Reimbursement For Medical Services: Today's Technology

Reimbursement For Medical Services: Today's Technology: I can remember being part of a summer day camp when I was in the 3rd grade in 1983. We did all kinds of cool things like going to the local...

Today's Technology

I can remember being part of a summer day camp when I was in the 3rd grade in 1983.  We did all kinds of cool things like going to the local nature reserve and spending the day at an amusement park.  I can also remember the day the counselors wheeled in the "computer".  It was a monstrous piece of machinery that had to be wheeled in on a huge cart.  I don't think even Superman could have lifted it!  As the blueish-black screen appeared, my buddies and I just sat there in amazement.  We had never seen anything like this before.  Also little did we know what computers would become over the next 30 or so years.

Flash forward to 2011.....We now have smart phones, the Internet, email, fax machines, texting capabilities, and the list goes on and on.  Anyone who has an i-Phone or Blackberry is basically carrying a computer in their pocket. I know what I saw in 1983 would not have fit into my parent's car let alone someone's pocket!

I try to network with people as often as I can for business purposes.  I always urge people to network as much as they can on a professional level.  The more people you met the more people you have a chance to learn something from.  I am amazed with the amount of people I meet in today's society that do not have email addresses or can't attach a document to an email or just flat out can not use a computer. If anyone wants to survive in today's professional world then knowing and understanding computers and technology is mandatory.  Now I am not saying that you should know indepth how the inner workings of a computer function.  That's why we have IT people!  I am saying that having the skills to work on a computer can not be taken lightly.  If they are then those people who do take computers lightly will be left behind.  Especially those who work in health care!

Always be prepared- A lesson learned

Our company helps the local adult education schools in our area by hosting some of their students that need to complete an internship as part of a medical billing and coding program. We provide the students with everyday hands-on experience.  Also, during their time with us, we provide them with advice from an employer's perspective on things they should do when looking for employment.  One of the major points we try to get across to students is to always be prepared.  We tell students that at any time someone could call them for a phone interview and that they should be prepared to answer questions over the phone.  We also tell them they should always keep copies of their updated resume with them (in their car)and to be ready to provide it at any time. This is because it always seems to be in a moment when it is least expected that they will make contact with someone looking for a biller/coder or know of someone looking to fill a position.  So be just like the Boy Scouts and always be prepared. 

Over this past weekend I did not practice what I preach.  I was in a local suit shop being fitting for a new suit.  The gentleman helping me was very nice and very talkative.  He eventually asked me what I did for a living.  After telling him I owned a medical billing company, he informed me that his wife owned a medical transcription company.  Immediately a new door was opened but I couldn't walk through it because I left my business cards and brochures at my office.  I was not prepared.  I did not practice what we preach in our company. Although I do get a reprieve because I have to go back to the suit shop in a few weeks after the suit alterations are complete.  Then I can pass along my business card and a brochure.  Some of you might be saying I could have just written my contact and compay information down and passed it along.  Sure I could have but it doesn't come off as professional as passing along a business card or brochure.  What if I made contact with someone at a busy airport and neither of us had time to write down some information as we rushed to our gates?

In the end....lesson learned.

Using Proper Grammar

In today's society there are a plethora of social media outlets that people use to communicate on a professional level.  It truly amazes me at the lack of attention to detail when it comes to spelling and grammar; especially when it comes to the proper use of our/are and there/their/they're.  There have been a countless number of times where a perspective employee has emailed me their resume with a message that they "appreciate me taking the time to look at "they're" resume.  Then when I open the resume they usually have "attention to detail" listed as one of their strengths.  This always makes me chuckle.

I strongly recommend the following links that will help clarify the meaning and use of these words.  This is a small but very important factor that will decide if you resume makes it to the next level or just gets filed away in the HR Department never to be considered again.

Our/Are: http://bit.ly/mZ9Aik

Their/There/They're: http://bit.ly/cE3LJ6

5 Questions With Cheri Freeman

Cheri Freeman is the Manager of Account Services for Virginia College Healthcare Reimbursement Services at their Austin, Texas location.  Since 1999 Ms. Freeman has specialized in physical medicine and rehabilitation billing and coding.  Her blog, which can be found at http://www.cherifreeman.com/, is a great resource for any medical biller and coder.



Q1:  How did you originally get involved in healthcare billing?

A:  I researched work from home businesses and was really drawn to the home-based medical billing company idea since I had a toddler at home and I am also a detail oriented person so it seemed like a good fit.  I did the research, got the training, made cold calls and about a month after my first cold calls, signed my first client.  I admit that I worked for 2 years without a profit, but then it all kind of came together for me after that.

