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By Debbie Yannete
Medical Billing Manager - MSO
Empowering your billing staff
Many physicians as well as practice administrators
find themselves wondering if outsourcing their billing
is right for them. If you are asking yourself the same
thing, take it a step further.
How much is your billing staff costing you in real
dollars?
You may aware of the obvious costs - staff salaries,
vacation time, sick time, benefits etc.
Have you
considered the cost of training? Are you sending your billing staff to
seminars and workshops? If you are not sending
your staff - do you know the cost of non compliance with
current billing guidelines? Education is the
best way for your staff to be brought up to speed on current
changes and trends in medical billing.
What is the cost of these seminars and
workshops and lost productivity during the time your
employee is attending? You may think the knowledge
imparted is worth the cost, but let’s face it.
Statistics show the average employee stays on the job
for 18 months. How well do they utilize CPT & ICD 9
codes? How extensive is their knowledge of modifiers and
how to use them? How extensive are your new employees
being trained for your office? Take into consideration
not only the time of the trainer, but the error ratio
for each new staff member. That’s right. EACH new staff
member.
Clean claims start at your front desk, go through
your clinical staff, on to your exit billing and end up
in your billing department. Every employee on your
staff, no matter how small, or large your staff is, has
a hand in the billing of each patient that passes
through your door. And we are all aware that each
patient passing through your door represents revenue in
your account. What outsourcing your billing does for you
is to help you keep those dollars in YOUR account.
If your “billing” staff, is not 100% up to snuff…this
is costing you more than you may be aware. By
outsourcing your billing, the agency you choose should
be 100% up to snuff. It is their responsibility to
insure that each of your staff members have enough know
how, to insure that your claims go through cleanly, and
promptly. With electronic submission, this should mean a
turn around time of less than 14 to 21 days.
Imagine performing an office visit or surgery on the
1st of the month and seeing payment come through for it
by the 21st of the month!
This of course brings us to next phase in the life of
a claim. The payment posting process.
(Another area your staff needs to be fully trained in.)
Are you aware of the contracted rate with each insurance
company for every service you provide? Is your staff?
How about your software? Does it have the capability to
be programmed to determine the fee paid is the correct
fee that should be paid by each insurance company you
participate with? If it does have that capability, what
is it costing you to have that database updated yearly?
Is it even updated yearly? Or is your staff so looking
forward to posting the next check to get through the
pile, that they simply take the word of the insurance
company on the EOB stating what the allowable is and
write off what the insurance company tells them to write
off?
That of course brings us to the collection process.
How much time and energy does it take for your staff to
go after, not only unpaid claims, those are easy, but
incorrectly paid claims? Do they know how to utilize the
insurance commissioners office? Do they know how to use
their provider relation representatives fully? Are they
aware of the policies of each insurance company as far
as the appeals process goes? Does your software or
submission process make it easy to prove timely filing?
(Insurance companies love to tell you it’s not on file).
And let’s not forget everyone’s favorite…patient
balances! How well does your office do on following up
on patient balances? Do they relay solely on the
statement cycle? Do they follow up with a phone call?
What type of return are you getting here? What
percentage is ending up in collection? If it is
unfortunate and necessary to send an account to a
collection agency (I know I feel like I failed with each
account that’s sent), is it being done when absolutely
all other avenues have been traveled to no avail? Or is
it being sent when it is so old it not only costs you
more in commission, it makes it difficult for even the
collection agency to collect on!
Your billing staff should be so fine-tuned that a
collection agency’s usage is miniscule!
The coding process, submission process, payment posting,
insurance collection and patient collection processes
should be second nature to your staff. If you are
finding a lag, then it is definitely time to start
outsourcing your billing. And Medical Service Options
billing division is your definitive answer!
MSO's Basic Billing Service:
1) Data entry
- a) Done within 24 hour period
- b) Patient demographics
- c) Insurance information
- d) Charge entry
- e) Weekly transaction report generated
2) Insurance Submissions
- a) Done on a daily basis.
- b) Electronically where applicable.
- c) Paper where it is not.
- d) Correct claims that are found to contain errors that
stop their submission electronically.
- e) Current secondary insurance submissions
3) Payment posting
- a) Post monies collected line by line as per EOB
- b) Indicate reasons for discrepancies in payment
- c) Indicate reasons for any denials incurred
- d) Weekly transaction report generated
4) Collections
- a) Respond to denials received by EOB from insurance
company
- b) Make corrections and resubmit when indicated
- c) Send patient statements when necessary
- d) Statements issued on a daily basis with a 30 day
cycle
5) Monthly reports generated
- a) Aged trial balance
- b) Insurance/patient aging report
- c) Practice Analysis
Platinum Plus
In addition to our Basic Service and Platinum
Service, we offer the following services for your 90 day
+ accounts. Most insurance companies deal with 90 day +
claims as “untimely”. A completely different level of
billing and collecting techniques are required to in
order to close these claims. In our experience, if
patient balances are more than 90 days old, most offices
find it virtually impossible to collect upon them. This
is where our PLATINUM PLUS service comes in. We offer:
Transfer these claims and accounts into our
computer system:
- a) Enter all notes into our system
- b) Review all office correspondence and activity on 90
day + open accounts to determine true responsibility
- b) Make corrections on claims where necessary
- c) Resubmit those corrected claims
- d) Bill patients as indicated
- e) Follow up on insurance balances
- f) Follow up on patient balances
- h) Complaints filed with Insurance Commissioner when
necessary
- i) Variety of collection level letters sent to
patients including attorney letters.
All accounts deemed “uncollectable” by these standard
practices will be reviewed by your office for final
determination. Ultimate resolution will be determined by
conferencing between your office and ours.
Platinum Service
All five aspects of the Basic Service with the
following additions:
Collections
- a) Patient phone calls regarding billing can be handled
by our
Office. Patients would perceive, if you wish, that MSO
is a direct extension
of your office.
- b) We will do all current insurance follow up based on
aged trial balance
- c) Written letters of appeal will be done when necessary
- d) Letters contesting denials such as medical necessity
- e) Letters appealing low rates paid
- f) Proper ICD-9 and CPT coding match ups will be
indicated to insure prompt payment.
- g) Phone calls to patients for follow ups on balances
due
- h) Severely past due accounts will be handled at your
discretion and direction.
- i) When resubmission or additional information is
requested, we will handle
resubmission or gather information and forward it.
- j) Secondary submission on current claims
If you would like some more information on MSO's
billing services, contact Debbie at (201) 670-9999.
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