Archive for January, 2011

Insurance Credentialing for Physicians

January 31, 2011

Time and again new practices invest countless hours and money focused on office space, equipment, software and staffing only to open their doors for business and find significant delays in getting adequate insurance reimbursements. More often than not, the problem could’ve be allayed by addressing the insurance credentialing process early and thoroughly – creating the necessary relationships with insurance carriers. Here are a few considerations to keep in mind as you address the insurance credentialing process.

Timing – Start Early!

Plan on starting the insurance credentialing process early – at minimum allow at least 6 months before you see your first patient. Carriers will often take as much as 3-4 months to review documents and make a determination, even if everything is in order, though it is known to take up to 12 months. If there are errors, missing information or a question about submitted documentation, several more weeks or even months can be added to the process. This 6 month allowance, starting from the time credentials are submitted, usually gives enough time to address problems should they arise. If too little time is granted before the practice opens, and you begin seeing patients before insurance credentialing is complete, you are open to the risk of getting an “Out-of-Network” rate, reimbursements might be sent to the patient, or, worst case scenario, you may not get paid at all.

Identify Target Carriers

To define which insurances you might credential with, consider your practice location and patient demographics. Will a significant percentage have Medicare or Medicaid? Is there a particular company or business in the area that employs a large portion of the surrounding population? A quick call to their human resources office to inquire what insurances they currently offer employees (as well as possible changes the near future) can be a good indicator of the carriers you’ll want to consider.  Also, check with colleagues, other providers, clinics and even larger hospitals in the area and ask who their most common payors are. Inquire about which payors are best to work with – who reimburses in a timely manner, which offer the largest enrollment, and which carriers might be at capacity with other providers in your specialty.

Contact Insurance Carriers

With your list, contact each of the provider services offices of each of your target carriers. One of your first questions might be to ask if they are accepting new practices in your specialty in your area. More often than not there’s no problem here, but don’t be discouraged if they say no – just keep moving down the list and prepare to check back with them later for an opening.   If the carrier is receptive to new providers, make sure you get all pertinent information about the process – i.e. names, addresses, phone numbers, timing, required forms, and so on. Don’t forget to ask about online submission too, as many carriers today allow you to provide all information online and mail in the supporting documentation.

Submitting Credentials

Now that you’ve completed your research and identified which insurance carriers you’re going to file with, you’ll need to compile and submit all of your information. Most will generally require you provide the following:

• Updated resume

• Personal demographic information

• Practice and business information

• State and federal DEA numbers

• State licensing and registration information

• Evidence of education – i.e. Diploma certificate

• Malpractice insurance information

• Information on any disciplinary actions

While this can be a lot, there is some good news – since most carriers ask for the same information, once the first submission is complete, you can just transcribe all the details from one form to the next. You will also benefit enormously in the future by storing copies of these documents in a safe place. As your practice matures and you seek to credential with other insurances, you’ll have this same repository of information readily available.

Once you’ve completed the application, don’t forget to double-check everything. In fact triple check it and have someone else look over it as well. Don’t expect carriers to correct an obvious mistake for you – it’s not their responsibility, and, frankly, they just won’t. The importance of double and triple checking cannot be stressed enough as the entire process can be held up by a month or more from the slightest mistake.

Finally, after your information has been submitted, allow an appropriate amount of time (1-2 weeks for mailed submissions) and follow-up with the provider services office to confirm receipt. If you were able to obtain a contact name in your early research call them directly. Once receipt is confirmed don’t hesitate to follow-up again in say, 3-4 weeks to see if they’ve reviewed it yet or if they found any problems. If everything’s on track, plan on checking back in another 3-4 weeks until the process is complete. This can save a lot of turnaround time if you can learn over the phone there was some sort of hold up. As alluded to above, expect this part of the process to take several months – credentialing offices are often centralized and may be reviewing hundreds of submissions for many different areas at any given time. If there’s no movement after several months, you consider stepping up your calls to a weekly basis.

Hopefully your hard work and phone calls has paid off and you’ve made it through the insurance credentialing process in just a few short months.

