Medical Billing Is Not Enough or many years, most of us have considered ourselves to be in the medical billing industry. For decades, that has been sufficient. However, now that healthcare is evolving and changing at such a rapid pace, it is probably not enough to just offer “billing services” and expect to be a viable company in the future. The traditional billing services we have offered are becoming more and more automated. Here are a few examples: • eligibility Inquiries 270-271 • Intelligent Claim scrubbing Programs • Claim status 276-277 • authorization/Certification 278 • Claims and Payments 835-837 given these advances in automation, we now need to move from being known primarily as billing experts to recognition as management and billing experts. Here is another way to look at it: we need to turn the data our clients entrust us with into information that will benefit their practices. Clients are always complaining about declining reimbursements, and you need to ask yourself, “How am I helping them increase revenue or control their costs?” It is unlikely that reimbursements will increase, so the only options they have are to offer more profitable services or reduce costs. Your company should help your clients address both of these areas. Have you ever done a cost analysis for your clients to determine what it actually costs them to deliver each of the procedures they provide to their patients? If you have not done this, I guarantee you will find that they have overpriced or break-even services, and services that are costing them money to deliver. after you have gone through the costing exercise, review the payment schedules from each payor they participate with to see what services may need to be renegotiated or which insurance companies they may need to drop altogether. Try compiling and examining referring physician data. You will deliver more value by finding out who is sending them the profitable patients. I once knew a doctor who always went out of his way to squeeze in patients from his friend who sent him a high volume of referrals. FROM THE rOaD He would stay late if necessary because he did not want to disappoint his oft-referring friend. However, after examining the data, we found that all the patients he was referring to my client had the same low-paying coverage. I called the referring doctor’s office to ask how they could have a sustainable practice by only seeing patients with this low-paying coverage, and the person I spoke to responded, “Oh, patients without that coverage are always referred to his brother-in-law’s practice.” The above is just one example of how you could make yourself more valuable to your clients. Here are a few other examples: • Provide feedback on how well their staff is collecting copays and deductibles. Not only does this improve the practice’s cash flow, it also reduces your patient billing and collecting costs. • Prepare e&m coding comparison charts that show each provider in the practice. I have seen an instance where one doctor only billed a level 3 for every patient, thinking that would protect him from ever getting audited. He reasoned that using a level 3 for each patient would balance things out in the long run. • examine the patient cancellation report. One practice I worked with discovered that a majority of their cancellations, although sporadic, occurred at the end of the day. They later found out that the doctor would run behind schedule on the days he made rounds at the nursing home before office hours, causing the staff to stay later by an hour or more in order to get through the schedule. so, if any of the staff had a commitment the evening of a nursing home day, they would simply fill the schedule with fictitious patients in the afternoon to ensure they could get out on time. These are just a few examples of how you can become extremely valuable to your clients. just doing “billing,” while important, is not enough in today’s challenging environment. remember, it is not the data, it is the information that will make you indispensable to your clients. Dave Jakielo, CHBME, is an international speaker, consultant, executive coach, and author and is president of Seminars & Consulting. Sign up for his free weekly success tips at www.Davespeaks.com. Dave can be reached via email at Dave@Davespeaks.com or phone at 412-921-0976. By Dave Jakielo, CHBME F 46 HBma BIllINg • maY. juNe.2014
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