Six Sigma Blogs

Besides a satisfied current customer, the next easiest person to sell your products and services to is a referral. Referrals can be an inexpensive source of new revenue. They come to you pre-qualified and pre-sold, will typically spend more money, and will refer others to you since they were referred.

So how do you get them? The best and easiest way to get a referral is to ask for them when the client is most receptive. Most often this time is when they are “basking in the glory” of their purchase. That sounds simple. Yet many businesses don’t take advantage of this untapped “word of mouth” resource.

The best way to gain referrals is to put a multi-step referral process into place within your business.

First, make a list of all of the ways you can communicate to everyone you are in contact with, ie: friends, family, clients, vendors, competitors, groups you are a member of, etc. Then, devise how you will connect with these groups and ask for referrals. If you can establish a few processes of getting referrals, you will receive far more than you are now. Think about how that might effect your business. Also, think about how much time and money you will save from not having to prospect and market to new clients.

Here are a few ideas to get referrals-

Give something for the referral. If you can’t give something away, offer a free service or offer to make a donation to a their favorite charity in their name.

Give your new referral services or products at discount on behalf of the person who referred them.

After your client has provided you with a specific number of referrals, offer them a special deal or discount.

Have your clients agree that if they are 100% satisfied at the end of their transaction that they will provide you with two referrals. But don’t forget to follow up on their promise!

Create a list of business and/or individuals you may want to do business with and see who among your circle can introduce you to them or better yet refer your services to them.

Ask your clients to pass out cards with their name on it to their friends and family highlighting your services. Each time a card is redeemed, your referrer receives a reward or discount towards their future business with you.

Send your client some type of thank you gift to their office. When others see what they have received, they will inquire, leading to referrals.

Offer a stepping-stone referral plan. The more referrals the client provides, the more rewards they receive. This works well because usually if a client refers once, they will refer again.

There’s a chance a lot of your business is already coming from “word of mouth.” With a referral plan implemented, this gives you the opportunity with a inexpensive, easy way to get new business and increase business and profits.

Is your business utilizing a referral program right now? If it’s bringing you success, we’d love to hear about it.

Kathy Jiamboi has 14+ years expertise in Relationship and Direct Response Marketing and is President of Creativedge Marketing and Ready2Go Client Contact, in Cleveland, Ohio. Ready2Go Client Contact, a done for you program, allows her clients to simply and swiftly boost client affinity. She provides FREE expert marketing tips to anyone looking to gain more clients.

It’s important to know how many physicians your medical billing company serves, because it gives you an idea of the company’s scale — and in this industry, scale is key.

For instance, If a $150,000 per year billing system administrator is required, then a medical claims billing company with 200 clients only needs each of its client to carry $750 per year of that person’s cost. If a practice of four providers employed this person, then each provider would need to carry $37,500 per year of that person’s cost; this is the value of scale. A medical practice can achieve significant advantages by leveraging the superior scale of a mid- to large-sized medical insurance billing company.

A good medical company uses resources and technology that stand-alone medical practices can’t afford to support. Here are some examples of such resources and technology:

- A state-of-the-art billing system, offering advanced reporting and claim management capabilities. Such systems are often too expensive for a small to medium sized medical practice to afford; so they select a sub-standard system that they can afford.

- A pre-submission claim scrubber that applies the payers’ adjudication rules before the claims ever leave the medical insurance billing services four walls.

- Competent billing system managers, who stay up-to-date with the regularly-changing rules used by payers. A good system manager can help you collect on claims caught up in the system because of changing rules.

- Advanced collection tools, such as predicting payment yields from patients (such as the amount the patient owes times the likelihood they’ll pay).

- Deep rosters that won’t slow down when the company loses a single employee (which most practices are likely to experience).

- A dedicated group of individuals that follow-up on claims that have not had a response from the payer within a reasonable time frame.

These and other advantages show that most medical practices can’t afford the personnel and technology to match the services that a good, properly scaled medical billing company provides.

Most of the costs of maintaining these technologies and procedures are fixed, so medical billing companies tend to distribute the costs among their clients. This is why bigger medical billing companies can afford to serve practices better than smaller ones. Smaller medical billing companies may struggle to simply keep up with developing industry technology.

In conclusion, selecting a medical claims billing company that has the scale to deploy sophisticated technology and processes can provide the average medical practice a huge advantage in terms of their ability to do battle with the payers that are working hard to keep every penny they can.

Copyright 2009 by Carl Mays II

Are you sure your insurance companies are paying you according to your contracts? You may be surprised to know that it’s unlikely that they are. The average medical practice loses approximately five to ten percent of their collections because most insurance underpayments are never pursued or even identified.

A recent National Health Insurer Report Card compiled by the American Medical Association measured payment accuracy of seven major payers: Aetna, Anthem BCBS, Cigna, Coventry, Human, United Healthcare and Medicare. All of these payers to some degree strayed from contracted payment rate.

