Billing/RCM Archives

Chiropractic Billing Secrets – Tactic # 4 – What Insurance Companies Don’t Want You to Know

Strategy Review In most cases insurance companies have 45 days to process the claim once they receive it. Key words, process, and receive. Remember, they make up to 50% of their profit from interest earned on your money. Not just premiums they have collected from patients. The insurance company strategy comes in four basic flavors. Delay claim submission Prevent claim submission Prolong the “processing” time. Take the money they paid back from the doctor. Now we know their motivation. If you look at the chart below it is pretty obvious. What tactics to they use to make it happen? Tactic # 4 – Complicated Submission Process Forget getting the coding correct. Even if you have that correct it is difficult just to get the claim physically to them. Quick, tell me 10 fields on a HCFAA form. Have you ever heard of CCI edits or LMRP. I won’t bore you with the details here. Google them. The point is there are so many fields and rules for a reason. Get one number wrong and you are delayed. Clearing houses can help automate some of this by checking for some of the submission errors up front. When you want to go to electronic billing you need to find a clearing house. Then you have to “enroll” with each insurance company to submit through the clearing house. Good luck figuring out that process. If you submit by paper there is no way to confirm the claim was received at all. There are a certain percentage of claims where you are told “we never got it”. Imagine telling your mortgage company you never got the bill. Delayed. Then the form has fifty plus fields. If you make on error or transpose one digit on a birth date, it is denied and delayed. If you make multiple errors it is not spelled out like that on the EOB, they only tell you about one error at a time. Even with clearing house scrubbing you are still left with a lot of errors that can prevent and delay payment. Then there are secondary and tertiary carriers. Appeals process in multiple levels.

Chiropractic Billing Secrets – Tactic # 3 – What Insurance Companies Don’t Want You to Know

Strategy Review In most cases insurance companies have 45 days to process the claim once they receive it. Key words, process, and receive. Remember, they make up to 50% of their profit from interest earned on your money. Not just premiums they have collected from patients. The insurance company strategy comes in four basic flavors. Delay claim submission Prevent claim submission Prolong the “processing” time. Take the money they paid back from the doctor. Now we know their motivation. If you look at the chart below it is pretty obvious. What tactics to they use to make it happen? Tactic # 3 – Coding – Here is one place where they exercise their power by making simple things complicated. It seems pretty simple on the surface. There are a few diagnosis codes, a few procedure codes and then maybe a few modifiers. But then add diagnosis code linking. Most docs don’t even know what this means. This means if you have four diagnosis code and five procedures you can designate which diagnosis code goes with which procedure. Shoulder pain goes with the extremity adjustment. To get paid for that extremity code though, some insurance companies, not all, require a specific modifier. You only have four diagnosis to work with. What if you have five procedures and you can’t link all of the procedures to the diagnosis codes that you have? You would like to add more but you can’t. Some diagnosis code are not accepted for extremity adjustments. The result here is simple. We went from a few codes to thousands of combinations. It is ambiguous leaving the doctor confused delaying not only payment, in some cases outright claim denial, but delay in the submission to begin with. It is not by accident. After seeing hundreds of thousands of claims being processed and denied I am sure of it. Delay is how they make their money right?

Chiropractic Billing Secrets – Tactic #2 – What Insurance Companies Don’t Want You to Know

Chiropractic Billing Secrets – Tactic #1 – What Insurance Companies Don’t Want You to Know

Strategy Review In most cases insurance companies have 45 days to process the claim once they receive it. Keywords, process, and receive. Remember, they make up to 50% of their profit from interest earned on your money. Not just premiums they have collected from patients. The insurance company strategy comes in four basic flavors. Delay claim submission Prevent claim submission Prolong the “processing” time. Take the money they paid back from the doctor. Now we know their motivation. If you look at the chart below it is pretty obvious. What tactics to they use to make it happen? Tactic #1 – Gain The Power to Make The Rules In a free market power is gained in two main ways. The first way is a Monopoly. The government is very concerned when a monopoly occurs. If you remember Microsoft spent millions defending itself in court when it was accused of having built a monopoly. At the time almost every computer in the country was using a Microsoft operating system. A monopoly occurs when there is only one supplier of a good or a service. When this is the case, that supplier sets the price. Since there is no competition they can unfairly raise the price. When the good or service is something that is a basic need, people can be taken advantage of. For this reason the government steps in. The second and less known way is an Oligopoly. In short it is a monopoly in reverse. Rather than one supplier there is only one buyer. If you were the only one paying for a good or service you would dictate what you would pay. 70% of insured who live in the US are covered by only three insurance plans effectively making them the only buyer. They dictate what they will pay the doctors, how long it will take to pay, and even shift the burden onto the patients. They get to make the rules. The government is not as likely to step in the middle here and it is difficult to prove an oligopoly exists. They do this by consolidation. This is the reason we see insurance companies buying each other up all the time.

