This week’s webinar was a live open mic Q&A session with ABS Founder and CEO Patrick Phillips. Co-hosted by Eric Ogea, Director of R&D. They took several questions from callers about starting a medical billing business, Obamacare, and several other issues affecting the healthcare industry in the coming years.
Behind every great athlete is a great coach. The same can be said for a lot of successful entrepreneurs. Join Patrick and Eric as they talk about how, when you start your own medical billing business, ABS will be your success coach for LIFE and how we’ll set you up to WIN.
By Patrick Phillips
(Originally published in HBMA Magazine – November 2013)
The healthcare industry is facing a state of complete disorder and confusion: Uncertainty surrounding the implementation of the Affordable Care Act, the looming switch to ICD-10, EHR and “meaningful use” deadlines, hospital acquisitions of physician practices, new HIPAA rules, and Health Insurance Exchanges… the list goes on. It seems like a challenging time for medical billing companies – and it is.
The good news is that not only can you prosper, you can bring hope and financial stability to struggling practices and salvage some that would otherwise collapse and shut down (or get swallowed up by a hospital or other acquisition entity). How can you assure your and your clients’ continued prosperity and growth?
Focus on becoming a full-service revenue cycle management company.
In today’s dynamic marketplace, billing companies that do not keep up with the constant changes will be left in the dust by companies that do. You must not only stay current with what is happening in the industry, you need to make alliances with other companies that can provide services to your clients that will help them solve cash-flow challenges beyond just their medical billing. The more services you can offer to your clients, the more you will be perceived as “the expert” who can solve their cash flow problems.
A brief review of the latest issue of Billing will introduce you to vendors that can be valuable to you in assisting your clients with medical coding questions, HIPAA compliance, EHR Meaningful Use attestation, online document management, patient portals, integrated payment channels, patient collections, and other revenue cycle issues. Do not forget that HBMA conferences will introduce you to technology partners that can help you keep up with changes in this dynamic industry.
Make sure you are using a billing system that is fully integrated with an EHR system.
Many outdated, server-based billing systems are trying to patch together a practice management system with one of the new electronic health record systems designed by a different company or on a different platform. The company that developed the practice management (PM) system creates an interface with an EHR system developed by another company. Chaos generally ensues.
If this is the case with your PM system, you are only asking for headaches and a possible loss of clientele. EHR companies are dropping by the wayside every day. Some of them are also server-based. Trying to get them to work together with billing software is like using “bubble gum and bailing wire” and will only lead to ongoing issues in your company. Two different companies, with two groups of programmers, trying to keep all the different parts of both systems running smoothly is almost impossible and can lead to turmoil in your company.
As painful as it may seem now, it may be a good idea to begin looking for a billing system that is totally integrated with an EHR system. That means that it was designed from the ground up by the same programmers in the same company. There are such systems available, and most of them are cloud-based (accessed securely 24/7 through a browser via the Internet).
Anything less than total integration of the two systems could be a disaster waiting to happen. Start your research now and find a system that will take you into the future, especially with any new clients you bring on. And, as part of your due diligence, make sure there is a way to import the data from your current system into the new system (at least the patient demographics). Then, begin to educate your current clients on why they need to start using an EHR, if they are not already, and why they might need to use a system that is fully integrated with your billing system.
Look for a system that has a way to electronically communicate with insurance company databases. You need one that checks for eligibility and automatically imports the patient data directly from the insurance company’s database to create new patient charts. This will save you hours of data input and will help you keep employee costs under control. It will also prevent you from submitting claims that are sure to be rejected because the patient was not eligible for the service and it will keep the practice from spending time seeing patients that insurances will not cover. This will increase your revenue for that practice and will eliminate a large number of claim rejections as well.
Keep up with changes in the industry.
I can predict the success you are going to have in your business – and in life in general – if you will tell me just two things: the people you associate with and the books (and periodicals) that you read. Do not get bogged down in the details of your billing business. You need to set aside time to attend industry conferences at least once a year and to read industry newsletters and books.
The person who does not read is no better off than the person who cannot read, so set aside time each week to read about our industry and keep up with the constant changes. Change is what life itself is based on, and if you are willing to change along with the industry, you and your clients will prosper.
Do not assume you will have your current clients forever.
You won’t. Things change in medical practices: staff turnover, new policies and procedures, new government rules and regulations, competition, updated technology, and the marketplace itself. All these things can cause you to lose a client from time to time. You must always be marketing.