Here are a couple of shortcuts to credentialing not mentioned above:

  • Hire professional assistance ~ There are many different organizations that can help with the insurance credentialing process. If you’ve contracted with a practice management company this process is often covered already. If you’re considering a medical billing company to manage your insurance and patient billing they certainly should have the experience with carriers to provide at least some guidance, if not manage the process for you. Also, there are a few professional insurance credentialing companies that specialize in this process for new practices but they can often come at a high price.
  • CAQH ~ The Council for Affordable Quality Healthcare has developed an online service intended to eliminate the need for multiple insurance credentialing submissions. In short, you complete one form for all of their participating insurance carriers and you authorize who will receive your information. The CAQH Universal Credentialing DataSource is located at: http://www.caqh.org/

Summary

The insurance credentialing process is critical to getting your practice off to a good start – and ensuring a quicker transition to profitability. While it can be time-consuming, an early start will give you the chance to address problems should they arise. Just be patient and keep these tips in mind and you’ll get through it:

• Start early – expect the process to take up to 6 months

• Choose a target list – don’t try for every carrier out there, you can always expand your list later

• Double check your work before you send it in

• Follow up regularly and keep the process moving

• Don’t be overwhelmed – it’s just paperwork

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Quotes

January 27, 2011

“Sometimes when you innovate, you make mistakes. It is best to admit them quickly, and get on with improving your other innovations.”  -Steve Jobs

Cowtown Netweavers 01.26.2011

January 26, 2011
Today, I was the one who had the opportunity to give my presentation at Cowtown Netweavers for our meeting.  I spoke on what services Medical Account Solutions provides and gave everyone a bit of education on the process. I am really passionate about what I do and was very inspired by all the questions that people had.  I particularly want to thank Don Henry, Eddie Dzurilla and Richard Sherman for their insight and feedback with additional information. 
 
Today’s inspiration came from a book called Never Eat Alone by Keith Ferrazzi:  “We all live one life…and that life is all about the people we live it with. Connecting lets us have our cake and eat it too…serving the interests of both our work and our life, ourselves and others.”  It is a great book on Networking and  if you desire to know more, you can google and get several “book reviews” to get more information or just go buy it or borrow it from someone like I did!

My Story: how I got into Medical Billing

January 24, 2011

My name is Misty Gilbert and I have been in the medical field for 15 years.  My experience in the medical billing industry comes from working in doctor’s offices and with my client’s. 

I took my first job with a Dermatology office in California, March 1996.  I was hired as a part-time File Clerk and only worked part-time, the first day!   I took on any task they gave me from the mountain of filling in the sample closet to typing surgical reports, preparing pathology slides for review, verifying benefits, answering the telephone and booking patient appointments, etc.  When the day came that one of the physician’s medical billers quit, the physician I was working for asked me what I thought about his decision to have me assist the other biller, I jumped at the opportunity.  I took lots of notes from Fawn and I quickly caught on to the way things needed to be done.  I enjoyed the work and was really grateful to be learning a “skill”, beyond just filling in and helping where ever they needed me in the office.  The day came when I received an offer from a Cardiologists office two doors down to work for them doing Medical Billing at a dollar an hour more.  You might not think that was much money, but to me, it was!  I jumped at the opportunity, besides it had Health Insurance Benefits too, something I didn’t have at the Dermatologists office.  My employer wasn’t happy to be loosing me, but he didn’t wish to give me a pay raise and he didn’t offer health insurance benefits.  When I left California to move to Texas in September 1997, I took a job as a Medical Receptionist in an OBGYN’s office making $2.00 an hour more than I had been in California as a Medical Biller.  I was really impressed.  I knew at some point I would want to get back into doing medical billing, but for the time being, I was happy with the pay increase. I eventually moved on from that job to a position in Accounting and was promoted internally to a Collections position where I learned lots about the regulations set forth pertaining to that.  The job was very stressful, but it allowed me to have even more experience that furthered my medical billing career as I worked at debt collection and payment plans pretty much all day every day.  The started looking for a better opportunity and the next position I took is what led me back into Medical Billing.  The years of experience in the medical industry and various positions I had working with different employers since 1996 has only increased my skills and expertise in many specialty fields, bring me to where I am today. 