Chiropractic Billing Network Effect

Looking at the landscape of the chiropractic practice management, we see a playing field tipped to benefit the payers and hurt physicians. By increasing billing costs, underpaying claims and conducting a growing number of post-claim audits, insurance companies strive to keep profits high while depressing those of individual practice owners. To counteract these methods, healthcare providers need to streamline their business practices and take advantage of a chiropractic billing network. The relationship between payers and providers is adversarial, but a billing network offers solid strategies that allow providers to get back into–and win–the game. The “billing network effect” allows a large number of disparate practice owners to capitalize upon their strength in numbers.

Is Your Billing CA Running You?

She pulled the X-ray from the viewbox and shook her head in disgust. One more time, and it’s over, she thought. One more personal call, one more rude comment to a patient, one more complaint and he’s gone. She was tired and frustrated, and her CA was gnawing at her last nerve. Oh well, leadership camp was 1 week away, and she was looking forward to a weekend with her mentor and the other doctors, honing their leadership skills. “He” was her first hire. A CA from another chiropractic office that was a brilliant biller and great with patients, that is until he started working for her. Somehow, the last few months have become worse and worse, but she found it hard to imagine actually firing him. Initially, he had been a great CA. He put together everything from her superbill to the computers in the office. He was a puppet master with technology. He even set up a server — she didn’t know what it did — but he insisted it was of the utmost importance. Now, he worked less and less, came late, left early, and never stopped complaining. She had to hire additional staff as he became less productive and her practice grew, but he didn’t seem concerned. He liked the other staff members, and they liked him. They were often chatting together at the water cooler, wasting precious time, while she worked fervently trying to keep the practice together. She would fire him in a second, if she wasn’t so terrified of running the office on her own. Her decision to hire a billing service with an integrated system happened suddenly. She had heard about the service from her mentor, and it seemed an answer to her problems. No servers, no software, and no superbills. She could get back to practicing chiropractic without worrying about what would happen if he suddenly decided to find another job. She had waited two days before announcing it to the staff. He waited exactly 30 seconds before lodging his first complaint. “This is ridiculous!” he told her. “Our software is faster and better than theirs. Our billers are better trained than their staff. You can’t even make labels with it. How are we going to send patient statements?” It was Friday, and her mind was already on camp. “We’ll talk about it next week,” she said, and opened the door to leave, hoping he would leave the office with her. At camp, she brought up the issue with her mentor. Her mentor explained how he had faced the same resistance from his staff and how he dealt with it. She was determined to start fresh on Monday. “I have made the decision to implement a billing service with an integrated practice management system,” she began firmly. This was her first staff meeting in months. Everyone just looked blankly. “It will be a big change. One of our biggest changes. Change is uncomfortable. We all know that. This change will be painful.. very painful. We’re all going to have to learn a new system at the same time as we enter lots of patient information, set up care plans, and upload X-ray images. Before we start, I need to know that everyone is with me. One hundred percent.” His shocked look changed to a frown. She had to stand firm. “Anyone who doesn’t feel like this is the right decision and is not going to support me 100% can leave now.” She dared them. They just stood, thunderstruck. She plowed on. “I expect full cooperation. I expect you to come in early and put in late hours. And most of all, I expect you to maintain a positive attitude. Two hundred practices have already done what we’re about to do. Most have survived. Those that failed, failed because they didn’t have their staff’s full cooperation.” “That is not going to happen here. We are going to band together and make this work. I’m going to ask one more time if anyone wants out. The door is behind you.” Silence. “OK. The first step is to sign on to the system and start watching the training videos. There are 12 videos. Each is about 1 hour long. There’s a test at the end of each one.” “How will we do that while trying to handle patients?” It was his first question. “We watch the videos during breaks, and before and after adjusting hours. Any other questions? Look. I know you’re concerned. I feel that this is the best decision we can make for the good of this practice and other practices as well. I need your help. Will you help me get this done?” “I will.” her CA said. She looked surprised as he uttered those words. He was the last one she expected them from. One by one, they all pledged cooperation and filed out to get started. He stayed behind. She looked at him quizzically, then left the room to adjust patients. Her mentor smiled as she narrated the story to him. “I guess he just needed direction,” he said. Perhaps they all need direction.

