Deborah Rieser founded Spectrum Medical Billing Services in Anchorage, Alaska 15 years ago to make extra money to help with paying the family’s bills. Today, she owns a thriving medical billing service with a team of “twelve lovely ladies”—as she likes to refer to them—that services clients nationwide. Rieser originally selected EZClaim’s medical billing software platform—because of its pricing structure—to use for her medical billing service.
Over the years, since her original purchase, she has upgraded to each new EZClaim version, which adding new features and efficiencies. Recently, she has made the transition to EZClaim Cloud, and continues to use it exclusively today.
With team members nationwide, Rieser prides herself on training her billers on properly classifying billing for medical offices so that there are minimal insurance denials. She is very particular about this since one of the reasons Deborah began billing was the insurance qualification struggles she had for her daughter with Autism. So, accurate billing is ‘personal’.
Recently, we found time to interview Rieser about her start in the industry, the ups and downs of being a business owner, and what hard-fought expertise she has gained that might help others considering to start their own medical billing service.
EZCLAIM: When did you get into the medical billing industry and why? RIESER: “I always had an entrepreneurial spirit, and I had an orchid business out of our house. Then my daughter, who was born with Autism, started working with an Occupational Therapist (OT), and they came to me to help with billing. I thought about it, and after a few weeks, I took it on. That was back in 2005.
“At that time, my daughter had over 75 volunteers and therapists in the community work with her from age three to age five, and had 50-60 hours a week of therapy. Today, she is a sophomore in university, has a boyfriend, is driving her car, and is thriving. From all of that, I have always felt the need to give back to the community for all their help. So, I used my business to take on other Pediatric, Occupational Therapy, Physical Therapy, and Speech Therapy clients, as well as, using my experience to help patients take care of their billing needs and get their bills paid by insurance.”
EZCLAIM: What are you passionate about when it comes to billing? RIESER: “For me, the biggest thing that I am passionate about is seeing my clients [medical offices] getting paid from insurance claims. I also enjoy helping patients get properly classified during medical visits, so claims are accepted. I have learned a lot from the mistakes and errors that have led to denied claims. From my experience, I can help medical practices observe their approach to patients’ needs so that services qualify when billing insurance companies. Being able to offer that to my clients is very satisfying.”
EZCLAIM: What are some of the challenges you have had to overcome? RIESER: “Originally, we grew word-of-mouth. I didn’t even want a website at first, but now I do have one. Going from one client to 65 is challenging because as your clients grow, your staff grows. Recently, I lost a client. You then have to decide what you’re going to do with your staff. The hardest part is that, for a business owner, your business consistently goes up and down. That fluctuation can be stressful. For me, I deal with that by going outdoors. My husband and I will go for a walk in nature and that will help relieve my stress.”
EZCLAIM: What advice would you offer others in the billing industry that have similar experiences? RIESER: “If you’re starting your own business, make sure it’s one you love. Know that there will always be highs and lows. Also, be sure to price yourself accordingly. You can’t go too high or people will look elsewhere.
“I do want to step back and highlight that some of my billing practices only do 2-3 claims a week, and that’s why I love EZClaim. The price of the software. When I was growing, I was working on EZClaim “Advance,” which is being retired. So, when I started looking around at other software providers, they were billed on a ‘per provider cost.’ Fortunately, EZClaim “Cloud” billed based on the number of concurrent users, which worked for me.”
EZCLAIM: How has your relationship with AMBA (American Medical Billing Association) benefitted you? RIESER: “I just joined last year in 2019, thanks to EZClaim and Dan Loch’s referral. I love that group. I joined their Facebook group because they have very useful information for us billers. I recommended that my team members join as well. They are good at supporting US-based companies and put the focus on supporting the group.”
EZCLAIM: What would you tell people who are wondering if EZClaim Cloud is right for them? RIESER: “The transition to EZClaim Cloud was easy. I was worried about the providers and the tax ID’s, but it all was very smooth. I would add that customer support was very helpful. As daunting as moving things over felt, it was very smooth. I attribute that to the planning and support.”
