Dec 14, 2020 | AMBA National Conference, Claims, Cloud Security, Denied Claims, EZClaim Cloud, EZClaim Premier, Medical Billing Customer Service, Medical Billing Software Blog
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 helped Spectrum 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.
Nov 10, 2020 | Medical Billing Software Blog, Partner, Revenue, Support and Training, Waystar
There are five ‘phases’ in the life cycle of a medical bill: Pre-appointment; Point of care; Claim submission; Insurance payment or denial; and Patient payment. This post will overview each of these phases, and could even be considered to be a “101-level” course on Revenue Cycle Management.
With high deductible health plans on the rise, the recent explosion of telehealth appointments due to COVID-19, and many other factors in play, it’s more important than ever for everyone to understand the life cycle of a medical bill, and how the process works. The healthcare revenue cycle is relevant not only to those who work in healthcare, but to the patient, too.
The revenue cycle is the series of processes around healthcare payments—from the time a patient makes an appointment to the time a provider is paid—and everything in between. One way to think of it is in terms of the life cycle of a medical bill. Although there are many ways this process can play out, this post will lay out a common example below:
1. Pre-appointment
For most general care, the first stage of the revenue cycle begins when a patient contacts a provider to set up their appointment. Generally this is when relevant patient information will begin to be collected for the eventual bill, referred to on the financial side of healthcare as a claim.
At this point a provider will determine whether the appointment and procedure will need prior authorization from an insurance company (referred to as the payer). Also, the electronic health record (EHR) used to help generate the claim is created, and will begin to accumulate further detail as the provider sends an eligibility inquiry to check into the patient’s insurance coverage.
2. Point of care
The next step in the process begins when the patient arrives for their appointment. This could include when a patient arrives for an initial consultation, an outpatient procedure, or for a follow-up exam. This could also include a Telehealth appointment.
At any of these events, the provider may charge an up-front cost. One example of this is a co-pay, which is the set amount patients pay after their deductible (if they are insured), however, there are other kinds of payments that fall into this category, too.
3. Claim submission
After the point of care, the provider completes and submits a claim with the appropriate codes to the payer. In order to accomplish that, billing staff must collect all necessary documentation and attach it to the claim. After submitting the claim to the payer, the provider’s team will monitor whether a claim has been been accepted, rejected, or denied.
[ Note: Medical coding refers to the clerical process of translating steps in the patient experience with reference numbers. The codes are normally based on medical documentation, such as a doctor’s notes or laboratory results. These explain to a payer how a patient was diagnosed and treated, and why. This information helps the payer decide how much of an encounter is covered under any given insurance plan, and therefore how much the payer will pay. ]
4. Insurance payment or denial
Once the payer receives the claim, they ensure it contains complete information and agrees with provider and patient records. If there is an error, the claim will be rejected outright and the provider will have to submit a corrected claim.
The payer then begins the review process, referred to as adjudication. Payers evaluate claims for accurate coding and documentation, medical necessity, appropriate authorization, and more. Through this process, the payer decides their financial obligation. Any factor could cause the payer to deny the claim.
If the claim is approved, the payer submits payment to the provider with information explaining details of their decision. If the claim is denied, the provider will need to determine if the original needs to be corrected, or if it makes more sense to appeal the payer’s decision.
Following adjudication, the payer will send an explanation of benefits (EOB) to the patient. This EOB will provide a breakdown of how the patient’s coverage matched up to the charges attached to their care. It is not a billing statement, but it does show what the provider charged the payer, what portion insurance covers, and how much the patient is responsible for.
5. Patient payment
The next phase occurs when the provider sends the patient a statement for their portion of financial responsibility. This stage occurs once the provider and payer have agreed on the details of the claim, what has been paid, and what is still owed.
The last step occurs when a patient pays the balance that they owe the provider for their care. Depending on the amount, the patient may be able pay it all at once, or they might need to work with the provider on a payment plan.
The above example represents one way the lie cycle of a medical bill can play out. Some of the ‘phases’ are often repeated. Because of the complexity of healthcare payments and the parties involved, there is not always a ‘straight line’ from patient care to complete payment. That’s why we call it the revenue cycle, and there are companies that provide systems for its management.
