http://www.articletrader.com/ Articles at ArticleTrader en-us http://www.articletrader.com/finance/compliance-program-guidance-for-third-party-medical-billing-companies.html http://www.articletrader.com/finance/compliance-program-guidance-for-third-party-medical-billing-companies.html Thu, 24 Jan 2008 00:00:00 -0600
The OIG recognizes the diversity of organizations that comprise the third-party medical billing industry; medical billing services ranging from publicly traded multinational organizations to the medical billing service operated out of a basement corner. The OIG also recognizes the diversity of services provided by these medical billing services.

The OIG believes that, regardless of the size, resources and services rendered by third-party medical billing services, every organization will benefit from the principles espoused in the compliance program. In order to be effective, the governing body of the billing service (Board of Directors, CEO, Partners, etc.) is required to formally commit (document) to a compliance program that includes at least seven applicable elements.

Before we get any further, a word about the seven elements. The OIG notes that these elements are based on the seven steps of the Federal Sentencing Guidelines. If you have any question about The Federal Sentencing Guidelines, they are detailed policies and practices for the Federal criminal justice system that prescribe appropriate sanctions for offenders convicted of Federal crimes.

Again, a medical billing company’s statement of compliance should contain the following seven elements:

1. The development and distribution of a policy indicating the processes and procedures designed to insure a company’s commitment to monitoring and addressing possible areas of fraud to include the claims submission process; code manipulation and financial relationships with vendors;
2. The designation of a chief compliance office (CCO) and other appropriate body, i.e. compliance committee, responsible for operating and monitoring the compliance program and who reports directly to the CEO and governing body;
3. The development and implementation for education and training programs for all applicable employees;
4. The implementation of a mechanism or process, i.e. a hotline, to receive complaints and fraud tips and procedures to maintain and protect the anonymity of the complainants;
5. The development of a system to respond to allegations of improper/illegal activities and the enforcement of appropriate disciplinary action against employees who have violated internal compliance policies, applicable statutes, regulations or Federal, State or private payer health care program requirements;
6. The use of audits or evaluations to monitor compliance and assist in the reduction of identified problem areas; and
7. The investigation and correction of identified systemic problems and the development of policies addressing the non-employment of sanctioned individuals.


I’ll continue to talk about the OIG’s Compliance Program Guidance for Third-Party Medical Billing Companies in future articles. If formulated and documented properly, a medical billing service’s compliance program will make up a significant portion of the company’s policy and operating manual - particularly for smaller billing services.

Disclaimer: This article is for informational purposes only and is not intended to be considered legal advice. A third-party medical billing service should consult with a lawyer or other professional when developing a compliance program.

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The author, David George, is an expert in electronic medical billing services and account receivable management. He specializes in significantly improving the cashflow, revenues and profitability of physician practices accross the country. David also authors the

Source: http://www.articletrader.com ]]> http://www.articletrader.com/finance/medical-billing-the-lights-are-on-but-is-anyone-home.html http://www.articletrader.com/finance/medical-billing-the-lights-are-on-but-is-anyone-home.html Wed, 23 Jan 2008 00:00:00 -0600
The Office of the Inspector General, in conjunction with the U.S. Department of Health and Human Services, developed and released the Compliance Program Guidance for Third Party Medical Billing Companies on November 30, 1998. The intent of this program is to promote a higher level of ethical and lawful conduct throughout the entire health care industry; and to protect the solvency and stability of the Medicare Trust Fund (also known as Medicare).

Before we go on any further don’t get the impression that the U.S. Department of Health and Human Services (HHS) carries some sort of grudge against or questions the validity of medical billing outsourcing services. Prior to the Compliance Program Guidance for Third Party Medical Billing Companies was established, the HHS had already issued compliance programs for the clinical laboratory and hospital industries as well as home health care agencies.

The legislation comes in response to the proliferation of medical billing out sourcing companies throughout the health care industry; the undo influence these medical billing services could have on a physician’s billing and coding practices; and the potential negative effects of unscrupulous billing and coding practices by these medical billing services on Medicare.

Like most OIG-issued compliance programs, conformity to the Compliance Program Guidance for Third Party Medical Billing Companies is strictly voluntary. On other hand, issues that arise due to a failure on the part of the medical billing service to abide by these “voluntary” compliance programs could expose the billing service to legal actions brought on by the U.S Government. Protect yourself and your business by interpreting “voluntary” as “mandatory” or be prepared to suffer the consequences.

