Are you working in the medical billing industry as a biller or an owner of a billing company? If so, the KEY medical billing insights and best practices that came out of our interview with Maura Jansen (VP of Operations) and Jennifer Withington (Director of Revenue) at Missing Piece Billing & Consulting Solutions will be VERY VALUABLE for you to consider.
Jennifer, an expert in understanding the problem-solving techniques and the investigative nature of medical billing, offers insights that both educate and inspire. Maura, an executive member of the billing community, also added an important perspective about EZClaim’s medical billing software. The following are some highlights from our interview.
EZCLAIM: When did you get into the industry?
JENNIFER: “I worked in group homes for the waiver side of group aid and then I went to Missing Piece. Missing Piece primarily deals with ABA providers and provides early intervention rendered to children. For me, the move from waivers with adults to professional billing, indirectly assisting children, was attractive and I took to the billing side of things.”
EZCLAIM: What does that mean when you say you took to the billing side of things?
JENNIFER: “Insurance doesn’t make a lot of sense when you first start. So, I took to the investigative side of making sense of medical billing claims. Figuring out what the payer’s rules are, reading their manuals, and figuring out the technical jargon with the purpose of preventing claim denials was attractive. I liked the puzzle of it.”
EZCLAIM: Are there things that you value in your work that offer meaning to what you do?
JENNIFER: “It’s really when I know that if I do not intercede with the insurance company and get this paid the patient is going to be responsible for the balance. So, to help, I have taken things to the department of insurance, or I have gone ahead and filed that third letter of appeal and really taken the time to research it. Because I don’t want a parent who is already struggling with having a child with more needs than maybe the other children would have, I don’t want them struggling with a $25,000 bill. ABA is extremely expensive because it works. And so, if insurance doesn’t pay it then the only other funder is the parent. And my goal is that parents should not have to pay any more than they absolutely have to.”
EZCLAIM: What are some of the strengths that make you good at what you do?
JENNIFER: “I am a good problem solver. I am good at taking a large problem and breaking it into smaller problems and knocking each one down until I solve the bigger issue. At the end of the day, that’s really what accounts receivable is.”
EZCLAIM: What would be an example of your problem solving on a day-to-day basis?
JENNIFER: “So you always start with the denial and then you have to work back to the billing. For example, if I have a claim denied for services rendered from an out-of-network service provider, but we know we are in-network then my first problem is, are we actually in-network? Then, you go onto the next link which is did the payer recognize you as in-network? It becomes like a decision tree, if you get a ‘yes’ then you are probably done, and you get the claim processed. If it is ‘no’, then you have to start digging with the payers contacting reps, make calls, and supply them with documents to get down to why they don’t have your provider listed within the network. Once you solve that problem, then the claim should be able to be processed. It is either going to pay or deny. Then depending on which one it is, you apply the same technique.”
EZCLAIM: What would you offer someone who is considering entering the field?
JENNIFER: “You should be good at processing and reading information because to get a claim paid you to have to know the rules of engagement. You need to be familiar with how to read a contract, how to read technical information about billing, and have to have a glossary of information about what you are billing. Those are the building blocks to get to know what you are doing.”
EZCLAIM: You work with EZClaim’s medical billing software platform, what role does their software providers and how does that impact your work?
JENNIFER: “EZClaim really serves to eliminate these denials before they happen, which is the ultimate goal of any accounts receivable or billing. EZClaim has edits that we use. It alerts us if the system thinks the claim is a duplicate, for example. It also helps in the set-up of the claim. We load all the fee schedules in EZClaim’s procedure code library and that lets us monitor the charge rate, make sure all the points of billing are on the claim (i.e. correct code, modifier, and charge). They also make sure that the authorization is appended to the claim. And then after we have actually done the work of getting a claim in the system, we use EZClaim reports to audit our own billing. So, we use the EZClaim service report. It makes it easier for us and our providers to see what has been billed and make sure that the billing is correct.”