Whether you realize it or not, your competition in this industry is not just other medical billing companies. The practice itself is your biggest competition. All it would take is for a new office manager to come into one of your practices and decide that they would rather not outsource their billing: they think they can do it themselves more efficiently and more economically. You must keep reselling your clients on your efficiencies and on your cost savings versus doing the billing themselves internally. Provide them with revenue reports that delineate what percentage of billed dollars (expected) are actually being collected. Show them you are the expert in this industry by producing and providing to them a professional newsletter with articles that show that you keep up with the changes in the industry. HBMA has a newsletter you can purchase and tailor with your company logo (www.hbma.org).
Take the practice administrator (or the doctor) to lunch from time to time and show them printed reports that illustrate the revenue collections from both insurance providers and patients. Hold “Lunch ‘n Learns” on a regular basis with your clients to bring them up to date on what is happening in the medical industry. Position yourself as the expert. People want to do business with “the expert” in every field.
When you buy a home, you do not want the new real estate agent: you want the guy or gal who has sold 100+ homes. When you look for a CPA, you do not want one who just hung out his or her shingle: you search for one who pays less than double digits of their own taxes and has a number of clients who they service. The same is true of a doctor’s office. They want to feel that they are dealing with the company that can bring in every last dime that is due to the practice.
Continue to network with other business people in the community and join your local BNI group or chamber of commerce. Get out once a week and let people know you can solve the cash crunch for doctors and help them build their practices through your contacts.
Set up an automated way of keeping in touch with everyone you come in contact with who is a prospective client. Let them know that you are the only company that they should do business with. When it comes time for them to decide to outsource their billing, you are the only choice that makes sense. People do not buy when you are ready to sell – they buy when they are feeling the pain. Be at the top of their list when they decide it is time for change.
Remind your current doctors and office administrators that you are looking to build your business. Assuming you have done a good job for them, ask them for a referral. You would be surprised as to how many billing company owners never ask their clients for referrals. Do not just ask for the name of someone. Ask your client to pick up the phone and call the other doctor or office administrator and tell them how pleased they are with your billing service and that they think it would be in their interest to meet with you.
You can shrivel up and die in this ever-changing industry, or you can make the choice to grow and prosper, starting right now!
Hosted by Patrick Phillips and Eric Ogea. Learn why the year 2014 is the PERFECT time to start your own medical billing business. Obamacare, Meaningful Use, ICD-10, and many other issues are creating a “perfect storm” and causing doctors to take a much more serious look at outsourcing their billing and using our stage 2 certified EHR product!
By: Patrick Phillips, Founder/CEO American Business Systems, LLC
(Originally Published in BC Magazine – Oct 2013)
When evaluating practice management software, there are key features you need to look for and there are some things you need to avoid.
Having worked with some of the major technology companies to find the ideal software to maximize the revenue of a medical practice, let me share with you, first, a warning about server-based software systems.
Server-based refers to software that is literally installed from a CD or DVD onto the hard disk of your computer-the “server.” This is old-school technology and should not even be considered for a modern medical practice. Especially in light of the HIPAA rules for patient privacy.
Imagine having a computer in your office, with all your patient records, stolen and sold on the open market! Even if you had a backup (another problem with server-based software!), your patient data is now in the hands of someone who could post it all on the Internet for the whole world to see (or sell it to some nefarious individual wishing to market some medical quackery to the patients).
And then there is the problem of hardware failure. It is not a matter of IF your hard disk will fail, but simply WHEN it fails. Then what? How many people make regular (read daily) backups of their hard disk data? And when a computer crashes, there goes all your patient history, including balances owed, and all your claims history, including insurance information.
And, if you are using a scheduling program, now you do not know which patients will show up when. It is a nightmare not worth even considering in today’s cloud-based environment.
There is even server-based software that can be installed on a VPN (virtual private network) to share the data between an outside medical billing company and your office. A piece of software is used to bridge between the medical biller and your computer. This is a huge HIPAA privacy risk, as well as a synchronization nightmare. Bottom line: Don’t even think about server-based software if you are currently shopping for practice management and billing software.
And if you are currently using server-based software, you need to start shopping for a cloud-based practice management system that is hosted on a software provider’s server and accessed via the web using any browser. If you are looking for a billing company, make sure you ask if they use a server-based system or if you can access the system through an Internet connection from anywhere, 24/7.
Here are some other things you need to check before outsourcing your billing or buying a practice management system for your office:
First and foremost, ask about the security of your data. If your patient and billing data is out there in “the cloud,” how secure is it compared to having your data stored on your own computer or server?
What you want to ask the software provider is this: “Are your servers HIPAA-compliant?” If the answer is yes, ask for proof. If the answer is “not sure,” run as fast as you can.
