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