EZCLAIM: If you were going to share something with your colleagues in the field, what would you share about the software that makes your life easier?
JENNIFER: “Number one, it is not the software itself, it’s the EZClaim staff. Their customer service is far beyond what a normal billing software company provides. If I have a problem, or if I have a report, or if I have a data point that isn’t in any report, they are available and they are there for me. And if they don’t have a solution for the problem, they will provide me with a workaround. So, that is very valuable. That is why Missing Piece works so well with EZClaim because customer service is number one for us, too. They don’t just want to answer your question, they want to help you understand your question.”
“The other thing that I find valuable is that their reporting modules are just a lot more robust than the other billing software companies that I have dealt with.”
EZCLAIM: Maura, do you have any thoughts from an administrative level that you can offer on EZClaim?
MAURA: “Well, when we hire a new person we know that, even if this person has very little experience in the healthcare field, it’s going to be a quick and easy process for them to learn EZClaim… EZClaim has also made it kind of a joy to work with. We really value them as a partner. We love the service they provide, and we value them as a platform.”
EZClaim can also help you with medical billing insights since it is a medical billing and scheduling software company. It 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, email them, or call them today at 877.650.0904.
The most important thing a medical practice can do for their financial health is collecting payments from patients. So, because patients are not usually savvy when it comes to the nuts and bolts of their contract, they become frustrated when you send them a bill and, beginning on January 1st, your office staff get inundated with the question, “Why do I have a balance?”
“Approximately 68% of patients with bills of $500 or less did not pay off the full balance during 2016—up from 53% in 2015 and 49% in 2014.” Source: Patients May be the New Payers, But Two in Three Do Not Pay Their Hospital Bills in Full, TransUnion Healthcare, June 26, 2017
So, let’s make sure your office is equipped and able for collecting payments from patients for the services you rendered, rather than them becoming a part of this scary statistic.
Let’s begin with the basics: Make sure that your staff understands these key terms, and is comfortable explaining them to your patients.
Deductible: The deductible is the amount the patient has to pay for covered services before the insurance plan pays. Some insurance plans will apply an office visit to the deductible, others will not. Family plans typically have an individual and family deductible.
Copay & Coinsurance: These are both the portion the patient will be responsible for after their deductible has been met. Copays are a set, flat fee. Coinsurance is a set percentage that the patient will pay.
Maximum Out-of-Pocket: This is the limit of what a patient will pay for covered services within a plan year. Again, on family plans, there may be an individual max and family max.
Now, keep in mind that your staff will not know the details of your patients’ plans, nor should they be expected to! In the ever-changing world of health insurance, patients need to become better consumers. So, just being able to explain these key terms and why they create a patient balance will help them become better insurance plan shoppers!
Use your tools. Look into using Integrated Eligibility (available through your billing software and your clearinghouse). This will allow your staff to check remaining deductible balances, copay, and coinsurance amounts with the click of a button. These results allow practices to confidently collect at the time of service rather than spending time and money on sending statements and working to collect after the visit.
In addition to that, create a plan and stick to it. Use this time to review the efficiency of your patient collections plan. Are you using an outdated plan or policy? Have you considered offering payment plans to patients with an HSA card kept on file? Make sure that your employees understand how important patient collections are to the practice, educate them on the plan, and support them when they hold patients accountable to the patient collections policy.
For more information on how EZClaim can help you with this journey, schedule time with our sales team. Or, if you ready to get started right now, then download your FREE 30-day demo today!
[ Written by Stephanie Cremeans of EZClaim ]
Educating patients about their payment options can improve your medical practice revenue.
Imagine for a moment that you are planning to buy a car. Before you even enter a car lot, you do some research on the type of car you need, the features you are looking for, and how much you are able to spend. You might even get an opinion from a friend or check out reviews online.
After you have gathered all the information you need, you feel you are ready to start shopping—and confident that you might even get some new keys by the end of the day.
