Problem Solvers on Orlando Medical News

Problem Solvers

By: LYNNE JETER

Posted: Friday, February 4, 2011 12:46 pm

Problem Solvers | Minerva DeJesus, Auriana “Audi” Reyes, Simple Solution Billing.

Medical Billing Experts Share How Doctors Can Improve Their Bottom Line in 2011

Minerva DeJesus and Auriana “Audi” Reyes are the “go-to” gals for medical billing problems in the Orlando area. After separately compiling impressive resumes in diverse medical circles beginning in the 1990s, they founded Simple Solution Billing, an Orlando-based medical billing firm that focuses on helping physicians control their finances while maintaining control of their practice. Orlando Medical News chatted with DeJesus and Reyes about ways doctors can improve their bottom line in 2011, from acquiring higher reimbursements for services rendered to keeping their fingers on the pulse of office administrators.

What are common mistakes that doctors make concerning the management of their practice?

Reyes: The most common mistake is putting complete trust in the employee handling your income. Just because finances are coming in, it doesn’t mean it’s the correct amount. We have the pleasure of knowing and working along side some fabulous office managers. On the other hand, we’ve also come across administrators that aren’t as hard working or as trustworthy as others.

The physicians that have a bad seed among them have no idea how much their in-house billers are writing off. For example, a few years ago, we got a call from a doctor to look at her books because she suspected embezzlement. We agreed to go after hours to meet with this doctor. Within the first hour of being on her computer, we found several suspicious items. Clearly something was going on! Even with all the evidence we showed, this doctor still has that office manager working at her facility. I don't get it! Doctors should be requesting reports on a regular basis that demonstrate what’s being paid. They should be asking questions regarding reimbursements and possible write-offs. If the biller is hesitantto give you anything, it’s a red flag that should not be ignored.

DeJesus: Another mistake is thinking your medical biller is always looking out for the employer. We got a random phone call from an office manager asking about a diagnosis code. Related to the topic of the call, we told her of a new code that could increase the reimbursement for the doctor by a significant amount for a service he/she may provide at their facility.

She shrugged off the suggestion by saying, ‘oh yeah, the doctor does that and I already know how to get paid for it.’ While that might be true, doing it her way didn’t get the doctor reimbursed the maximum amount he could get for a service he provided. It’s a simple step of going back, taking a few seconds to change a code, and resubmitting the claim. The insurance company will send the difference once the revision has been made. Because that staff member gets the same paycheck regardless of office revenue, she didn’t seem to care about taking the extra steps toward being a more effective employee.

Reyes: Another mistake physicians make is thinking that no one will audit them. Eventually, everyone gets audited. Therefore, it’s better to do everything by the book and not play costly games that will come back and bite.

DeJesus: When you play by the rules from the very beginning, you sleep better and have less stress. There are so many other factors that can keep you from getting paid if you let them, so don’t add to decreasing finances by trying to be dishonest. One audit can wipe you out when you play with fire. We get asked if physicians can do ‘something,’ and we simply tell them ‘no,’ because usually what they have in mind isn’t allowed. We don’t dance around it. Our reputation means more than any scam with huge payouts. It’ll eventually come back around and hit you where it hurts: your wallet.

What are some misperceptions about medical billing practices?

Reyes: Most doctors blame the insurance company for their decreasing bank accounts. That’s not the case. Think about it: the insurance company is going to do all it can not to have to pay for services rendered. It’s not right, but it’s a fact. Even with that fact, it’s not the fault of the insurance company for low or no payments.

It’s the fault of the person submitting the claim for either being unaware of the specifics needed to complete the job, not making the effort to learn more enhanced ways of doing the job, ignoring new codes and/or policies, giving up without a fight, or simply not caring because ultimately, it doesn’t directly affect their bottom line! If they lose their job for not producing the numbers, they’ll find another job. Meanwhile, the physician is losing money every second because of unsubmitted claims and decreasing finances. This leaves the doctor hiring the first person they find, possibly worsening an already bad financial situation.

DeJesus: Another misperception doctors have is not understanding the importance of medical billing. They think anyone can do it. While the concept is simple, the task can be challenging. Sure, anyone can punch numbers into a computer, but are those numbers in the right place? Are they the right numbers? Is the code correct, given the provided service? Will that number get you the maximum reimbursement? I haven’t even gotten into the follow up phase. Remember, the insurance companies aren’t just going to hand you the money with a red bow.

Doing it the correct way the first time a claim is submitted makes all the difference. You have to keep up with them and sometimes tell them where they made an error that resulted in a denied or underpaid claim. Keep in mind: the person working for the insurance company may not have the medical background necessary to understand the claim submitted. Some might say that employees are only as smart as the ones that trained them, which sadly in some cases, is not saying much.

How will the new federal mandates affect medical billing practices?

Reyes: As far as the new mandates, we haven’t heard anything specific (as of mid-January). Physicians have expressed concerns about socialized medicine and decreasing reimbursements, but they haven’t asked us anything in particular. We’re all anxious about the unknown. We don’t know what’s going to happen and when you build your entire career off of what’s current, the unknown can mess with your mind, especially when Washington gets involved.

Whatever the government decides, they have to make these physicians want to continue in the field. While it’s nice to think all people get into medicine to heal, the reality is—while some won’t admit it—the paycheck is an underlying factor. You can’t blame physicians for wanting to get paid a hefty salary after going through 12 years of agonizing schooling, and then dealing with difficult patients, facing the liability that comes with the job, confronting lawyers that at times try to make a case while they tried to save a life, and so forth.

Meanwhile, a guy on Wall Street can make a $13 million bonus for having a big part in screwing up our economy. Don’t get me wrong. Like any other profession, medicine has its liars and criminals. However, I’ve seen some great miraculous things done by dedicated healthcare providers in our medical community and those are the people I want to fight for.