Q2: What are some of the changes you have seen in medical billing and coding during this time?
A:  When I first started in the industry, it was all about filing electronic claims vs. paper.  In a short time it seemed that most provider offices were filing their claims electronically. Since then, I have seen changes and updates to the electronic filing formats such as the new 5010 format coming in 2012.  I have seen NPI implemented.  I have seen more and more EMR (Electronic Medical Records) systems implemented in provider offices so that it is now becoming the norm. In addition, I have seen practice management software go from stand alone systems that required remote access via PC Anywhere, to ASP (Application Service Provider) systems, and then true web based systems that can be accessed from any location with an internet connection --even notepads and cell phones!  Now we are at the brink of the biggest change yet, (at least in my opinion) that of ICD-10. I heard whispers and inklings of information about ICD-10 many years ago when I first got started in the industry, but I honestly wasn't sure if it would ever become a reality--and here it is, right around the corner!

Q3: What advice do you have for billing and coding students preparing to enter the industry?

A:  The industry has become a lot more complicated over the years and I recommend new billers and coders get as much training and hands-on experience as possible from reliable sources before entering the job market.  I would also recommend that these students try to get that training and experience in all aspects of the revenue cycle, thus gaining an understanding of the "big picture".  Lastly, I strongly encourage new students to obtain one or more certifications in their field and to stay current with all the changes that never cease in this industry.  Those that do not stay abreast of the rapidly changing scenery of this industry will find themselves stagnating or left behind.

Q4: What advice do you have for today's physicians?

A:  I am very concerned about the dwindling reimbursements facing today's healthcare providers.  I would encourage them to take a hard look at their practice management reports and payer contracts to determine if it might be prudent to change their network status to out-of-network or non-participating with certain payers. As long as providers continue to accept reimbursement cuts, the payers will continue to give them. I would also encourage them to diversify.  Look into offering ancillary services and even cash based services and/or products that are beneficial to their patients but not necessarily covered by insurance such as: screenings, education, fitness center, etc. to boost revenue.

Q5: What do you think the future holds for Medicare and Medicaid?
A:  I think the trend towards privatizing these entities will continue with even more "advantage" and Medicare replacement plans coming into play despite recent sanctions against several of these plans, as well as more Medicaid HMOs managed by private insurance.  I also believe we will see even more regulation within the traditional Medicare and Medicaid programs.

Health Care Reform

My wife gave birth to our second child in May.  We are just now receiving the Explanation Of Benefits from Anthem on the charges for the delivery and the four day hospital stay.  Even though I own a medical billing company and see medical charges on a regular basis, I was still amazed that Anthem was charged $33,000 for everything.  I am very thankful that we have health care coverage that covered a vast majority of this amount, leaving us only a small co-insurance amount to pay.

As I looked over the Explanation Of Benefits, I continued to try and wrap my mind around $33,000.  It made me wonder how those without any form of health care coverage survive.  I can only imagine the type of financial burden this puts on them.  I hope I am never faced without health insurance.

Unless you have lived under a rock the past 18-24 months you have heard about the health care reform President Obama has put into motion.  Now I am not taking any political stance with this blog post.  I am not sure that what Mr. Obama is proposing is the the answer or not.  I do know it's a start.  I know there is still a lot more work that needs to be done with health care.  All I can do is urge everyone to get involved and start communicating with your elected officials and urge them to continue working on a solution to the health care fiasco.

5 Questions with Cyndee Weston

This is a continuation of our series of "5 Questions".  Cyndee Weston is the Executive Director of the American Medical Billing Association (AMBA) based in Davis, OK.  Cyndee has 25+ year of experience in medical billing and is very well versed with healthcare regulations.

Q1:  How did you originally get involved in healthcare billing?

A:  In my previous life, I worked as a senior claims examiner for a couple of the major commercial insurance carriers. My experience in dealing with claims that were not properly completed led me to the idea of starting a billing service. It seemed like a natural fit to me. I was comfortable with the claim form itself and I knew how carriers processed claims. As it turns out, I was right. Starting a billing service was the best thing I could ever have done.

Q2:  What are some of the changes you have seen in medical billing and coding during this time?

A:  When I first started my billing company back in the Eighties, there weren’t a lot of people offering claims processing services. In fact, most people that started a billing service only offered electronic claims filing services. In the Nineties, more claims were filed electronically and then Medicare mandated electronic claims filing.  Billers began to offer full practice management services and as well as other services that met the needs of healthcare providers. Today, we are seeing changes that may require billers to adapt their business models to once again fit the needs of providers.