This is very similar to how most business transactions work: They have a need, they research the best ways to meet their need, and they make a purchase.
However, the healthcare industry doesn’t follow this formula. Your medical practice is a business just like any other, but your customers—aka, patients—often seek out your services not knowing exactly what they will be “buying” from you, nor how much they will be paying. Add in health insurance and surprise bills and you have a confusing hodgepodge of information that calculates the patient’s final bill, which they likely will not see for several weeks.
The current system is inefficient, and it is part of the reason that up to 30% of patient bills go unpaid every year.
Changing the Patient’s Financial Experience
Many practices have improved their revenue flow by simply treating their patients more like customers. In other words, they educate them on the financial side of things, as well as how to manage their health.
In a recent NexTrust webinar, three-quarters of poll respondents (doctors and practice managers) said that they speak to patients about their payment options. Thirty-one percent said that they currently use electronic communications, and only 8% use printed materials (flyers, signs, etc.).
While speaking to patients is a good start, getting payment information in writing is crucial to driving this information home. Patients already have a lot to remember regarding their care. A simple handout on how and when to make their payments can make it much easier for patients to manage their payment responsibility.
Most providers—over 90%—educate patients about how to pay on their statements. It certainly doesn’t hurt to communicate this information this way, but don’t rely on it exclusively. Most people skim the statement to see how much they owe and most miss important instructions.
So, as you educate patients on their payment options, keep these four key areas in mind to improve your medical practice revenue:
1) Set Clear Expectations about Payments
The first step in financially engaging your patients is to remind them you are a business, and that you require regular, on-time payments to keep your doors open. Patients often don’t see their doctors as business owners. A simple statement upfront about your payment expectations encourages patients to be more proactive about paying their bills on time.
2) Educate Patients about Your Payments Process
When patients understand your payments process, they are empowered to be more proactive in participating in it. You know where billing and payments fit into your practice workflow, so make sure patients understand that, too. If you require copays to be paid before a visit, communicate that beforehand so they can be prepared. In addition to that, also communicate clearly about when any remaining balances are due.
3) Push Your Online Payment Options
The best thing you can do to increase payments is to educate patients about their online payment options. Don’t just say “We accept payments online” and leave it at that. Show them where to go to complete payments. Also tell them about the variety of payment options available to them.
For example, EZClaim customers have several online payment options:
• Guest Pay: Patients can quickly pay their balance without having to set up an account
• MyProviderLink.com: If the patient wants access to more features (such as the ability to check their balance without having to call the office or to set up automatic payments), they can register for an account through BillFlash’s payment portal
• LinkPay: The practice sends a payment link to the patient before their visit, so they can pay what they owe before the visit starts
• PlanPay: Split up larger bills into smaller monthly payments
Online payments are the future of healthcare. So, make sure your online payment options are front and center whenever you bill patients. This could include a note in their statement directing them to pay online, handing out instruction cards on how to pay online, and posting signs throughout your office directing patients to your payment portal.
4) Reach Out to Patients You Haven’t Seen Lately
Forty percent of patients defer or skip care because they don’t think they can afford it. Make sure you get the word out to your entire patient base that you can accommodate any patient’s financial circumstances, whether that means setting up a payment plan or delaying payment for a few months. If patients know they have affordable payment options, they will be more likely to seek you out when they need help, rather than going somewhere else or deferring care entirely.
Empowering Patients to Take Ownership Over Their Healthcare Bills
Most patients want to pay their medical bills promptly and in full, but being in the dark about what they are being charged for and what their payment options are makes that difficult. The patient financial experience matters, and when you educate your patients on their online payment options and are transparent about costs, they usually respond positively, and you will improve your medical practice revenue.
Learn more about the pay services available to EZClaim customers by visiting their partner’s website, BillFlash.com, or by e-mailing firstname.lastname@example.org.
To learn more about EZClaim’s medical billing software solution, visit their website at EZClaim.com.
[ Written by Angela Carter with BillFlash ]