The key to a prosperous and profitable medical healthcare practice lies in the ability for the medical biller to spot – and STOP – negative trends.

Users of medical practice management billing and electronic claims processing software program (like VertigaPM) have an easy way to spot those trends and deal with them quickly and effectively.

Using key reports provided within the VertigaPM program (and those provided by the VertigaEDI clearinghouse), savvy medical billers can immediately spot negative trends whether in claim reimbursement or in claims processing.

Even more savvy medical billers will schedule a recurring monthly meeting with both the medical provider and their staff – either together or separately – to review the results of the reports and establish new protocols and procedures to bring the trend to a more positive state.

Keeping your numbers in check will keep your business humming! Make it a oint to have everyone involved working together and watch your business flow!

A medical practice is business.  Yes, you are in the business of serving those whom are ill and taking care of their health, but lets face it: you are a business and like any other business out there your practice needs to make money.

Users of medical practice management billing and electronic claims processing software program (like VertigaPM) have an easy way to make more money while collecting it: it’s called “Statement Advertising”.  Here is how it can work for you:

In the Statement setup, you should have the ability to add a generic message on each statement.  Here is where a medical office can take advantage of this space to promote their business putting messages such as:

10% discount on your Flu Shot

FREE sample of _____ with your next visit!

$25 credit on your account for each referred patient to our practice!

And so forth.  The idea here is to advertise your own business while you are trying to collect money from your patient’s for their past visits.  Remember, don’t assume they know everything you offer.  Send them timely messages on their statements to get their interest peaked and watch your profits grow!

At the start of every New Year insurance companies, like Medicare, begin applying the annual deductibles meant to help patients have lower insurance premiums by making them more financial responsible.

Users of medical practice management billing and electronic claims processing software program (like VertigaPM) have it much easier when it comes to correctly posting claims that apply to deductibles.  They also know that a quoted patient’s deductible from a call made to their insurer, may or may not apply to their actual charges and thus do not shy away from billing the insurance and waiting for their response prior to requesting money from their patients.

Here are three things to keep in mind when it comes to insurance plans that have deductibles:

(1) Not all services rendered are applied against the deductible – meaning, that state or federally mandated services (like yearly exams, etc), are not subject to annual deductibles, nor are other specific services.  You should contact the insurance company for their complete list of servies that the deductible does not apply to.

(2) Not all claims are applied against the deductible.  Claims are processed on a first-in basis.  If you are not the sole provider of service for a patient for that calendar year (meaning, if the patient has been seeing other providers as well as you), the other provider’s claims may be the ones to process against the deductible if theirs is received first, and the deductible may already be met by the time your claim gets around to being processed.

(3) Each health plan may have different rules that apply to how a claim is processed against the deductible based on how the employer group set up the plan.  For example: some plans have a rule that states that if the patient exceeded their out-of-pocket maximums for the calendar year by the last quarter of the last calendar year, then this calendar year’s deductible does not apply.

Medical Billers that collect the patient’s deductible in advance, without knowing how the deductible rules are applied, are doing a disservice to the patient and causing more work for themselves.

Make your job a lot easier by getting to know the deductible rules before treating the patient.

Okay, it’s not official, but it should be!  Think about it: billers no longer just have to know how to bill, they also have to learn how to use complex EMR/EHR programs as well and be able to do all their other duties as office managers and keep everything running smoothly on top of it all.

Never in history has a medical biller have to do so much during their work day and get paid what they do! The great part is that users of medical practice management billing and electronic claims processing software program (like VertigaPM) know that they have a lot of one-on-one help when they need it via phone call, email, fax, or web based help right at their finger tips.  If you don’t, maybe it’s time for you to change to a medical billing and electronic claims processing software company that does, because it isn’t going to get any easier from here.

Well, unless you are also users of the VertigaPM program with the integrated SpectraEMR which then makes your billing a breeze!  With the integrated SpectraEMR and SpectraBilling, medical billers have their needs met with just a push of a button – literally! No duo programs to use. No duplicating work.  Just a fast, simple, easy-to-use electronic medical records (and electronic health records) solution to make medical billing a lot easier and keep medical billers very happy!

Here’s to the unofficial Year of the Medical Biller!

The one complaint we here from medical healthcare billers always has to do with the lack of time they have to get their billing and postings done, let alone their follow ups.  This seems to be especially so for those offices that have just one administrative person running the entire show acting as biller, receptionist, secretary, accountant, and all those other hats they seem to wear.