The OIG has identified seven fundamental elements to an effective compliance program. They are:

1. Implementing written policies, procedures and standards of conduct;
2. Designating a compliance officer and compliance committee;
3. Conducting effective training and education;
4. Developing effective lines of communication;
5. Enforcing standards through well publicized disciplinary guidelines;
6. Conducting internal monitoring and auditing; and
7. Responding promptly to detected offenses and developing corrective action.

In future articles I will continue to explain the Compliance Program Guidance for Third Party Medical Billing Companies in plain English so you can take the steps necessary to protect your medical billing service from unwanted government intervention.

If you are a health care professional outsourcing to a medical billing service you too should be interested in this program. Ask your medical billing service to provide you with documentation showing the steps they take to insure compliance to this very important program. Be a smart business owner and protect your practice from unwanted government action.

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The author, David George, is an expert in electronic medical billing services and account receivable management. He specializes in significantly improving the cashflow, revenues and profitability of physician practices accross the country. David also authors the

Source: http://www.articletrader.com ]]> http://www.articletrader.com/business/career/medical-billing-how-are-uncollected-copays-like-rotten-fruit.html http://www.articletrader.com/business/career/medical-billing-how-are-uncollected-copays-like-rotten-fruit.html Sun, 20 Jan 2008 00:00:00 -0600
The lonely fruits and veggies left without a home just sit in the bins losing their value with each passing day; until they reach the point that no one will buy them regardless of price. They’re worth nothing, nada, zip, nothing. So they just get tossed in the trash bin.

So what’s my point? If you’re a doctor with uncollected patient accounts or unpaid claims, the outstanding monies are just like the spoiling fruits and veggies sitting in a grocery store bin; losing value until the uncollected monies are written off – the grocery store equivalent of getting tossed in the trash bin. Make no mistake – uncollected money goes stale pretty quick.

Here’s an example. The easiest way for a doctor or any other health care professional to increase their revenues by percentage points is to simply collect co-pays from each and every patient that walks through their doors.

Consider the costs involved in collecting a $20 co pay – after they’ve been treated and walk out the door. Let’s say the $20 sits in receivables for six months. By that time, based on the future value of money, those twenty dollars are now worth nineteen. The value of that co pay has dropped 5%.

The cost of time and materials for the three statements your staff sent to the patient add an additional cost of $1.80. Now that $20 co pay is only worth $17.20 – 86% of the original value. Odds are by this time the patient has no intent of ever paying the bill.

The only other option is turning the account over to a collection agency. The agency’s fee will be 30% of the monies collected so the value of that $20 co pay drops by $6 to $11.20; or 56% of the original value.

Apply this example to a health care professional’s entire outstanding receivables and you’ll see that he/she can significantly impact their bottom line simply by instituting a policy that requires collecting the co pay of each and every patient at the time services are rendered.

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The author, David George, is an expert in electronic medical billing services and account receivable management. He specializes in significantly improving the cashflow, revenues and profitability of physician practices accross the country. David also authors the Start a Medical Billing Service blog offering tips, tricks and advice for medical billing and coding entrepreneurs.


Source: http://www.articletrader.com ]]> http://www.articletrader.com/business/career/the-truth-about-medical-billing-and-coding-careers.html http://www.articletrader.com/business/career/the-truth-about-medical-billing-and-coding-careers.html Fri, 18 Jan 2008 00:00:00 -0600
To the college I was just a salesman with a quota to fill. To me, I was a professional responsible for providing a high school senior, a drop out with a GED or a person “re-careering” with objective information to help them make a decision that could effect their life for quite some time. I wanted to do my part to help that person get the most out of the time and money they were willing to invest in themselves.

A common theme with many of the students I enrolled in the medical billing & coding program was an interest in a health care career without the “blood and guts” (a term I remember using to relax and get a smile from the student); or in other words the close contact with patients that would be experienced by a medical or dental assistant. For them, an administrative position like billing & coding was just what the doctor ordered (pun intended).

In this school, like many others, the medical billing & coding program was combined and came in two flavors: a nine month certificate program and an eighteen month degreed program. The difference? At the conclusion of the nine month program, the student received a certificate (not to be confused with a diploma) documenting their completion of the coursework.

The student was also prepped to take the American Health Information Management Association’s (AHIMA) Certified Coding Specialist (CCS) exam. Upon passing the exam, the student was awarded the CCS credential. At the conclusion of the eighteen month degreed program, the student would have earned an associate’s degree and, like the certificate program, would be prepped to take the CCS exam.

