Dianna Watkins, owner of Billing Therapy Solutions LLC, is a medical billing auditor business owner who has more than 16 years experience in healthcare.
Here she shares about her experience with revenue cycle management and the challenges facing therapists when it comes to medical billing. Read on:
Tell us your story. How did you get into revenue cycle management?
Sixteen years ago I took a position as an office manager of a Speech Therapy clinic without any previous experience with medical billing or coding. I immediately contacted the state medicaid program and local provider representatives of commercial insurance companies to learn the process of medical billing. I enjoyed the process and wanted to learn more. However, after researching old records, I discovered the previous manager had been stealing money from the company for four and a half years. Seventy-five thousand dollars in stolen revenue later, I worked with the company to report details when they turned her into authorities. After working with this company for a couple of years, I decided to work with a billing company to learn more about medical billing from a variety of providers.
Tell us about Billing Therapy Solutions . What do you feel differentiates your service and sets you apart?
After my experience, I realized how providers were not educated on protecting their business. I make sure my clients understand all aspects of billing and how to protect themselves and their business.
Can you talk a little bit about the landscape and complexity of your billing?
Most of my clients are physical, occupational and speech pediatric therapists, however I work also with pediatricians, general practitioners, chiropractors, and psychologists. I offer a variety of services to include auditing, training, billing options and credentialing.
What are some of the specific challenges related to billing for therapists?
Benefits for pediatrics for therapy in particular make billing complicated. Many insurance companies will not allow developmental delay diagnosis codes, yet many children can not receive a specific medical diagnosis until they are a particular age. It’s been proven that early intervention therapies for special needs children help improve their lives overall faster than receiving therapy later in life.
What are the common mistakes or oversights your see your clients making? How do you help them correct those mistakes?
Most mistakes I find when first meeting a client are with credentialing or untrained staff. Staff can sometimes see me as a threat when I first come in, however, I listen to their issues and help set up plans to eliminate human errors as much as possible along with communicating the concerns to the providers. Mismanagement and organization can really break a practice financially.
What types of medical billing news or trends would you advise your clients to follow right now? What types of regulatory issues are therapy practices facing these days?
www.cms.gov is a must for any provider. With most of my pediatric therapists, knowing what the correct rules and regulations set by each state can be not specific enough for auditing regulations. Rules seem to continue to change quarterly and are often conflicting as to the guidelines set by their national boards.
What’s your plan to stay competitive with major players like Athenahealth, eClinicalWorks and McKesson?
My services are never a competition with software companies. I work with smaller companies who need a more one-on-one training. No software can possibly take the place of the constantly changing issues in the medical billing world. I’ve worked with all of these software companies and they still need do not meet all the needs of a provider by a long shot.
How has the Affordable Care Act affected your business? What about patient pay? What has been the impact on your work?
ACA has allowed more patients to receive medical services, so work caseloads have been slightly higher. The policies, however, are usually very different than other commercial policies, with many codes not allowed. Most policies have high deductibles, which sometimes has been hard to collect.
What headlines or trends in the world of revenue cycle management are you following today? Why do they interest you?
I’m always interested in new software companies or what new options software companies are offering for providers. Good tools not only help my clients, but my business as well.
What predictions do you have for the future of revenue cycle management? How will the field evolve?
Even with software systems offering billing and credentialing, these companies do not lobby for providers rights. Providers deal with so many rules and regulations they often feel frustrated not having more time to research medicine and innovations in the medical fields due to dealing with ongoing changes with commercial insurance regulations. I honestly can see more and more providers working toward a one-pay system or cash only in the future.
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