I have experience in the following fields:  Dermatology, Cardiology, OBGYN, 3rd Party Pharmacy Claims Processor (for Tricare beneficiaries), Home Healthcare, Pediatrics, Family Practice, Internal Medicine, Orthopedic, Ophthalmology/Ophthalmic Plastic Surgery, and Optometry.  I have worked as a File Clerk, Receptionist, Data Entry Clerk, Medical Biller, Collections Representative, Billing Analyst & Collections Manager, Billing Manager, Office Manager and Accounting Manager. 

My experience as a medical biller and office manager have given me the opportunity to have insight into assisting medical practices increase their cash flow and maximize reimbursements.  I started my own Medical Billing Agency, Medical Account Solutions, June 2004 when I felt I could offer more than the typical medical billing agency does in today’s market.  It is my goal to help physicians thrive at doing what they do best.  They need staff that is organized, focused and efficient and our goal is to help them accomplish this.  Medical Account Solutions offers al-cart or full service medical billing services, consulting and training.  I worked solo for the first 4 years and hired my first part-time employee in 2008 and my second later that year.  I am passionate about what I do and enjoy helping business find solutions to their problems.  Our team provides expertise and accuracy and you get a personalized hands-on approach with the services we offer. 

My long-term goal for the business is to offer classes and training to physician’s as they complete their residency program.  They are not taught basic business practices, the medical billing rules and regulations, what is required to start a medical practice, what aspects are involved, or the length of time the credentialing processes take.  Physician’s graduate expecting that as soon as they get their practice setup and start seeing patients that they will be making money.  I want to be a resource and assist them with better tools to start out their medical practice in a different position then they typically do.

This is my story on how I got into doing Medical Billing.  Do you have a story to share?

Quotes

January 20, 2011

“Real riches are the riches possessed inside.”  -B C Forbes

The Surprising Truth about What Motivates Us

January 17, 2011

Our motivations are unbelievably interesting.  We are not as endlessly manipulable & predictable as you would think!  Reward or punish?  This is the typical motivational scheme.  Once you get above rudimentary cognitive skill, rewards don’t work that way.  For simple straight forward tasks…if you do this then you get that, this is great!  But when a task gets more complicated, it requires conceptual, creative thinking, these kinds of motivators don’t work.  FACT: Money is a motivator.  If you don’t pay people enough, people won’t be motivated.  Pay people enough to take the issue of money off the table.  This helps them think about the work, not the money.

3 factors that lead to better performance:  autonomy, mastery, and purpose.  Autonomy = desire to be self directed.  Mastery = the urge to get better at stuff.  Purpose = brings better tallent…doing sophisticated, technically, highly skilled, challenging work. You flourish when you are animated by purpose not just profits.

This lively RSA Animate, adapted from Dan Pink’s talk at the RSA, illustrates the hidden truths behind what really motivates us at home and in the workplace.  www.theRSA.org

Quotes

January 13, 2011

“Our work is the presentation of our capabilities.”  -Edward Gibbon

Setting Goals that Work

January 10, 2011

The plans of the diligent lead surely to plenty, but those of everyone who is hasty, surely to poverty. – Proverbs 21:5

“Are you a goal setter? Do you typically set goals at the first of the year? If not, why not? Goals give you a starting point and a destination. It is the easiest way to give meaningful direction to your life, which releases you to effectively use your talents,” Dan Miller writes in his book 48 Days to the Work You Love.

So what do you want to accomplish and become this year? This year doesn`t have to be like previous years. You can set goals and keep them. Don`t just dream about how you wish things would be. Develop a plan and make it happen! Something amazing happens in our lives when we take the time to write down our specific goals, not just keeping them intangible thoughts in our brains.