EZCLAIM: What would you say would be a strength of someone who is good at billing and coding? RIESER: “It is important to be a very good communicator, professional, out-going, and enjoy what you do. One must be able to communicate with providers over denials, success, celebrations, and always keep talking with the staff and the providers. Also, always try to put yourself in the patients’ shoes by offering patience and compassion. Lots of times patients don’t understand their benefits and why they are denied. So, try to explain in layman’s terms. They understand better and appreciate that. It ends up being a good connection with the patient, and benefits you as the biller, too.”
EZCLAIM: Final thoughts? RIESER: “I am grateful to EZClaim for their services. As a business owner, you have to monitor expenses and things can add up fast. So, I am thankful for EZClaim Cloud and its pricing structure. That has helpedSpectrum Medical Billing Services to grow and thrive.”
[ The above answers were paraphrased as closely as possible to the original answers given by Deborah Rieser on November 25, 2020 ].
ABOUT EZCLAIM: EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support. Combined, they help improve medical billing revenues. To learn more, visit EZClaim’s website, e-mail them, or call a representative today at 877.650.0904.
It IS POSSIBLE to improve medical billing revenues, and here are a few ways to do just that.
Healthcare practitioners, whether established or just starting out, have many overwhelming tasks: Managing a practice; Seeing patients; Working to staying up-to-date on administrative tasks; The whole host of compliance at the federal, state, and local level; and Overseeing the billing.
One of these that can lead to loss of revenue is not properly managing the medical billing, which can also lead to HIPAA fines and rejected claims. However, there is a solution: a medical billing system that balances the budget and optimizes revenues of medical practice.
EZClaim, an expert in the medical billing software market since 1997, provides a solution that improves the efficiency of an office’s billing process in many ways. The following are the primary reasons.
Reduce Coding Errors Medical procedures become codes, codes become claims, and claims become revenue. Any error in this process can make claims to be denied, your workload can be increased, and revenue can be lost. To help in avoiding errors, it is essential to use billing software that offers the easiest implementation and access to descriptive diagnosis and treatment codes. EZClaim’s medical billing solution offers ease-of-use in coding, billing, and strong partnerships with Clearinghouses which act as an additional ‘safety net’ for catching errors.
Administrative Support Most medical practices are a small team of people tackling a wide range of tasks, so when one cannot understand the function of the billing software, accessing reliable support is very important. EZClaim prides itself on having dedicated support experts available, and that was how the company was established. Founder and President Al Nagy has said, since day one, “We are a support company that happens to sell medical billing software.”
Maintain Industry Compliance It is important to recognize that industry compliance and a practice’s revenue go hand-in-hand. Filing and batching inaccurate and non-HIPAA compliant claims can often be traced back to an outdated healthcare revenue management system. Conquering these tasks requires a focus on multiple fronts: A properly trained billing team, clear office procedures, patient payment policies, and a reliable medical billing company. These are all ways to help buttress against non-compliance and rejected claims.
Streamline Workflow Recently, a study was done that showed almost 80% of medical bills contain errors. These incorrect medical claims often end up as lost revenue originally, not to mention the additional cost of resubmissions and collections. One of the best ways to resolve this problem for your practice is to make use of both well-trained, experienced billers and coders, combined with a competent medical billing solution that aids in catching these errors. EZClaim software features a library of standard validation, the ability to add custom validation, and integrates with Alpha II for full claim scrubbing.
Follow up Errors will and do occur, so establishing a system for follow-up on all denials will close the loop and protect against lost revenue. Being consistent with the follow-up process, and having a medical billing solution that tracks these things will help close that gap.