If I used any sales tactics it was to persuade the typical billing & coding student to enroll in the degreed program. By typical I mean a person with a high school diploma/GED and little to no practical work experience. The reason? Not because the school made more money (they did), but because I firmly believed - and still do - in education as the best way for someone to better themselves personally and professionally.

To me the certificate program was a strong second choice and usually selected by those students that, among other things, wanted to get in to the workforce faster or couldn’t afford the degreed program. As I mentioned earlier, upon graduation the student would receive a certificate stating that they completed the coursework and be prepped to take the CCS exam. To me the real value was taking and hopefully earning the CCS credential.

There are several credentials that can be earned by a medical billing and coding professional. Credentialing is a big deal. Why? Having those letters after you name (e.g. Jane Doe, CCS) proves that you have demonstrated the knowledge, skills and ability required to pass an exam issued by a nationally recognized American Medical Association (AMA) sanctioned organization. In the world of medical coding there are two organizations offering credentialing sanctioned by the AMA: AHIMA and the American Academy of Professional Coders (AAPC).

When you check out the AHIMA and AAPC websites - and I really hope that you do - you will notice that their credentialing programs are all about medical coding. You may have visited the websites of some allied health colleges and noticed that their medical billing & coding programs are really a bunch of medical coding classes with a couple of billing courses thrown in for good measure.

I think there are a couple of reasons why most curriculums focuses the bulk of their coursework on coding rather than billing:

:: Students are more “employable” with combined coding and billing skills
:: The health care industry is placing more value on coding skills
:: Medical billing can be learned on the job and requires little to no technical knowledge

I may repeat this in other posts but if you really are thinking about making the financial and personal commitment to a medical billing or a billing & coding program, I can’t stress enough the importance of performing your due diligence so you can make the quality decisions that will put you in the best possible position to be successful.

By due diligence I mean partnering with a parent, mentor or someone else you trust to be honest and objective to help guide you in your decision making process. You also need to be completely honest with yourself, know your strengths and weaknesses and apply that knowledge to your decision making process. For example, if you struggled in high school or have a learning disability you may not be able to pass the coursework and should consider other employment options. On the other hand if you were an outstanding student you might consider pursuing an undergraduate degree in health information management (see AHIMA.org for more information about a health information management program).

You should consult with the AHIMA and AAPC websites to see of there are schools near you on their approved list. I do know the AAPC also offers Internet-based or distance learning courses. If you are considering a program not approved by either organization then be sure to at least check out the school on the Better Business Bureau website and Google to see what previous students have to say.

Finally - and I’m probably get some hate mail - but please be very wary about any company offering medical billing correspondence courses and certificates. You will find out the certificates aren’t worth the paper they’re printed on when it comes time to find a job. Why? There is no AMA sanctioned body that issues medical billing certifications. The certificate is simply documentation showing that you took and passed some billing training program.

I can’t tell you how many times someone sent me a resume just because they had completed a medical billing correspondence course. I would not hire anyone with no prior experience. Why? I don’t want to train a newbie and can’t afford the liability exposure - someone not knowing what they’re doing can run off clients. I stick by this hiring policy after learning the hard way. Bottom line - no prior experience, no job.


Sources:

American Health Information Association (ww.AHIMA.org)

American Association of Professional Coders (ww.AAPC.com)

Also see:

“Billing and Posting Clerks and Machine Operators” Occupational Outlook Handbook 12 December 2007 http://ww.bls.gov/oco/ocos277.htm

“Medical Records and Health Information Technicians” Occupational Outlook Handbook 12 December 2007 http://ww.bls.gov/oco/ocos103.htm

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The author, David George, is an expert in electronic medical billing services and account receivable management. He specializes in significantly improving the cashflow, revenues and profitability of physician practices accross the country. David also authors the Start a Medical Billing Service blog offering tips, tricks and advice for medical billing and coding entrepreneurs.


Source: http://www.articletrader.com ]]> http://www.articletrader.com/business/career/medical-billing-so-you-want-to-start-a-home-based-medical-billing-service-part-1.html http://www.articletrader.com/business/career/medical-billing-so-you-want-to-start-a-home-based-medical-billing-service-part-1.html Sun, 16 Dec 2007 00:00:00 -0600
Although the FTC has litigated most of the major medical billing scammers out of business; their bogus sales pitches enticing unwitting victims with claims of easy number with no experience has seemed to persist. Over the past several years, there has been so much hype and discussion about medical billing as a work from home job opportunity that it has almost become the stuff of urban legend. Apparently everyone knows a friend of a friend that once met someone who somehow made a good living working in the medical billing industry.