Goals that work must be:

  • Specific
  • Measurable
  • Yours
  • Time-sensitive
  • Written

“Saying you want to be a better mommy, have a better job, or learn a new language is admirable, but without listing steps of measurable, specific goals, you will not move toward any specific action. Then another year will pass without any real change,” Miller quotes.

Don`t get discouraged if your goals aren`t accomplished in the exact way and down to the second the way you originally planned. Some flexibility is definitely needed, but as long as you are focused on the end goal and are taking proactive steps toward achieving it, you are an achiever and on your way to great things.

As Earl Nightingale put it, “Success is the progressive realization of a worthy goal or ideal.” You can be successful this year with your specific, measurable, and time-sensitive written goals!

taken from: http://www.daveramsey.com/article/setting-goals-that-work/lifeandmoney_goalsetting/

Keys to Achieving Your Goals

January 10, 2011

Another year and another set of resolutions. If you’re like most Americans, you’ll probably forget your goals by mid-February. So how do you make your resolutions actually happen this year?

First, keep in mind that goals are dreams; but don’t stop at just dreaming. Turn your dreams into bite-sized pieces that will gradually create a big event in your life. If you’re waiting on an outside variable to change your life, you have a long wait. You have to do something. It’s your responsibility to fix your life, not someone else’s. It’s time to sit down, make some goals, and take control.

Goal setting is how you win. Once you’ve made your resolutions, they will drive you forward. The goals will motivate you to seek activities that will help you succeed. It’s not always fun, but those exercises bring you closer to your goal and make you a winner.

If you want to actually achieve your goals this year, then consider the following:

1.Be specific.

When setting goals, be specific in what you want to achieve. Vagueness will only cause you to feel overwhelmed, and you will just give up.

2.Make your goals measureable.

In order to know if you achieved the goal, it must be measurable. For example, if you want to lose weight, don’t simply write down “lose weight” as a goal. How much weight do you want to lose? Or don’t just write “spend more time with family.” How much time do you want to spend with your family every night?

3.Are they your goals?

Only you can set your own goals. If your spouse, co-worker or friend sets a goal for you, you’re not going to achieve it. Taking ownership will give you more incentive to meet your goal.

4.Set a time limit.

Setting a time frame will help you set realistic goals. For example, if you want to save more money, list how much money a month you want to put into your savings account.

5.Put them in writing.

Putting your goals in writing will make you much more likely to achieve them. Write down your goals and review them often. This will give you motivation to make them a reality.

This is the process to succeed. Successful people reassess their lives and then start living intentionally, in writing, on paper, on purpose. Make your resolutions a reality in this year!  What are your goals for 2011? Leave a comment below.  Check out Dave Ramsey’s resources to help you achieve your financial goals.

article taken from:

http://www.daveramsey.com/article/the-keys-to-achieving-your-goals/lifeandmoney_goalsetting/

Quotes

January 6, 2011

“Obstacles are those frightful things you see when you take your eyes off your goal.”   -Henry Ford

Cowtown Netweavers 01.05.2011

January 5, 2011

Today was another great meeting…Mike McCaleb shared with each of us today that we all must have goals.  May I encourage you to read this:

Another year and another set of resolutions. If you’re like most Americans, you’ll probably forget your goals by mid-February. So how do you make your resolutions actually happen this year? 

First, keep in mind that goals are dreams; but don’t stop at just dreaming. Turn your dreams into bite-sized pieces that will gradually create a big event in your life. If you’re waiting on an outside variable to change your life, you have a long wait. You have to do something. It’s your responsibility to fix your life, not someone else’s. It’s time to sit down, make some goals, and take control. Use Dave’s online goal tracker now.

Goal setting is how you win. Once you’ve made your resolutions, they will drive you forward. The goals will motivate you to seek activities that will help you succeed. It’s not always fun, but those exercises bring you closer to your goal and make you a winner.

If you want to actually achieve your goals this year, then consider the following:
1. Be specific.
When setting goals, be specific in what you want to achieve. Vagueness will only cause you to feel overwhelmed, and you will just give up.