Q3:  Why did you start the American Medical Billing Association?

A:  After starting my billing business, I had a great need to network with other billers to share education and resources. I have always been a gatherer of information, literally. I love reading anything related to billing, coding and compliance. I had a lot of information to share with other billers and it dawned on me one day that we needed an organization for medical billers. I was already spending a lot of time sharing information with others.  I really felt like this would be a good fit for me. I knew the industry and I knew what it took to be a successful independent biller. So I started the association in hopes that it would lead to better opportunities for billers. I knew that collectively, we (billers) would have a stronger voice and be able to share ideas and information as well as continuing our education.

 Q4:  What advice do you have for today's medical billers and coders?

A:  Don’t be afraid to step up and learn something that is outside of your comfort zone. It has been said that management does things right, but leaders do the right things. Everything you do for your business is about doing the right things most often. That means sometimes, you have to do things you may not want to or are a little afraid of. It also means that sometimes, you’ll make mistakes – but, if you use those lessons as an opportunity to learn and try not to make the same mistakes twice, you’ll make a lot more right decisions than wrong ones.

   

Q5:  What advice do you have for today's physicians?

A:  You must have a compliance plan in place and follow it. You cannot afford to operate your practice without a good fraud and abuse detection and prevention program. You must regularly audit your practice to see if you are an outlier compared to your peers on billing codes and modifiers and other areas auditing entities are reviewing. If you find that you have an issue, you must be ready to disclose it, refund the payor, and prevent similar issues from happening again. The days of non-compliance are over. There are so many auditing entities using predictive modeling to identify fraudulent and abusive billing practices and trends based on previously submitted claims data that the chances of being audited have increased significantly for all healthcare providers. It is imperative for providers to do all they can to prevent improper billing practices. It’s both offensive and a little frightening to know that doctors are being targeted to repay monies they’ve long since spent for treating patients that are long gone, for the sake of funding healthcare reform. Not knowing what’s happening in your practice won’t work when the state or Feds come knocking. I can’t stress enough that you need to do everything you can to prevent improper practices in your office.



* If you would like more information about AMBA visit www.ambanet.net or contact their office at (580)-369-2700 . 

5 Questions with David Mohler

I recently interviewed David Mohler who is the CIO at Vandalia-Butler City Schools and the CTO at ClearLogic Corporation. 

David offers nearly three decades of information technology experience ranging from the DEC PDP-8/A through today's current platforms.

In 1988, David founded Stillwater Software and developed products for construction estimating, payroll tax accounting, RS-232 interfaces, and POS software.

In addition to developing various software solutions for construction, transportation and healthcare, David has managed migrations of systems from DEC OpenVMS (Alpha) to Microsoft Windows; Novell Netware to Windows; GroupWise to Exchange; and also designed and managed installation of the wireless MAN used by the Greater Cleveland RTA's bus & train GPS system. Since 1985, David has managed individual projects of up to $15 million.

David is a Microsoft Certified Application Developer, and his experience includes storage & SANs; data migration; disaster planning; electronic health record systems; practice management systems; PACS and RIS; dictation systems; television, radio & multimedia; telephony/VoIP; and LAN/WAN design.

David is a lifelong resident of Dayton, OH, and attended Wright State University. He is a commissioned Kentucky Colonel, an FCC-licensed commercial AM/FM radio operator, and an active member of CompTIA and ISTE.

Specialties

Certs: MCP; MCAD; MCSD; CCNA; 3Com NBX.
Healthcare IT Systems
Parametric Planning for EHR
Disaster Planning
Project Management
SQL and Application Development

Q1:  How many years have you been involved with healthcare related IT?
A:  21 years


Q2:  What made you decide to get involved with healthcare from an IT perspective?

A: Prior to starting ClearLogic, I was responsible for the construction of special systems in hospitals (data, nurse call, patient monitoring, etc.) and so the fit was natural. As data systems evolved into personal computing rather than mainframe systems, I was at the forefront of that integration. In the mid 1990's, medical practices started using personal computers, networks and serves, and our role grew along with that adoption.


Q3:  What are some of the biggest advancements in technology that have you seen that have had or will have the biggest affect on providers?