The worst offender was United (did not pay contracted rate in 38.4% of cases), followed by Cigna (did not pay contracted rate in 33.8% of cases), Aetna (did not pay contracted rate in 29.2% of cases), Anthem BCBS (did not pay contracted rate in 27.9% of cases), Humana (did not pay contracted rate in 15.8% of cases) and Coventry (did not pay contracted rate in 13.3% of cases). Even Medicare missed contracted payment rates in almost 2% of cases.

Tracking these underpayments is tricky. If you watch many different medical practices, you’ll find the same CPTs receiving underpayments, at around the same deficiency, from the same payer, and around the same period of time. But after a month, you may find the payer playing the game with different groups of CPTs to avoid being spotted.

Most underpayments aren’t substantial when considered one by one, but they can accumulate to thousands of dollars in the long run for any medical practice. Payers use a combination of switching the CPTs being underpaid every month and keeping underpayment amounts too small to attract notice, which makes these underpayments hard to spot.

Medical billing services may have difficulty finding these underpayments without comparing them with your contracted rates, as well as dealing with multiple procedure complications properly. Dealing with multiple complicated tables can be a challenge.

Billing services (and medical practices with their own in-house billing solutions) need to get and utilize industry technology to identify and correct underpayments. Most systems today are incapable of providing a workable solution.

Despite the complexity, however, it is worth solving this problem. Comparison of payments to allowables can increase a medical practice’s collections by 5 to 10 percent. This of course requires a strong process, powerful reporting technology and ability to track complex procedures methodically-in the end, it can however add thousands of dollars to your bottom line.

2009 copyright by Carl Mays II

Carl Mays is President and CEO of ClaimCare, a medical billing company that services clients across the nation. Carl is an expert in medical billing and physician practice management. He has an MBA from Wharton and a BSE from Princeton University.

A recent Medical Group Management Association survey showed that medical practices utilizing medical billing companies typical see improved performance across multiple dimensions. The survey focused on practices that used medical billing companies instead of in-house billing solutions.

Here are some of the interesting facts that the survey revealed:

- 73 percent of practices using medical billing companies reduce their AR;

- 73 percent also received higher collection rates;

- About three in every five practices have fewer denied or lost claims;

- 59 percent enjoyed significantly better reporting and practice performance insights; and

- Almost half experienced better staff productivity.

The MGMA study found that more than three out of every four practices that employ the services of a good medical billing company enjoy impressive improvements in productivity and performance. This confirms the long-held notion that utilizing a medical billing company improves a medical practice’s performance.

Some of the more obvious benefits of using a medical billing company include the following:

1. Medical billing companies have more scale to purchase and deploy the technologies required to properly submit claims, battle with insurance companies and collect personal balances.

2. A medical billing company can attract a higher caliber of billing specialists and retain these individuals.

3. Medical billing companies keep a deep bench of employees, so their clients don’t have to deal with the risk of losing a key billing employee from an in-house billing solution.

4. Billing companies are better positioned to properly utilize the technology they have.

5. Medical billing companies have a broader view of the medical industry as a whole because they deal with many different medical professionals at the same time. This knowledge helps them deliver better services to their clients.

If you’d like to see the survey for yourself, check the MGMA website.

Copyright 2009 by Carl Mays II

Before deciding upon a medical billing service be sure to visit ClaimCare’s Website. It provides in depth information about outsourcing medical billing. Carl Mays is a national renowned expert on medical billing operations and revenue cycle management.

A recent Medical Group Management Association survey showed that medical practices utilizing medical billing companies typical see improved performance across multiple dimensions. The survey focused on practices that used medical billing companies instead of in-house billing solutions.

The survey found that for practices switching from in-house billing to a medical billing company:

- Almost three in four practices that use medical billing companies reduce their AR;

- 73 percent realized higher collections;

- About three in every five practices have fewer denied or lost claims;

- 59 percent cited improved reporting and practice performance insights; and

- Almost half experienced better staff productivity.

The MGMA study found that more than three out of every four practices that employ the services of a good medical billing company enjoy impressive improvements in productivity and performance. This confirms the long-held notion that utilizing a medical billing company improves a medical practice’s performance.

This is not a surprise since medical billing companies have several advantages over most in-house billing solutions:

1. Medical billing companies are often better-armed to buy and use technology to submit claims properly, deal with insurance companies, and collect on personal balances.

2. A medical billing company can attract a higher caliber of billing specialists and retain these individuals.

3. Billing services keep a deep employee roster, giving medical practices the security that an in-house billing system can’t. For instance, practices using a medical billing company won’t face the risk of losing a key employee in the billing department.

4. Billing companies are better positioned to properly utilize the technology they have.

5. Medical billing companies have a broader view of the medical industry as a whole because they deal with many different medical professionals at the same time. This knowledge helps them deliver better services to their clients.

A copy of the survey is available from the MGMA’s website.

Copyright 2009 by Carl Mays II

Before deciding upon a medical billing service be sure to visit ClaimCare’s Website. It provides in depth information about outsourcing medical billing. Carl Mays is a national renowned expert on medical billing operations and revenue cycle management.

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