Cash Practice and Chiropractic Billing Precision Integration Webinar

Dr. Brian Capra: Hello, this is Dr. Brian Capra with Billing Precision. Today I’m really excited to talk to you about one of our best integration ever with another software and that’s with Cash Practice and the founder and owner of Cash Practice is on the phone here today with me. His name is Dr. Miles Bodzin, Dr. Bodzin if you want to talk a little bit about the features of your system and then we can talk about the unique integration that we now have together. Dr. Miles Bodzin: I’ll start this way, we have three systems that all combine into one, I guess whole super system Cash Practice. The three systems or the three modules Careplan Calculator: It’s main feature is it gives you the capability to print the customize compliant payment plan or Cash plan as it’s commonly refer to, that actually prints all of your patients sign to buy your services. So, if you’re signing him up for six months care, eight months, a year whatever, the program as you’re doing it creates that actual agreement for them to buy your services. Auto Debit System: It’s main feature is payment processing. Credit card, debit card or eft. So, if you’re creating a plan with that first module that gives the patient the choice of making monthly payments. We need a compliant way of collecting that money. So, the auto debit system is that system, it will actually do the auto debiting for you. Drip Ed: This feature gives you the ability to do email marketing and campaigns on education. I should say so that you’re automating that process of sending patients emails and keeping in contact with them. So today’s world you want to stay in contact with people and that’s the purpose of this feature. So, altogether with the three systems in one step you’re able to create a plan for patient, enroll them in it, sign all their payments that are due and assign an campaign of emails literally in one click of one button. The main benefit is it increases your compliance, it increases our patients retention and it reduces your cost by eliminating significant numbers of payroll hours that your stuff are spending right now. Dr. Brian Capra: When we saw that we realized there is no need to reinvent the wheel when somebody is doing something so well. That’s when we saw a great synergy between our two companies. Billing Precision clients can go right through the schedule and click “more” and “cash practice”, that will take you to a landing page where you can sign up for Dr. Bodzin’s system cashpractice.com right from there. If they are already signed up clicking on cash practice will automatically take you to those features seamlessly. Dr. Bodzin, where can people find more information about Cash Practice? Dr. Miles Bodzin: There is a number of places, you go to cashpractice.com and there is information there. We would be happy to do a live demo for you over the internet by just calling us at 877-343-8950. Surely you can send a email to us, simply just send it to support@cashpractice.com is probably the best way that way it goes to our support system and everybody sees in a ticket, the request. You can also find us on Facebook, facebook.com/cashpractice literally with Cash Practice with our immigration module is software companies like Billing Precision could come in and they can add a capability that you’re able to from within your software with a click of a button immediately log into Cash Practice without having to do a separate log in. Cash Practice honors all of the permissions and things of that you would set up for your staff so it’s still honoring all of that stuff and when you log in it immediately takes you and you’re able to actually use Cash Practice inside of Billing Precision as if you are still using Billing Precision. So, as far as the use is concerned they’ve never left Billing Precision, they are in it.It gives you incredible efficiency by doing it that way and what it does for Billing Precision is it gives them this capability of all these features we have immediately. What’s unique about our integrated solution is that you guys have done is you’re the only company that done it where that you automatically import all of your payments, a 100 percent of them. What I mean by that is that when you’re using Cash Practice and let’s say you do a payment, you open it up, you open up one of the tools and you run a payment. Where the integration works is as soon as the payment runs there is a receipt produced live on that spot, that receipt can then be posted automatically in that persons account. That’s for one time payment that you’re doing right now if you’re live on the spot with the patient. And the reality is that you’re primarily using Cash Practice for the auto debit is the recurring payment that run automatically that happened every night. So those happen in middle of a night and you’re not, and you’re not there, logged into Billing Precision that time. Other software companies expect you to download the file from Cash Practice and then you have to manually import into their software. Well, Billing Precision is done as they have gone one step further where their software automatically pulls in those payments that run every night. So, eliminate the step of your CA at the front desk having the download the file and then manually imported. Billing Precision has eliminated all of that. That’s the process they have gone through is they wanted to make it so that it’s so automated that literally it’s as automated as possible. What Billing Precision had done as well is made it so that when you go to add a client into Cash Practice it will automatically take all of the patients data,

Billing Network – Accountability and Support – Part 2

Dr. Charles Majors DC uses Genesis Chiropractic Software.

