80-20 Rule or Pareto’s Principle was discovered by Italian economist Vilfredo Pareto. He noticed a natural imbalance that greatly affects everything in this world… your life… your business… everyday.

He noted that 20% of the world’s population enjoyed 80% of the wealth but soon discovered this law of nature appears everywhere.

Just think…. only 20% of what you do produces your desired results… the other 80%… may not count for much… waste of your time and efforts.

A Simple Time Management Strategy

Identifying and focusing on activities that are important to you and identifying and removing unnecessary activities - this is the definition of time management.

Traditional Time Management focuses on cramming and adding stuff into your day. It feeds the employee mentality need to always appear busy working hard at one’s ‘real’ job. Not a good idea for the solopreneur.

When a business experiences success, the owner starts drowning in the Multiplicity of Stuff Syndrome. The solopreneur really feels the effects of this syndrome. Not only are they the CEO (chief executive officer) of their business… they are also Chief Everything Officer.

They end up spending the bulk of their day on the 80% that does not produce results or profits.

Divide All Your Activities Into Four Activity Zones

- high-profit activities - high-reward activities - low/no profit activities - low/no reward activities

With high-profit/high-reward activities, devote 20% of your time- Work ON your business.

Devote 80% of your time to the low-no profit/low-no reward activities - Working IN your business

Following this strategy enables you to continue growing your business profits while dealing with day to day stuff of running your business.

Any strong medical billing process and medical billing company must compare insurance payments to your contractual allowables and aggressively pursue underpayments. If this is not happening then most likely 5 to 10% of your practice’s revenue is being lost.

Medical billing services have a number of basic steps they should incorporate into their billing process. These steps should include using a claims scrubber, use of no-response calls, posting zero pays, pursuing underpayments, and using likelihood of payment scores for patient collections.

This article focuses on just one of the key elements you need from your medical billing service: pursuit of underpayments. Pursuit of underpayments starts with a critical step: comparison of EOBs to your contractual allowables (the payment your payers have agreed to make for each CPT code). You cannot count on payment posters to catch underpayments with their naked eye; the comparison must be automated and systematic. It goes without saying that if you do billing in-house the comparison still should be done.

The reason that comparison to allowables must be automated is because of the clever and systematic manner in which payers typically underpay claims. These underpayment patterns can be difficult to spot, but one of the advantages a Medical Insurance Billing Service has is that it sees payment information and patterns across many clients for many payers. This allows medical claims billing services that regularly and systematically compare payments to contractual allowables to spot patterns that a single practice might miss.

A pattern that is often seen by billing companies is one where a payer will underpay the same codes across multiple providers by the same dollar amount in month one. Then in month two, the payer will resume paying the code correctly and will begin to underpay a different code (or codes) across multiple clients.

These underpayments are not huge (5 to 10 percent) but they add up quickly to big dollars for a medical practice. The combination of switching the codes being underpaid from month-to-month and keeping the underpayment amount “under the radar” can make the underpayments difficult for an individual practice to spot.

Needless to say, it would be difficult for a payment poster to remember enough about the allowed amounts across a practice’s tens of payers and dozens of CPTs to spot the underpayment strategy described above. This is why it is critical that automated comparisons be performed by your medical billing service.

What does all of this mean to your top line? A medical insurance billing service that properly implements the pursuit of underpayments can increase your revenue by between 5 and 10 percent - and this is pure profit.

Spotting the underpayment is only part of the battle, of course, the billing service also needs to have a systemic process in place for pursuing the underpayments. It is critical to pursue event the small underpayment amounts. Once a payer sees that their resources are being tied up readjudicating claims because of a $5.00 underpayment, the underpayments will often cease to happen.

Copyright 2008 by Carl Mays II

If your are not aware and prepared for the 2009 cardiology billing and coding changes you may be leaving a lot of money uncollected.

Not since the mid 90’s has cardiology seen such significant coding and billing changes as have been put in place in 2009.

Cardiology practices were hit harder than the average physician by this year’s changes (with a 2% reduction in Medicare fees instead of the 1% increase seen by the average physician) driven in large part by changes that will impact imaging performed in the office.

As a result some cardiology practices will see revenue decreases far exceeding the average 2% (particularly the offices heavily dependent on echo services). Other cardiovascular services may experience increases if properly managed.

Some of the 2009 cardiology coding changes are:

- Sweeping changes in the codes for following up on implanted devices (sweeping as in all of the old codes are gone and the new ones have significant differences). The new codes include such things as specific codes or internet (remote) device checks, codes for devices with leads in 3 chambers, ICM device follow-up codes, and codes for periprocedural checks.

- 30 and 90 day global periods are now in place for follow-up for some devices. Also, the new codes are specific to either an interrogation evaluation or a programming evaluation. The codes are no longer dependent on whether reprogramming occurred.

- 2009 also brings codes specific to a wearable cardiac telemetry device such as a Cardionet type service. This is the end to billing with the unlisted procedure code; but there is a catch here too. These codes also have global days.

