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 .