One of EZClaim’s partners, Waystar, aims to simplify and unify healthcare payments. Their technology automates many parts of the billing process laid out above, so it takes less time and energy for providers and their teams, and is more transparent for patients (Click here to learn more about how Waystar automates manual tasks and streamlines workflows.) When the revenue cycle is operating at its most efficient, providers can focus their resources on improving patient care—and that’s a better way forward for everyone!
For more information of how Waystar works together with EZClaim, click here.
[ Article and image provided by Waystar ]
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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 sales@ezclaim.com, or call a representative today at 877.650.0904.
Nov 10, 2020 | Alpha II, BillFlash, Claims, collections, Denied Claims, EZClaim Premier, HIPAA, Medical Billing Software Blog, Revenue, Support and Training
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.
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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 sales@ezclaim.com, or call a representative today at 877.650.0904.
[ Photo credit: Studioarz ]
Oct 12, 2020 | Electronic Billing, Features, Medical Billing Software Blog
EZClaim Launches EZClaimPay, a new feature in its medical billing software that makes credit card processing painless!
EZClaim, a company with the mission of elevating its clients to stay in front of the ever-changing landscape of medical billing, announced today the launch of its credit card processing feature and service called, EZClaimPay.
EZClaim released the product in August 2020 as a solution to the ever-changing landscape of payment reconciliation. It was cited by customers as a timely response to a ‘pain point’—credit card payment processing—another example of EZClaim’s devotion to their mission.
Dan Loch, VP of Marketing commented that “EZClaim’s goal continues to be making life easier for medical billers at practices and billing firms. EZClaimPay is just one more feature within our mission of living up to that goal.” This feature will help companies get in front of the changes in medical transparency that are coming soon.
EZClaimPay provides for consolidated reconciliation (Payment reports; Chargeback management; and Reconciliation reports) and a single point of contact for support (Hardware; Software; and Payments).
EZClaim has developed a robust payments platform—tightly integrated with their software and support—to make accepting credit cards for payment PAINLESS! EZClaimPay makes software and payments better together.
For more details about EZClaimPay, view this web page: https://ezclaim.com/ezclaimpay/
ABOUT EZCLAIM:
EZClaim is a medical billing and scheduling software company that provides best-in-class customer service and support. To learn more, e-mail them at sales@ezclaim.com or call a representative today at 877.650.0904.
Sep 10, 2020 | Live Compliance, Medical Billing Software Blog, Partner
So, what’s the best path for HIPAA Compliance? It’s risk analysis.
The HIPAA Security Rule requires covered entities and business associates to ensure the confidentiality, integrity, and availability of all electronic protected health information (ePHI) that it creates, receives, maintains, or transmits.
Conducting a risk analysis—which is an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of the ePHI held by an organization—is not only a Security Rule requirement, but is also fundamental to identifying and implementing safeguards that comply with and carry out the Security Rule standards and implementation specifications.
However, despite this long-standing HIPAA requirement, OCR investigations frequently find that organizations lack sufficient understanding of where all of the ePHI entrusted to their care is located.
Although the Security Rule does not require it, creating and maintaining an up-to-date, information technology (IT) asset inventory could be a useful tool in assisting in the development of a comprehensive, enterprise-wide risk analysis, to help organizations understand all of the places that ePHI may be stored within their environment, and improve their HIPAA Security Rule compliance.
How Can You Manage This at Your Organization?
You can try to manage this by yourself, but it would probably be more efficient and superior in implementation if you used an expert. A partner of EZClaim, Live Compliance, is one of those experts. They can help you easily manage, maintain, and assign your hardware and technical inventory to remote or in-office employees.
Do You Have Additional Questions?
If you have any questions about the best path for HIPPA compliance, contact Jim Johnson at Live Compliance (E-mail: jim@livecompliance.com; Phone: (980) 999-1585).
For more on EZClaim’s products, either schedule a one-on-one consultation with their sales team, or download a FREE TRIAL to check it out the software yourself. For additional information right now, view their web site, send an e-mail to sales@ezclaim.com, or contact the sales team at 877.650.0904.
[ Article contributed by Jim Johnson of Live Compliance ]