Just Google “medical billing” and you will see a dizzying and confusing array of websites selling the work-at-home medical billing dream through training, education, software, books, website memberships, blogs and forums; and that doesn’t count the thousands of websites representing the actual medical billing businesses themselves.

I can understand why the casual observer could come to the conclusion that the demand for medical billing seems to outstrip the supply. An aging population fueling the increase in demand for entry-level allied health positions just adds to the hype. Is the projected growth in demand for health care professionals legitimate? Yes. Will this demand somehow affect your opportunity to own a medical billing business? That’s a complicated answer I will attempt to answer over the course of several articles.

My goal is to share my experiences and knowledge not only to provide the tips, tricks and how-to’s of owning and operating a home-based medical billing business; but more importantly to shed some light on the home-based medical billing industry in particular and the medical billing outsourcing industry in general. If I can provide any information that might help you to better invest your valuable time and money then I will consider my job done.

In that vein, I would be remiss if we didn’t first take a look at some of the more in-demand administrative positions in the health care industry – any of which could provide the foundation for someone interested in starting a home-based medical billing service.

Typically, when someone mentions medical billing they might be making a general reference to one of the following administrative health care positions: 1) medical billing clerk; 2) medical coder; 3) health information technician; and 4) health information manager.

Medical Billing Clerk

The medical billing clerk may be the job description that comes to most people’s mind when they think of the work-at-home medical biller or home-based medical billing service. The medical biller is responsible for ensuring the paperwork generated from patient treatments are entered in to a computer program; sent to the insurance companies in a timely manner and paid promptly to the provider of service.

The U.S. Department of Labor publishes a great resource called the Occupational Outlook Handbook. As an aside, I suggest using the OOH to get the scoop on any job or career you are seriously interested in pursuing. Following is a summary of how the OOH views the current and future state of the position of medical billing clerk:

::The health care industry employs 1 out of 3 workers.
::Most jobs in this occupation require only a high school diploma; however, many employers prefer to hire workers who have completed some college courses or a degree.
::Slower-than-average employment growth is expected as increased automation of billing services reduces the need for billing clerks.

Here is a real world employment ad recently posted on Monster.com for a medical biller:

“…position as medical biller with stable, well known, prestigious organization is hiring! Successful candidates will need at least 1 full year minimum experience in medical billing, verifying insurance and/or medical claims and must be able to deliver great customer service. Salary: $11-$14/hour.”

Based on the ad’s description, the individual will probably be performing several jobs - medical billing; verification of patient coverage and probably working the front desk. The fact that a physician’s office is more likely to hire someone cross trained to perform many of the office’s administrative functions makes sense; while a medical billing service is more likely open to hiring someone with only medical billing experience.

Pros:

::Medical billing clerks do not work directly with patients
::Physician’s office or medical billing office will provide a professional working environment
::Work is performed at a desk and is not physical in nature
::Does not require a degree or certification; usually a high school education is sufficient

Cons:

::Demand for someone possessing only medical billing skills is anticipated to be weak
::Heavy computer and telephone work may lead to repetitive motion-related injuries
::Requires previous experience in most cases
::Employer may require additional schooling or training
::Employment opportunities will depend on geographic location
::One of the lower paying allied health positions; entry-level wages of $10/hour or less

Prerequisites:

::Knowledge of computer systems
::Strong keyboarding/typing skills
::Additional training or education may be required by the employer
::At least one year of experience
::Self starter with a can do attitude
::Strong organization, communication, problem solving and multi-tasking skills

have oftentimes heard of former medical billing clerks starting their own medical billing services simply by convincing an employer to allow them to work from home. If medical billing is an opportunity you wish to pursue, check out all the resources you have at your disposal - online job boards (Monster.com, Careerbuilder.com, etc.), staffing agency websites, local hospital websites, newspaper ads, etc. - to verify job qualifications, starting salaries and overall job demand for medical billing professionals in your geographic location.

Stay tuned for Part 2 in which I review the medical coder, health information technician and health information manager positions.

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David George is founder and CEO of Accuclaim Medical Billing Services and author of the Accuclaim blog. Visit David's blog for more valuable information as he shares his advice, answers questions and addresses the issues of the day in the medical billing industry.

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