Collections Finally, probably the most important aspect that optimizes a practice’s revenue is to get paid. Portals and payment collection systems definitely help with this, but having collections integrated into the medical billing system is, of course, the best. EZClaim has pain-free payment processing integrated into their solution, called EZClaimPay. It solves all the problems associated with payment processing: Bank deposits, reconciliation, statements, changing fees, and ‘finger-pointing’ when there is a problem. EZClaimPay’s robust platform will greatly increase a practice’s collections success, and improve their revenue.
ABOUT EZCLAIM: EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support, and can help improve medical billing revenues. To learn more, visit their website, e-mail them at email@example.com, or call a representative today at 877.650.0904.
Getting Claims Right the First Time. Contributed by Timothy Mills, Chief Growth Officer, Alpha II, LLC
The numbers are staggering. Industry averages report that nearly 20% of all claims are denied, rejected or underpaid. And considering the cost to rework claims — not to mention even higher appeal costs — as many as 60% of returned claims are never resubmitted.
With figures like these, it’s no wonder medical practices continue to face intense financial pressure. As negotiated reimbursements stagnate and operating expenses like rent and salaries continue to increase, the struggle to maintain steady revenue becomes even more crucial. For many practices, conducting reviews of their revenue cycle workflow would show gaps in their claims process. The good news is – these gaps can be bridged with the help of emerging technology.
With a saturated market of coding, billing, and compliance solutions, how do you begin to find the right technology for your practice?When trying to improve revenue integrity, it is important to understand exactly what vendors offer. For example, consider the term “first-pass claims rate,” which is still used by some healthcare IT vendors to represent the number of claims initially accepted by payers. But what is often overlooked is the number of those initially accepted claims that will be denied or underpaid. A better question would be – what percentage of claims are getting paid the first time they are submitted?
The fact is, practices that do not employ the latest clinical coding and editing tools within their revenue cycle are leaving money on the table. This is revenue that is rightfully theirs but is being pursued at high, incremental costs. It’s time to rethink traditional denials management practices, move beyond “first pass claims rate,” and embrace the future of denial prevention.
It’s your money. Go after it.
Still not convinced that investing in emerging clinical coding and editing software can save your practice money? Let’s see what relying on traditional denials management methods might really be costing you.
Each rejected, denied or underpaid claim represents earned revenue your practice is missing out on. Based on industry reports, the average cost to rework a claim has been pegged at more than $25, and appeal costs can skyrocket to over $100. It’s estimated that as many as two-thirds of all denied claims are recoverable. But practices often weigh the reimbursement amount of a claim against the cost to rework or appeal that claim. For smaller claims, many decide it just isn’t worth the effort, which is why getting claims right the first time should be the ultimate goal.
So how much are practices losing by simply correcting and resubmitting denied claims using traditional denial management methods? Let’s look at an example using figures from an actual mid-sized specialty practice. This practice submits 1,900 claims a month and the average claim is $150. They have a better-than-average denial/rejection rate of 10 percent. Even with that lowered rate, this practice is losing roughly $28,500 a month to unresolved denied claims. If two-thirds of those denied claims are recoverable, they stand to recoup $19,095 in reimbursements after the claims are corrected and resubmitted. Factor in the cost associated with reworking denied claims using the industry average of $25 per claim, and this practice is spending $4,750 in administrative charges alone to recover their own revenue. This brings their actual recovered revenue down to $14,155 per month or almost $170,000 annually.Investing in a comprehensive clinical coding and editing solution is still cheaper than what the practice spends per month when reworking denied claims.
The Alpha II Solution
Are you ready to submit precise claims the first time?Contact Alpha II, a leader in revenue cycle solutions. Our comprehensive clinical claim editing solution, ClaimStaker, covers the entire continuum of care, verifying claim data from the payer’s perspective and allowing for corrections prior to filing.
Check out our Denial Impact Assessment Calculator to see what your denials really cost your practice or contact us today for a free personalized Claims Assessment. See why ClaimStaker does more than clear claims. It gets claims paid.
We work hard to update our blog to keep you up-to-date on what’s happening in the field of medical billing software. If you have a topic you would like to see discussed, please contact us.
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