The Smart Medical Practice

CPC, CMMP, Merrilee Severino on Best Practices for Medical Billing and Coding


Merrilee Severino, CPC, CMMP and CEO of Your Business Medic, is a national speaker on practice management, billing and coding, and compliance whom has worked with some of the largest named publications in the medical industry.

We recently asked Merrilee for her expertise on revenue cycle management and get her take on best practices for medical coding and billing. Here’s what she shared:

How did you get into revenue cycle management? Can you tell us the story behind your company? What do you feel differentiates your service and sets you apart?

In 2007, my mother was diagnosed with breast cancer. I was the only of her three children who was in a field that would allow me to find work from home. I left my full-time job and began working from home helping my best friend launch his practice by doing credentialing, billing and revenue cycle management. To supplement my income, I also did several coding and billing webinars and talks with the help of BC Advantage Magazine and a few other sources. When my mother passed in 2008, I had intended to return to the office setting. However, I found I really enjoyed helping so many different practices that I never returned to one particular office full time.

This was the birth of Your Business Medic. I had a waiting list of clients who had said, when you are able to travel please let us know. I began all of my site visits and I’ve been busy since. I think what sets my company apart from others is that I prefer to stay small enough to offer “concierge” service to my clients. I take on various projects of all sizes, but always keep enough staff to make it work that nobody is ever a number.

Can you talk a little bit about the landscape and complexity of medical coding today?

I think we have been in a time of shifting sand for a while for billers and coders. With EMR, shifting pay models and the implementation of ICD-10, it has been a time that an employee in the field can no longer have a “job”; it must be a career choice. It requires a person to want to learn on their own time, to go the extra mile to stay current and effective in the process.

Can you tell us about what areas of medical billing/RCM you specialize in?

Primary Care, Concierge Medicine and Internal Medicine

What niche have you claimed as your own?

Marrying compliance with increased revenue in smaller practices.

Describe the nuances surrounding your specialty that you find the most challenging.

I find it most challenging when providers do not take the time to implement the education. We are all living fast-paced lives, but when we have educated and demonstrated the increased revenue and providers do not want to put in the effort to enforce what they have learned or allow staff to fall back into unproductive ways, it is very frustrating.

What do you like the most about your speciality?

I love helping the solo or smaller groups to survive because I believe there are providers out there that just want to practice medicine and should be free to do so. It makes me so sad to see the smaller practices get taken over by large groups or hospitals and then later see the provider so unhappy they leave just to start all over.
What are the most common knowledge gaps you observe in practices as far as coding is concerned?

I see practices that suffer quite frequently from lack of education and not staying current. Medicine is dynamic so why would a practice think a biller/coder shouldn’t need to go to continuing education? There is also sometimes a vast disconnect in coding and billing. They are two different things. It is vital to have all your key players work together from credentialing to AR management.

How often should practices be conducting coding audits? What are best practices for conducting an audit?

In my opinion, a practice should be conducting audits no less than quarterly depending on their size. These should also be pre-bill audits and there should be open discussions with key staff regarding the results in order to implement necessary changes and education.

What can practices do to avoid improper coding? Where do they most often make mistakes?

Practices often under-code in my experience. I find that many practices get their advice from someone before them who learned from the person before them and so on. Or even worse, the salesperson that sold the equipment.

I think a key part of adding services and compliance should be updating your research of payer review policies on each service code quarterly and spreading the information and updates to the staff that needs the information. Not all payers want the same service reported the same way. You must be aware of payer guidelines as well as coding guidelines.

What are your favorite resources for professional medical coders to reduce errors and stay-up-to-date on industry changes?

My very favorite resource is BC Advantage Magazine and their website for CEU’s. I also like CMS and First Coast Service Options websites for auditing. I have found EncoderPro to be a resource I use daily. For appeals and working claims, I use appeal solutions product AppealLettersOnline.com and add to them on my own using info from LMRP’s, etc.

How has the Affordable Care Act affected your business? What about patient pay. What has been the impact on your work?

The Affordable Care Act has brought with it demand for credentialing for new plans and the need to educate staff on why it is so important to verify benefits at the time of service vs. billing a patient after services are rendered. It is a game changer with the importance of providers to know the difference of who is here for preventative care vs. sick care. The staff must have a plan in place to educate the patient on the coverage and differences of these services and protect the practice from loss.

It has been hard on us as billing staff to go back and collect from patients who were not educated properly prior to service being rendered. It is not doing the patient a favor when you allow them to have an uncovered service only to be stuck with a large patient responsibility later. It is a burden of resources on the practice and unfortunately providers some times have not caught up to the fact that the responsibility of this debt is now on the front office staff to perform more as billers at the time of service and be “gatekeepers”.

What headlines or trends in the world of revenue cycle management are you following today? Why do they interest you?

I am interested in HCC coding right now, I feel that with the implementation of MACRA we will find more practices that perhaps fall off the grid due to the lack of proper education. I think if more practices had stayed current on education and providing services that were being reimbursed they would be more ready, but I heard a lot of my providers complaining it was “too much work for so little reimbursement”.

What predictions do you have for the future of revenue cycle management? How will the field evolve?

I think more solo and small group practices will have to combine resources to stay alive. I have seen a lot of providers sell to hospital groups only to be unhappy and leave later. I see so many MD’s leaving and more and more ARNP’s and PA’s taking their place. We need to do all we can to protect our smaller practices and solo providers. They are some of our most caring providers and brilliant practitioners and unfortunately are being left to the wayside.

I remember more than 15 years ago being asked to teach ICD-10 to a PA school. Do any MD’s every get that kind of education in med school? Unfortunately not. We have unfortunately set them up for failure and in the end it is not really them alone who are hurt by their failure. Revenue cycle management needs to become more involved on the front lines helping with documentation prior to claims submission.

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