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.
Claim denials are the bane of every RCM company. Chasing money is costly and navigating regulations, coding edits, and health plan particularities can frustrate even seasoned billing professionals.
The American Association of Family Physicians puts the average claim denial rate at around 20 percent and reworking a single claim can cost hospitals and offices anywhere from $25 – $118 on average, so the initial validity of every claim is critical. While denial percentages have been dropping – thanks to technology that allows billers and coders to verify accuracy of their work and catch the most egregious errors – the reality is you can do better. Use the following seven tips as a starting point to determine how you can maximize revenue by reducing denials.
Recognize that the revenue cycle begins in the front office.
Providing services to patients whose insurance has changed or lapsed will result in a denial—even if it’s coded correctly. Make it a point to check your patients’ insurance at each visit, including copays and deductibles. Front-end verification can prevent back-office headaches.
Look beyond first-pass clean claim rate.
A high first-pass clean claim rate may look great on the month-end statement you provide to your bosses, but what does it really mean? This rather meaningless metric only gauges the percentage of claims that are initially accepted by a payer. It says nothing about the denial rate, which is where the real work begins. Focus on metrics that matter, such as denial rate, collections as a percentage of revenue, or days in A/R.
Learn from your mistakes.
Use denied claims as a learning experience. Why did the claim deny? Some common reasons include a lack of medical necessity, a mismatch of diagnosis and treatment codes, upcoding or unbundling, incorrect coding, and missing/wrong modifiers. Use claim data content with comprehensive edit logic to perform a deep dive into denials. Is the problem an individual coder, clinician documentation, or a certain procedure or treatment type? Understanding the “why” behind every error will help you uncover how the organization can do better.
Examine your workflows.
Your increased denial rate may be occurring because your operational workflows aren’t aligned with billing best practices. If you are performing claim editing only after the claim is generated, you’re not allowing for actionable change by those who created the errors. Also, are those who work denied claims relaying the information back to the relevant department? If your billers, coders, and clinicians don’t know they are making mistakes, they will continue to make them
Edit claims early in the process.
This goes hand in hand with our previous step. Recognize that revenue cycle management truly begins in the front office and flows through everyone who generates a charge, codes a procedure, or prepares a claim. Develop the mindset that everyone who touches a patient record should understand the implications of coding. For example, a clinician who sees charting as a burdensome task may make inadvertent mistakes that results in incorrect coding, which in turn creates more work for your billing staff who has to work the denial. Fixing these costly mistakes takes precious time that would be better spent on more complex tasks.
Examine your claims technology.
Claim editing software is a must to reduce denials. But not all software is the same. As we said before, claims acceptance is important but has little bearing on overall denial rates. Many electronic medical records and practice management systems have generic claim edits that check for obvious technical mismatches such as age-related discrepancies, date of service issues, and CCI mismatches. But those systems will do nothing to help your billing department move the needle on denials. An advanced clinical claim editing solution with constantly updated content is worth the investment. The edit explanations help your coding staff recognize the changing parameters that can affect denials.
Train for better performance.
Not everyone on your staff or in your billing organization needs to understand coding and claims at a detailed level. However, everyone should understand the role they play in the revenue cycle process. Don’t simply demand that front office staff check insurance every time – explain why it’s important to the claims process. Make sure clinicians understand the differences between common visit types and procedures so charges are captured accurately on the front end. And ensure your coding and revenue cycle personnel are working to add value to the organization by performing high-level work. A robust clinical coding and claim editing software can help educate coders on procedural changes and provide tips to keep claim denials as low as possible.
Just as everyone who interacts with a patient affects that patient’s perception of your practice, reducing your organization’s claims denial rate is the responsibility of every staff member who interacts with the patient’s data. Ensuring accuracy throughout your entire revenue cycle will improve the overall integrity and result in improved revenue.
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.
If you enjoyed this article about denied claims and seven tips to improve revenue integrity, visit our blog page to see more interesting and informative articles. You may also Follow Us on Facebook to stay up to date with our most recent events at EZClaim.
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