Users of medical practice management billing and electronic claims processing software program (like VertigaPM) know that they have a lot of help already built into their software.  Features like Electronic Claims processing, automatic ERA postings, the ability to Repeat Claim, as well as the ability to import patient demographics into the system.

Users of electronic medical claims processing clearinghouses (like VertigaEDI) know how easy it is to get claims corrected and reprocessed, billed to the secondary, and can even take advantage of electronic pateint statements so that they never have to send out a statement on their own (the clearinghouse does it for them!)

But what about manpower in the office?  Here are two good ways you can get the help you need without “hiring” anyone:

(1) Solicit interns from colleges or trade schools that specialize in medical billing. These are students that are in their last year of school and need to get hands on experience before they get their diploma.  They have all the skills they need and have at least 3 to 6 months of time they need to put in as medical billers before graduating.  This is a free service that you can take advantage of.

(2) Solicit other medical billers to do your follow-up work. They get paid a percentage of what they are able to collect from you but only if they collect.  Since there is no money up front, and there is no payment unless they make you money, you have nothing to lose.  They can do it at their place of business or yours.

Put a plan together to get the help you need and watch your business grow profitably!

The phrase “Stickin’ it to the Man” essentially means “fight back” or “resist”. For those in the medical healthcare business, the “man” is the insurance company that instead of working with you to help their member (your patient), they seem to work against you (and them) by preventing your claims from processing.

There are many tactics an insurance company will use.  Our all-time favorites are:

- “We never got the claim.” (Even though you sent it with a bunch of others at the same time and those got processed)

- “The information provided on the claim is incomplete, missing, or invalid.” (Seriously, make up your minds! Which is it?!)

- “The zip code is not in the correct format.” (And other format related excuses for non-claim related information when claims are sent electronically.)

What is even worse is when they decide to downcode the claim and pay you a lesser amount because they simply felt like it even though – time and time again – you provided everything they needed at the time the claim was submitted.

There are many others, but you already know them.

So, how can you stick it to the man? Let me count the ways:

(1) your provider belongs to an association of some sort (the AMA, NMA, APMA, etc) – use the power of numbers to get many others on board and have the association work on your behalf to represent you against the insurance company directly, and against the goverment (both State and Federal) to control these wrongdoings.

(2) start writing letters of complaint to your Councilman, Senator, and State Representative. Create a template on Microsoft Word that you can use each time, and copy and paste into the letter the rejections (or those things that just don’t make sense) into the body of the letter, along with the claim information which can be extracted from the medical practice management billing and electronic claims processing software program (like VertigaPM) that you are using.  Enough people sending these types of letters is bound to get someone to help you.

(3) turn them in to your local TV station.  Many TV News stations offer a “Working for You” type of service where their investigative reporting team will go out and investigate corporate wrongdoings.  If enough of your fellow Medical Billers and Medical Providers have the same problems, a case can be opened up against them.

Make sure you keep adequate and detailed records, and – as always – make sure you’ve done all you can to keep your billing clean.

Medical Billers are always pregnant – pregnant with the desire to see the claims they created mature into payments and come full circle.  But when you are expecting, anything can happen: from claims being rejected for no valid reason, to benefit denials due to insurance companies misinterpretation of the services rendered, to endless requests for additional supportive documentation in a never ending cycle.

Users of a medical practice management billing and electronic claims processing software program (like VertigaPM) have the opportunity to easily track these types of issues and the insurance companies that cause them and take definitive action to stop the madness and get the payment they deserve.

When all else fails, there are three things a Medical Biller can do to keep their Medical Healthcare Business afloat and get the reimbursements they are due:

1. Complaining to the Insurance Commissioner of your state.  Google “Insurance Commissioner of” followed by the state you work in and find the name, address, and phone number of the Insurance Commissioner. He or she can become a very powerful ally in your fight against insurance companies that do you wrong.  The Insurance Commissioner’s office acts as both consumer protection advocates as well as insurance regulators. This is the office that gives the approval for an insurance company to operate in your state following certain mandates.  They can help you fight for your cause if it can be proven that the insurance company is causing problems for the insured, which you, as a medical biller, represent.

2. Get the Patient involved.  Remember, it’s the patient’s bill – not yours.  When the insurance company is not doing what they should be, remember, the patient CHOSE that insurance to help pay for their balance.  Bill the balance to the patient and have the patient fight it out with the insurance.  Have a clearly worded policy in place that all patients sign in agreement to that state that your acceptance of their insurance is only as a means in helping them defray their final out of pocket costs and that your office will not hesitate to bill them as a patient directly for the charge if need be since the services were rendered to them and not their insurer.