Most systems that are cloud-based are HIPAA-compliant. Which means, they are in a secure facility with redundant backup servers (the data is stored on more than one physical server). These servers may be in the same physical location, so make sure there is at least one other physical location (preferably in a different electrical grid somewhere else in the country). That way, if one server crashes or there is an electrical outage, the other server will kick in, and you, the user, will not even be aware there was a problem.
Make sure that the data on all the servers is backed up, daily, onto other media and stored in a separate, secure location. This is something that needs to be automated and happens “behind the scenes” at least once a day. Again, what if the server in one location blows up or the building it is in burns down, and the other server malfunctions and the hard disk crashes? Your provider needs to be able to restore the backup data to new servers and get you up and running within 24 hours. Ask specifically for their backup protocol.
Next, ask about specific features.
System Features. Is the system truly cloud-based? That is, can you access the system from any computer with an Internet connection? (One way you can tell is to ask if there is any software that needs to reside on the computer you are using in order to access the system.)
Is the system accredited by EHNAC (www.ehnac.org)?
Is the system connected to a certified CAQH COR Phase 1 Clearinghouse? (Google any of these terms you are not familiar with.) Is the system totally integrated with a clearinghouse, the billing system, scheduling, and clinical (including EHR)?
Is the EHR compliant with the data standards that are mandated by Meaningful Use?
Does the system automatically post payments and adjustments to the patient ledgers from electronic EOBs (ERAs) from payers?
Does the system have a Patient Portal that is integrated (all data entered by the patient is immediately available in all parts of the system)? Will the software provider assist with seamless data interchange with other healthcare systems?
Some of the standards that assist with integration and that you should ask about include Health Level 7 (HL7), ANSI X12 (the HIPAA Standard), Secure FTP (File Transfer Protocol), and HTTPS. You may not understand what all these mean (Google them!) but your software provider will know.
System Users. How many users can you put on the system? Is there a charge for additional users? Can each user be assigned limited access to certain parts of the system? You may have a data entry clerk who only needs to be able to add patient and insurance data. Another may just need to process the insurance claims. Another may be in charge of patient billing. And, of course, you will need full access for any person authorized to administer the system (adding and deleting users, setting their access level, running reports, etc.).
Billing. What is the average claims rejection rate from all payers (some systems average less than 2% rejection)? Can you place a claim on hold if more data is required? Can you print in PDF format or directly to CMS 1500 forms? Can you track your claim (like you can a FedEx package)? Can you create secondary claims to payers? Can the system email you if a claim is rejected? Can the system automatically, on a periodic basis, report on the first pass of all claims, total rejects, rejection categories, reworked (resubmitted) claims, and transaction summaries? Does the system have the ability to show reports as multi-colored bar charts, suitable for printing?
Reporting. What specific types of reports can be generated? Can you create your own reports? If not, can the software developer create reports for you, and, if so, is there a charge for this? Can the reports be exported to Excel or PDF format as well as being viewed on the computer? Can the reports be restricted to certain users only?
Eligibility checking. Can the system run eligibility checks on any patient at any time? Is this done in real time, checking the insurance company’s database and reporting back to your system immediately and accurately? Can the system automatically re-check the patient’s eligibility a day prior to every patient’s visit? Is there a charge for each eligibility check or is this covered in the monthly access fee for the system (or included in the percentage charged by the billing company)? Upon a successful eligibility check, does the patient data import from the insurance payer directly into the system?
Scheduling. Does the system have a web-based scheduler, available from any web-connected device, including smartphones, iPads, and tablets? Will it accommodate multiple providers and their appointments? Is it integrated with the eligibility feature?
Codes. Are all CPT and ICD-9 codes built into the system? How often are they updated, and is there a charge for updating the codes? Is the system ICD-10 ready?
Training. Is there live training available via GoToMeeting or live on-site training? How many hours of training will be given to our practice? Can as many staff members be trained as needed or is there an extra charge for additional users or hours of training? Are there recorded training modules available via the Web? Can all users access this training?
Support. Is support available 24/7, and, if not, what hours is it available? Is support by phone, live chat, email, or all three? How many support personnel are available and at what times? Is support available to all users or just the Administrator? Has the company won any awards for their customer support? Are there any references I can call to verify the level of support they get?
In summary, ask lots of questions, even if you don’t know exactly what they mean. Your software rep will know what they mean and will get you the answer if they don’t know the answer. Write these down and hold them to getting you the answers or tell them you are not going to consider their software/system.
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