2. Make your goals measureable.
In order to know if you achieved the goal, it must be measurable. For example, if you want to lose weight, don’t simply write down “lose weight” as a goal. How much weight do you want to lose? Or don’t just write “spend more time with family.” How much time do you want to spend with your family every night?

3. Are they your goals?
Only you can set your own goals. If your spouse, co-worker or friend sets a goal for you, you’re not going to achieve it. Taking ownership will give you more incentive to meet your goal.

4. Set a time limit.
Setting a time frame will help you set realistic goals. For example, if you want to save more money, list how much money a month you want to put into your savings account.

5. Put them in writing.
Putting your goals in writing will make you much more likely to achieve them. Write down your goals and review them often. This will give you motivation to make them a reality.

Start 2011 with a Clean Slate

January 3, 2011

Management guru Peter Drucker always recommended that you examine every part of your business regularly to determine if there is anything you are doing now that you wouldn’t do again if you could start over.

What if you did this Zero-Based planning for your LIFE? If you could wipe the slate clean on January 1st, and look at your life in this way, what would you change? The real hallmark of truly successful people is not that they do more but that they can decide what they are going to stop doing. What are you going to Stop Doing on January 1st?

And you’ll see that planning for success means more than just having a great job or making lots of money. Make sure you plan for success physically, spiritually and in your family relationships as well. Decide what you want your life to look like next year.

– article by Dan Miller @www.48days.com

[2011] Business Goals

January 1, 2011

business goals
#1 obtain 3 new Clients this year with the goal of one a quarter

#2 complete design of business marketing materials: postcard & brochure by February 1st, 2010

#3 Home Office remodel will be completed by mid-January 2011

#4 enroll in accounting courses to further education -spring 2011; take a course in Microsoft Office to learn more about graphs and pivots

#5 review EntreLeadership materials quarterly for refreshment & encouragement (rehearse, execute, review); check in with EntreLeadership friends to motivate, encourage, gather ideas, share and cheer each other on success;  review & define motivation, delegation, responsibility, accountability, and authority in my position so that I have a clear picture in view to stay focused on what I expect of me & my team

[2010] …YearInReview

January 1, 2011

I subscribe to Seth Godin’s blog and he has a lot of great thoughts, many many times.  This post was one of those and has intrigued me to reflect on my year for 2010.  He states:  “This might be a useful exercise. Doesn’t matter whether it was a hit or not, it just matters that you shipped it.”

Here’s a basic list from the 2010 year with some of the highlights in my business life:

  • logo was finalized and stationary produced
  • website was launched March 2010
  • created a business blog with weekly articles
  • started attending Networking events in August, have met some really great business people to refer to and coordinate business with
  • was offered and accepted a Board Member position with Cowtown Netweavers
  • was offered and accepted Treasurer position with Network for Enterprising Woman
  • obtained 6 additional Clients, some of which utilize my business services PRN
  • business revenue down 15%, with net profits just the same as last year even with increased marketing expenses
  • gave a speech 10.22.2010 @Networking for Enterprising Woman on my life
  • gave a speech 11.03.2010 @Cowtown Netweavers on What Is Success?
  • gave Dave Ramsey’s book Financial Peace Revisited to every attendee at the networking meeting on 12.01.2010 @Cowtown Netweavers with the goal to inspire each person to be Debt Free
  • gave Dave Ramsey’s book Financial Peace Revisited to every Client & Client’s staff as a year end gift with the goal to inspire each person to be Debt Free

Seth’s suggestion:
“You’ll probably be surprised at how much you accomplished last year. Go ahead and share with your friends, colleagues or the web… don’t be shy.”  So I challenge you to do the same!

If that is not for you…try this:
The Simple Dollar, another blog that I follow, suggests:
Think of the five best things that happened in 2010. What were the best things that happened in your life this year? What new relationships did you build? What ones did you reaffirm? What goals did you achieve? What changes occurred in your life that put you in a better place?

I would love to hear your thoughts…please share with me as I have done with you!