Workbench and Accountability Once the staff is committed, they must be actively managed and made accountable. One way that a Billing Network can ensure staff accountability is to provide a rigorous mechanism for information exchange between the practice and the billing service. Instead of calling the practice and leaving messages when common billing issues arise, the Billing Network electronically records information requests to the practice. These requests accumulate in a “workbench” that the practice can monitor any time. We are often asked about the “workbench” and the amount of “extra work” that it adds to a practice. The workbench’s function is precisely to make the staff accountable and help the practice owner manage the process without having to look at every claim. The workbench effectively “opens the billing drawer” and exposes all the claim rejections and unpaid services that are typically hidden by billers and billing companies. Successful practices implement a policy whereby no one leaves the office until the workbench is clean. Reconciliation Another pitfall is lack of reconciliation. Many client issues stem from a misunderstanding about how the Billing Network computes the monthly invoice to the client. In our example, Billing Precision receives and posts both EOB and ERA (electronic EOBs) without confirmation of whether the money actually was deposited into the provider’s account. The reason is simple: Billing Precision has no access to the provider’s account and therefore completely depends on the provider to reconcile their bank statement to the monthly check report to make sure all the money was deposited by the practice. Any provider that does not reconcile their payments runs the risk that the insurance companies make a mistake and send ERAs without sending the money, or worse, that checks and EOBs are received by the office, but that the checks somehow get lost before being deposited. This could quickly lead to a misunderstanding where the office believes they are being overcharged for money that was posted as collected by the Billing Network, but was not actually deposited into the provider’s bank account. It is therefore absolutely imperative for the practice to reconcile their statements at least on a monthly basis and notify the Billing Network immediately if any checks are posted as paid in Vericle but not received by the practice. Support Protocol Finally, practices often have an unrealistic expectation of how quickly a Billing Network can respond to their support requests. Billing Precision and Vericle support a complex organization of technologists and billers who are constantly working to improve the technology and follow-up on claims. Constant phone interruptions by practices decimate productivity of all Billing Precision and Vericle employees as they struggle to switch between the tasks that they are trying to accomplish and the problems and questions posed by the clients. On demand phone support also leads to long hold times (average hold time for BCBS NJ is 22 minutes!) and very frustrated clients. Billing Precision believes in empowering clients to find solutions on their own and at their convenience. Providers and their staff must be willing to take initiative and search the available web resources for their answers. Of course, we recognize that sometimes the information needed is simply not available in the online resources. In those cases, offices can register and join the daily QA sessions and ask their questions in a group settings. Alternatively, they can open a ticket directly from the Home screen and let the appropriate team respond within 1-2 days. Summary After reviewing these items with the doctor, I suggested that he take some time and really think about whether his practice is a good fit for our service. Does he understand the benefit of joining a Billing Network? Does he want to contribute to the greater good and help all members benefit from his experiences, just as he benefits from theirs, or will he expect perfection and leave at the first sign of trouble? Does he have the complete commitment of his staff? Are the staff members “self-starters” that can try to resolve issues on their own or simply open tickets and wait for replies, or will they demand instant hand-holding and instant results? The doctor took a deep breath and thought for a moment. He tried to visualize his staff grappling with the workbench while trying to learn a new system. He imagined their frustrations and complaints at having more work to do. He considered whether he really believed in the concept of doctors banding together and learning from each others’ mistakes through a unified system. Then, he thought about the insurance companies and how unfair it was for them to be able to benefit from their large scale and all the data available to them. He thought about hundreds of billers in India fighting for his claims and using the aggregate knowledge gained from processing hundreds of thousands of claims every month. He thought about our successful client and how he was able to rally the troops and implement the system quickly and efficiently. He imagined his practice discovering a flaw in the process, and working with Billing Precision to correct the flaw and help hundreds of practices across the country avoid the same mistake. His decision, at the end, was a personal one. Whether he decided to join the network or go it alone is not nearly as important as the thought process behind it. For the Billing Network to benefit everyone, all providers in it must be “on mission”. As Aristotle put it “The whole is greater than the sum of its parts.” Or, if you prefer: “All for One and One for All.”

Billing Network – Commitment & Accountability For Medical Billing, Part I

Erez Lirov, creator of Genesis billing software and billing network.