3. Most patients did not really get a choice in the insurance policy offered by their employer. In many cases, employer groups are the very best advocates for your patient when it comes to dealing with insurance companies.  After all, they can move their entire membership (all of their employees) to another insurance company when it comes time for open enrollment thus causing the insurance company a greater financial loss then them simply paying for the bill presented.  Get your patient to work with their HR department or their Employer Group’s office to assist you.

Follow the above and you can make certain that you get what you are expecting.  After all, you worked hard for it to not to!

Most Medical Healthcare Billers tend to spend time chasing down denials as soon as they get them – either paper or electronic rejections – unaware that most insurance companies have an unspoken rule that a percentage of all claims are automatically denied without being looked at and usually for a reason that does not make sense.

As billers we have found time and again where a claim sent just like all the other ones for the same patient, for the same condition, etc., comes back rejected even though claims immediately before it, and claims immediately after it, are processed correctly.  After spending time on hold to speak to a representative, they found nothing wrong with the claim and sent it for processing only to have the claim process as it should have with no reason being given as to why it denied in the first place.

Users of a medical practice management billing and electronic claims processing software program (like VertigaPM) have the opportunity to automatically rebill their rejected claims when it just doesn’t seem right for to have gotten rejected in the first place.  Those with electronic billing, and using a clearinghouse (like VertigaEDI) to process their claims through, can simply reprocess all rejected claims with a simple click or two instead of sitting on the phone (literally for hours at times) just to get someone to do the same on the other end.

Mind you, if that same claim now rejects a second time for the very same reason, now you have something to investigate.  If you have double-checked on your end to make sure everything is correct and don’t want to spend the time following up with the insurer, you can always get the patient involved and have him or her do the follow up for you – after all, it is their bill!

One of the worst things you can do as a biller for your Medical Healthcare Practice is to financially cut your own throat by submitting claims that are not accurately priced.

Many billers bill claims at the provider’s agreed fee schedule matching their submitted charges with what the insurance company states is allowed.  Users of a medical practice management billing and electronic claims processing software program (like VertigaPM) have the opportunity to set up a fee schedule in the program for reimbursement posting purposes; however, when billing out a the claim, the street price should be the one billed.

When a provider participates with an insurance company they normally must submit a list of their street prices – the charge that they apply to a service regardless if the patient has insurance or not.  From that list they calculate what the provider’s approved amount will be that they will then base their percentage of coverage upon.  If the provider begins to consistently submit claims at the insurance companies approved amount, the insurance company will consider that charge as the new price and will subsequently reduce the approved amount and thus the reimbursement.

Billers should have only one fee per procedure/service regardless of whether or not they are billing an insurance company or a cash pateint (unless the insurance company specifically penalizes the provider for billing higher than the approved amount).  By billing that same price each time, the biller reduces their chances of getting short changed in their reimbursement.

There are good Medical Billers, and then there are excellent Medical Billers.  The key difference between the two is the difference between your having a day-to-day practice and a profitable one.

What makes an excellent biller is knowing how to get claims in accurately, expediently, and turned into cash within the shortest amount of time.  To do that, the office needs to be working as a team with the biller as its leader.  Remember the golden rule: “He who has the gold, makes the rules.”  In the case of a medical office, he or she whom brings in the gold, makes the rules.

The biller needs to set the pace of the office.  He or she must control how the data is entered into the system from the front end (patient demographics, insurance information) and needs to make sure that the information is always being verified.

Secondly, the biller needs to control the manner in which the provider is noting the services performed.  Preferably the chart notes should be electronic and tied into the medical practice management billing and electronic claims processing software program (like VertigaPM) so that they are typed and not handwritten and so that they are easily accessible and printable as supportive documentation for claim filing.

Additionally, the provider should be trained to use a pre-printed form (such as a SuperBill or a Day Sheet) so that selections are made with a check mark or a circle so that there is no time wasted in trying to read and interpret anyones handwriting.

Lastly, the biller needs to make sure that on a daily basis not only are services keyed in accurately and expediently, but that their electronic submission is followed up on within 24 to 48 hours to resolve any possible returns.

Taking charge of the office and making sure things run efficiently is a great way to make the most out of the billing process and get the most return for your practice.