- Codes that bundle multiple echo services under a single code have been introduced. Examples include a single CPT for bundling an echo with both a Doppler and color flow and a stress echo CPT that bundles both the stress test and stress echo.

As the examples above demonstrate, the magnitude of this year’s cardiology billing changes are more significant that has been seen in recent years. Without proper education, cardiology billing training, software upgrades and billing resources cardiology practices may see marked reductions in collections and increases in AR.

Copyright 2009 by Carl Mays II

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

How can 20% add to increased productivity and less work hours for your business? 20% can make momentous impact towards the success you want to achieve.

Try These Five Strategies to Help You Increase Your Productivity

1. Attain Organization

People loose about 7 hours each week due to disorganization. Organize your office into productive environment. As a business owner, you can create your work environment. It’s critical toward your long term success to work in an environment which supports you.

2. Create time synergy

Some people are night owls other are early bird. When you know which type you are, you can schedule your task and projects more effectively around your energy cycle.

3. Go Into Super Focus Mode

Limit access to yourself… turn off the phone, email and twitter. No interruptions. Set a timer and stay 100% focused on the task at hand. Group your tasks in bunches. Return emails and phone calls at the same time. Do all your writing in chunks, dedicate certain days for project, etc.

4. Take Care of Yourself

Self neglect can cause tension on any business through increased stress and strain. Keep personal health a priority as it is effective in good business management.

5. Relax and refresh

Sometimes when you feel overwhelm and pressure, take a brain break. Let your mind wander for a few minutes. Taking a quick break almost always leads to a boost in productivity.

Choose one strategy at a time to complete, take time, assess, and have flexibility and realism to projected goals.

One of the key advantages of billing outsourcing, when it is done correctly, is the clear alignment of incentives between the practice and the billing company.

Almost all medical billing companies are paid a percentage of what they collect. This means they are only paid when you are paid. It also means the more they collect for your practice, the more they are paid. Internal medical billers, on the other hand, are almost always hourly employees. They are paid based on showing up in your office, not based upon how well they perform your medical billing or how much money they collect for your practice. This is not an alignment of incentives.

Most people would prefer all their service providers to have “skin in the game” and only be paid for success versus just for making an attempt. For instance, would you prefer to pay your mechanic only if he properly fixed your car (and only for a previously agreed to price) or would you prefer to pay him an hourly rate and hope he will be as effective and efficient as possible in performing the job?

In a conversation I had recently with a busy cardiologist I heard a story that is not unusual. One of the office’s medical billers called in sick. Some information was needed while she was out so the office manager went looking through her desk. She did not find the information she needed, but she did find over $40,000 worth of claims that had not been billed and had gone beyond the timely filing deadline. That is right, $40,000 worth of claims that could not be billed and for which no money would ever be realized. Upon the billers return she was “sternly reprimanded for this egregious error. Not fired, but reprimanded for costing the practices tens of thousands of dollars. There is no alignment of incentives present in a situation like this.

This reaction is surprisingly common. Typically practices have so much trouble recruiting, training and retaining billing staff they are reticent to let one go. In addition, the billing staff complains about how understaffed they are and how they cannot be held responsible for not being able to complete even basic medical billing tasks. In this office’s case they moved the biller to the front desk and had her in charge of collecting patient demographics. A place where she can do even more harm through poor performance.

This volume of missing charges should not have gone unnoticed. There should have been multiple reports that could have identified such a problem. The practice, unfortunately, did not know how to properly utilize the capabilities of the billing system and so, the required reports were never run. Proper use of a billing system requires much investment in time and training, an investment that hourly employees often do not make. This $40,000 in unbilled charges is likely a proverbial roach of this practice - in other words, for the one you see there are likely hundreds you do not.

Utilizing a medical billing company is not a panacea for such situations, but if you insure the following actions are built into your agreement with the billing service, you should be in good shape:

- A fully integrated tracking system (charges by locations/provider and payments by source - lock box, office, PO Box) should be in place and you should have full visibility into the system at all times.

- Your medical billing company should reimburse your practice for what you would have been paid by the payers based on your allowable for any claims that go past timely filing for reasons within the medical billing company’s control. What this means is that you never suffer financially if the billing company drops the ball. Try to have your billers reimburse you if they drop the ball.

- You should have access to the billing system so that you can see real time status of your account.

We often hear from the physicians how hard and long they work for ever decreasing reimbursements. All this is true. However, too often we also see practices (through various reasons) hurt themselves financially - over and over again.

No - your staff will not work harder for you just because you employ them; and No - the biller who lost you $40,000 will not do any better job collecting money and gathering information from patients. You will probably need to “sternly” reprimand them again.

Selecting a world-class medical billing service that provides total visibility into their process and has incentives that are fully aligned with those of the practice is the most reliable road to outstanding medical billing and financial excellence.

Copyright 2008 by Carl Mays II