Recently I had a conversation with a potential client concerning his trepidations about joining Billing Precision, a Billing Network. He mentioned that he spoke with several clients that were ecstatic about the service, but he wanted to know what the negatives were. In other words, what did clients who did not have a perfect experience with a Billing Network have to say about the service? What negative experiences could he learn from? And most importantly, what makes a client a “bad fit”? What type of clients would do better billing on their own or with a traditional medical billing service? Billing Network We started by looking at the concept of a Billing Network, which bands together many smaller practices so that they can benefit from each others’ experience and contribute to the greater good. This is in stark contrast to an in-house billing process, where each provider has their own system and has an isolated view of only their own claims. In the contest between Payers and Providers, Payers already have an aggregated view of many providers and are able to benefit from a large data set, more efficient processes, and more streamlined management. Whereas each individual provider needs to develop their billing processes and controls, hire a good operations manager, and continuously train and tweak the process to keep up with the payers, the payers do it once and apply it to tens of thousands of providers. This is one of the reasons why it’s easier for payers to offshore their operations and benefit from the lower cost of labor. A “good fit” client for a Billing Network has a very thorough understanding of this concept. They understand that even if they could hire someone at a lower hourly rate than the commission that the Billing Network charges, that the person they hire would likely not be able to build and manage a complete and efficient billing process, and they would definitely not have access to the large data set available to the Billing Network. Clients that do not get this concept are forever comparing their cost of billing to what they would pay per hour for someone to work part-time on their claims and forget about the benefits of being in a Billing Network. Good clients are looking to contribute to the network where possible. When they run into problems, they are determined to help the Billing Network identify the core problems and improve its processes so that others do not have to trip over the same land mines. Commitment The next issue is staff commitment. In any practice, the commitment level of the staff often determines whether or not an office becomes a content, successful participant in the Billing Network. Staff members are often fearful of change or resentful of the extra work required to make the practice successful in billing. Such team members can easily sabotage the process or the relationship and lead to a complete disaster. Anything from not submitting EOBs, not working the workbench, or simply infusing the process with a negative attitude have all led to failure of the office to benefit from the Billing Network. Often, lack of staff commitment to joining the Billing Network is just a symptom of overall lack of staff control in the office. It’s amazing to see the difference between very successful offices who are often seeing 1,000-1,500 visits per week with 3-4 staff members, vs offices struggling to see 100 visits per week with a staff of 2-3. It starts at the beginning of the engagement. One of our high-volume practice owners began the integration process by gathering his team together and telling them that: He has made the decision to join the Billing Network The transition will be difficult for everyone He expects 100% staff cooperation and commitment Anyone who can’t commit to delivering 100% should leave now Very simple and very effective. The office was up and running in 3 days and was able to fully benefit from the Billing Network within 3 weeks. In Part II, we explore accountability, reconciliation responsibilities, and support protocols, and we discuss how Billing Networks differ from traditional billing services in these respects.

Billing Network Effect – Dr. Chris Zaino – How Billing Precision Levels the Playing Field with the Insurance Companies

Dr. Chris Zaino says, “There’s a lot of things that are involved in building a great successful practice but there’s a lot of things that kind of get in your way and one of them is insurance.” A lot of times the insurance, the whole insurance structure of collecting money or working with it even though we want to use it when we can, and our patients want to use their insurance. The whole game of the insurance scheme is tilted in their favor. So that when it comes to profiting you might think, oh they make their money off the premiums. OK but it’s not the premiums alone. It’s called the float and the float is that, that they’re holding the money, delaying payments so they could put in, get interest, or reinvest it, and it will make 50% of their profit. Then add auditing. You know their audit is about, for every dollar they spend, they’re going to make about 13 dollars back. They statistically know this down to a science, they have a science to this. So if you’re just a local practitioner and you don’t have the right team involved with this, getting those funds back to where it should be, which is in your hands. This is what’s happening, so this is why you need a, really a trained force to do so. Now you finally realized what’s really going on. Sad part is you could look back, and even that billing person you have, I know they’re great and they’re wonderful but you realize that you’re absolutely unqualified to really deal with this and it’s impossible to do it alone so…but here, Billing Precision we’re going to level the playing field. The only way you could do that is having a sophisticated technology and automation using a massive group of people. They’re doing tens of thousands of claims and you’ll never know when Medicare or any type of insurance company starts to tweak their system. The only way you could tell is by looking at trends and immediately you could see that trend start to happen and once they find that, they know exactly how to counter it and level the playing field to your benefit. –Dr. Chris Zaino

Category: Billing/RCM