Any strong medical billing process and medical billing company must compare insurance payments to your contractual allowables and aggressively pursue underpayments. If this is not happening then most likely 5 to 10% of your practice’s revenue is being lost.

If you make the decision to outsource medical billing or are currently outsourcing, then there are a number of critical tasks and process steps that your medical billing service should provide. These include scrubbing claims before they are submitted, systematic follow-up on submitted claims, posting denials, pursuing underpayments, using patient expected payment scores just to name a few.

This article focuses on just one of the key elements you need from your medical billing service: pursuit of underpayments. Pursuit of underpayments starts with a critical step: comparison of EOBs to your contractual allowables (the payment your payers have agreed to make for each CPT code). You cannot count on payment posters to catch underpayments with their naked eye; the comparison must be automated and systematic. It goes without saying that if you do billing in-house the comparison still should be done.

The need for automated comparison to allowables is not because of any short coming with the average payment poster, but because payers employ sophisticated techniques to make underpayments difficult to identify. Medical billing companies with well designed processes can counteract these techniques because they have much more scope than a single medical practice. By scope I mean that they see what payers do across multiple providers in multiple states. This broader view of the world allows a billing company that is leveraging its scope to uncover payer behaviors more easily than a single medical practice.

A disturbing pattern that can regularly be seen by a medical billing company that is paying attention is one where a payer will select a set of procedures and underpay this set of procedures across a large number of providers (often by the same amount). This will continue for about 30 days and then the payer will resume paying the procedures at the correct amount and begin underpaying a whole new selection of procedures.

These underpayments are not huge (5 to 10 percent) but they add up quickly to big dollars for a medical practice. The combination of switching the codes being underpaid from month-to-month and keeping the underpayment amount “under the radar” can make the underpayments difficult for an individual practice to spot.

As you can imagine, these small underpayments switching from CPT to CPT would be difficult for a busy payment poster to notice. They will often spot the large underpayments (which occur with a much lower frequency than the small underpayments), but without automated comparisons the smaller underpayments are typically missed.

This single action (comparison of payments to allowables) can increase a medical practice’s collections by 5 to 10 percent. This is why you need to insure this critical step is being completed by your medical billing service.

Identifying the underpayments is the first step of the journey. Dogged pursuit of the underpaid amounts is what actually drives up your practice’s revenue. This pursuit needs to go down to even small underpayments because once a payer sees that the small underpayments are being pursued they typically taper off and contractual payments resume at the appropriate level. Much like a small child, the insurance companies are trying to see what the can get away with.

Copyright 2008 by Carl Mays II

This article is about a potential employer’s view on medical billing schools. My experience has been that they simply are not worth the time and money for the students. I have interviewed many medical billing candidates from many medical billing schools and I do not find that the education makes the individual a more attractive candidate than other inexperienced candidates.

In fact, when I do hire a medical billing school graduate they typically are started along side inexperienced new hires in our apprenticeship program. They start at the same pay and in need of almost the same training as individuals that have not spent the money or time on medical billing school. I would say at best, they start 3 months further up the learning curve than a completely inexperienced hire. This translates to about $0.50 per hour difference for 3 months (at best).

Although medical billing schools teach some terminology and medical billing concepts, they do not provide any of the experience necessary for an individual to start as a medical biller. In fact, more often than not we find that they have taught incorrect concepts and the “eduction” has to be unlearned before the individual can actually move on from being an apprentice. Many times the medical billing school graduates also have an inflated sense of confidence because of their training and are harder to teach and mentor in terms of proper medical billing because they are under the impression that they have already learned all they need to know.

A better path into medical billing is to avoid spending money on a medical billing school and instead spend time finding a medical billing company or doctor’s practice that will let you start your medical billing career by calling on medical claims or verifying patient insurance information prior to the patient’s appointment.

Both of these activities give individuals a solid base for launching a medical billing career. They provide the individual with both a grounds up understanding of the building blocks of medical billing and a real medical billing job on their resume.

Most organizations do not have a formal apprenticeship program, but if you interview with the specific tasks outlined above in mind then you can find an entry level opportunity. This opportunity will pay you to learn about medical billing and build your resume.

The certified coder that does not already have medical billing experience is typically hard pressed to find a coding position. Once, however, your have medical billing experience you can get real value from a certified coder certificate.

So, if you want to break into the field of medical billing please consider pursuing an apprenticeship model it will serve you (and your future employer) much better than a medical billing school education.

Copyright 2008 by Carl Mays II

ClaimCare Medical Billing Services has interviewed countless candidates that have just graduated from a medical billing school and coding school. As a rule, we find that the courses in a medical billing school (and coding school) add little value or knowledge to the resume of an individual with no prior medical billing experience.

In fact, when I do hire a medical billing school graduate they typically are started along side inexperienced new hires in our apprenticeship program. They start at the same pay and in need of almost the same training as individuals that have not spent the money or time on medical billing school. I would say at best, they start 3 months further up the learning curve than a completely inexperienced hire. This translates to about $0.50 per hour difference for 3 months (at best).

The terminology and concepts taught in medical billing school no more prepare a person to be a full fledged medical biller than reading a book on how to drive a car prepares one for the challenges of actually driving a car - it is practice behind the wheel that is required. The academic elements can be helpful - just like supplementing practice behind the wheel with a manual on safe driving makes sense. Unfortunately, however, this is only true if the academic material is accurate. I have found that often students have been damaged by medical billing schools that either teach incorrect medical billing concepts or leave the students with a sense that they have nothing left to learn.