A: There are two principal advancements that have had a the biggest effect: imaging and electronic health records. The effect has been a relatively difficult adoption for providers, because the cost to store the data is a surprise to them. What used to be stored in expensive filing systems and expensive folders is now stored on expensive hardware, and requires oversight. The data did not go way; it is still being stored, but now we are doing more and there is even more data than the old filing systems used to have. The long-term effect can be better healthcare and higher profits, but it must be managed correctly. The days of a nurse acting as a manager for all things administrative are long gone.



Q4: Providers are getting bombarded on a daily basis by companies trying to sell them their EHR product. What advice would you give a provider who wants to implement electronic health records?  Where should they start?  What types of questions should they ask?

A: No two EHR's are alike, and - make no mistake - EHR sales people are slick, making promises that can never be fulfilled and not disclosing the full cost of EHR. Without exception, every practice should hire a healthcare IT integrator, like ClearLogic (937-424-1383) or Edison Lightworks (937-203-2939), to conduct interviews, and manage the implementation process. These companies have no loyalties to products or vendors, and serve the practice by negotiating the vendor's price, features and promises, while mitigating lost productivity, and designing the work flow that EHR will demand. They also oversee practice-specific issues like remote access, medical device interfaces, or data bridges to billing entities like Reimbursement For Medical Services. The questions any practice should be asking would take pages to list - and those questions are the result of experience. Practices should retain that experience by partnering with an independent integrator to oversee their EHR acquisition and implementation. This will always cost less money, in terms of thousands of dollars, than trying to do it themselves.


Q5: What advice do you have for practices that are considering selling to hospitals?

A: I think that it depends very simply on four initial factors: 1.) How old are the doctors?; 2) How large is the practice in terms of patient volume?; 3) How specialized is the practice? 4) What is the practices' patient demographic? If the doctors are preparing to retire within three years or so, then sell to a hospital. But if the doctors are relatively young, they should think twice because hospitals will not, in the long haul, allow them the autonomy they inherently desire. Physicians are autonomous creatures, and hospitals have a way of sucking the life out of autonomy - they have numbers to make, and only the numbers matter.  If the practice has a high patient volume, they should be hesitant to sell to a hospital. There is money to be made on high-volume practices with professional business management, and they might consider that route instead of selling out. If the practice is specialized, they should consider whether they can "own the market" and serve multiple hospitals, instead of selling out to one hospital. Finally, if the demographic is such that revenue depends on government policy (e.g., Medicare) then the practice might consider selling to offload that risk to the hospital.


Upcoming "5 Questions" interview: Cyndee Weston, Executive Director of the American Medical Billing Association

Some "Do's and Don'ts" For Potential Employees

I have seen some pretty crazy things on resumes and been involved in some very interesting interviews during my 12 years as an employer.  I feel that I need to provide some "do's and don'ts" in regards to resumes and the interview process.

1.  Create a professional email address.

I recently had a resume where the applicant had listed their email address.  It was something along the lines of sexyhotmama @whatever.com.  Once I saw this I was no longer interested in looking at the rest of the resume.  I strongly suggest that everyone create a professional email address for their resume. 

2. Verify that your references will provide a positive response.

I contacted a reference an applicant provided only to realize they had a falling out with each other.  This reference did not paint a very good picture of this person. 

3.  Prepare yourself/family for a phone call.

Any incoming call can be a potential employer.  Be prepared to get a call for a phone interview at any given time.  Our company spends a lot of time on the phone speaking with our clients and their patients.  So strong phone skills are a must.  Use proper grammar.  If you provide a phone number that anyone in your family may answer, be sure to let them know you may get a call from a potential employer.  About a year ago I called a phone number listed on an applicant's resume and her boyfriend answered.  He was belligerent and actually cost his girlfriend a chance at an interview.  Also leave a basic voice message recording.  Don't try to be a DJ and have a clever intro with music.  Employers are looking for professional people.

4.  Dress for success

Take the time to dress professionally; even if you are just dropping off a resume.  There is nothing worse than having someone drop off a resume wearing flip-flops and cut-off shorts.  Once again employers are looking for professionals.  Personally I would rather have someone come to an interview overdressed as opposed to underdressed.

5.  Don't share your personal problems.

Have you ever been standing in a check out lane at the grocery and the person behind you shares way to much personal information?  People would be amazed at the personal things people have shared with me during an interview.  There is no need to share your personal health problems or the drama you are currently going through with your parents, boyfriend/girlfriend, husband/wife, or kids.  These types of comments are a huge red flag for employers.  Always keep personal issues just that....personal!

These are just five areas that potential employees can take into consideration when applying for a job.  In the end remember everything boils down to being professional.