Almost without exception, the best way to break into medical billing is to find a medical billing service or a physician practice that will allow you to execute basic medical billing tasks such as verifying insurance or calling on claims to find their status.

Both of these activities give individuals a solid base for launching a medical billing career. They provide the individual with both a grounds up understanding of the building blocks of medical billing and a real medical billing job on their resume.

If you approach organizations with this plan in mind it is quite likely that you can find an entry level opportunity. Such an opportunity will allow you to earn an income while learning medical billing and will look much better on your resume than medical billing school.

Once you have a few years of real medical billing under your belt (not just the entry level tasks, but more advanced medical billing you move into as you master the entry level tasks) then you are ready to extract value not from medical billing school, but from coding classes. With the core knowledge in place you can make the most of the coding classes and will have credibility with potential employers.

So, if you want to break into the field of medical billing please consider pursuing an apprenticeship model it will serve you (and your future employer) much better than a medical billing school education.

Copyright 2008 by Carl Mays II

Medical billers and medical billing services are the financial life blood of a practice. Practices that do not have the right medical billing expertise in their corner can easily lose more than 20 percent of their practice’s potential revenue.

Outsourcing medical billing is growing in popularity as an approach for addressing this tremendous loss of practice income. The range of outsourcing options runs from extremely large organizations to individual freelancers who work from home to provide medical billing services.

In thinking through the billing options available, it is crucial to understand that medical billing is complicated and requires deep expertise and broad experience. When a specialty is involved, such as surgical billing, the requirements for success become even harder to achieve. Success requires that the medical billing company have a team that is well versed with the complex rules utilized by insurance companies to adjudicate surgical medical claims.

The choice of an experience billing provider has become all the more important for surgeons as they watch their cost rocket upwards. With their margins shrinking they must be confident that their surgical billing service is collecting every dollar the surgeon is owed. Selecting the proper medical billing service is made all the more difficult by the fact that many companies claiming to be experts in billing for surgeons actually do not do the billing themselves, but outsource the work to other vendors that are based in India or work from their homes.

Deep familiarity and comfort with surgical procedures and terminology does not come from serving one or two surgeons. Surgical billing success requires both broad and deep expertise in order to collect all of the money owed the surgeon and successful appeal claims which have been denied or answer questions the payers may have about a claim.

Good surgery billing requires the ability to track underpayments. This is more complicated than typical medical billing because of the rules around multiple-procedures. This complication often exceeds the capabilities of the billing software used by generalist billing companies. This is a critical failing since proper pursuit of underpayments can increase a surgeon’s collections by 7 to 10 percent.

These billing complications extend to the patient collections arena as well. The patient collection process for specialists like surgeons is more complicated because of the large patient balances often owed, the complexity of the procedures/EOBs that must be explained to patients that do not understand their bills and the older population surgeons often serve. A medical billing service with expertise in billing for surgeons knows how to deal with these situations. Billing services without such experience will increase the risk of both lower patient collections and upset patients confused about their bill.

The safest way for a surgeon to navigate the medical billing land mines outlined in this article I to travel the medical billing battlefield with a surgical billing service that has deep and proven expertise in traversing the surgery billing hazards. Family doctors should not be performing surgery and generalist medical billing companies should not be providing medical billing services to surgeons.

Copyright 2008 by Carl Mays II

This article is about a potential employer’s view on medical billing schools. My experience has been that they simply are not worth the time and money for the students. I have interviewed many medical billing candidates from many medical billing schools and I do not find that the education makes the individual a more attractive candidate than other inexperienced candidates.

Typically graduates we hire from medical billing school start in our apprenticeship program alongside individuals that have not graduated from medical billing school (i.e., they start in the exact same role as folks that have not made the investment in money or time for medical billing school).

The terminology and concepts taught in medical billing school no more prepare a person to be a full fledged medical biller than reading a book on how to drive a car prepares one for the challenges of actually driving a car - it is practice behind the wheel that is required. The academic elements can be helpful - just like supplementing practice behind the wheel with a manual on safe driving makes sense. Unfortunately, however, this is only true if the academic material is accurate. I have found that often students have been damaged by medical billing schools that either teach incorrect medical billing concepts or leave the students with a sense that they have nothing left to learn.

A better path into medical billing is to avoid spending money on a medical billing school and instead spend time finding a medical billing company or doctor’s practice that will let you start your medical billing career by calling on medical claims or verifying patient insurance information prior to the patient’s appointment.

Both of these activities give individuals a solid base for launching a medical billing career. They provide the individual with both a grounds up understanding of the building blocks of medical billing and a real medical billing job on their resume.

Most organizations do not have a formal apprenticeship program, but if you interview with the specific tasks outlined above in mind then you can find an entry level opportunity. This opportunity will pay you to learn about medical billing and build your resume.

Once you have established skills as a medical biller, then it can be helpful to study for and take a certified coder exam. A certified coder with no medical billing experience, however, is not in great demand.

In summary, medical billing school is simply not worth the investment for an inexperienced student. You will find more success and greater financial rewards if you skip the medical billing school until you have the experience under your belt to make the certified coder courses a worthwhile investment.

Copyright 2008 by Carl Mays II