The Smart Medical Practice

Expert Interview: Kate Gilman of medicalbusinesspartners.com on the Importance of In-Depth Practice Analysis


Expert Interview: Kate Gilman of medicalbusinesspartners.com on the Importance of In-Depth Practice Analysis

Kate Gilman is the Operations Executive at Medical Business Partners, where she oversees all the operations. She is a nationally Certified Coder and Revenue Cycle Management expert, with over a decade of experience. Kate is also a regular speaker at medical society conferences and coding forums.

We recently checked in with Kate to get more insight about the changing landscape of revenue cycle management and the importance of regular audits for practices. Here’s what she shared:

Can you tell us the story behind your company?

Many providers are really frustrated with the conditions of the current healthcare system. They want to practice medicine, yet are overwhelmed by all the administrative work that needs to be done. We saw a void in the marketplace for a billing company that delivers much more than just billing proficiency. We set out to help!

Our team comprises various experts in different areas of revenue cycle and practice management. Our goal is to help physicians increase their revenues and decrease inefficiencies and expenses. We are passionate about facilitating providers with optimizing revenues, understanding regulations, staying compliant and offering the best patient care.

In addition, we want to make an impact in improving our healthcare system. We are actively involved in advocating better reimbursement and transparency from the payers, through many medical societies, educational outreach programs and payer committees. We fight to see more fairness towards the providers and patients!

What do you feel differentiates your service and sets you apart?

Medical Business Partners is different from all other billing companies because of our personal touch and dependable results! In addition, the following services really separate us from the crowd:

1. We fight for every outstanding dollar for our clients. We always ask “why” and “how can it be prevented” for every denial and rejection. By understanding and keeping track of trends for unpaid claims, we’re able to be proactive rather than reactive, and collect maximum revenues for our clients, quickly.

2. We personally meet with every client on a regular basis (weekly, monthly, etc.) to go over any trends we’re observing in their coding and billing, industry updates, reports analysis, suggestions for improvements and to ensure we’re always aligned with their objectives. Having direct and on-going communication, helps eliminate errors quickly, and makes us part of the in-house team, even though we’re an outsourced company.

3. We conduct random, quarterly (or as needed) coding audits for our clients. We meet with them to go over the results and make sure they are coding and documenting all their services correctly. We spend a lot of time providing educational training to providers and their staff, so they can feel confident they are being compliant and not leaving any revenue unclaimed.

4. The services we offer are 100 percent customized to the needs of each client, and adapt to their evolving growth and goals. In addition to full revenue cycle management services, we provide credentialing, coding audits and education, compliance review, software set-up assistance, reports analysis, staff training and practice consulting. Our services are all bundled together, based on specific needs and goals of the practice, so our clients don’t have to worry about paying extra for each additional request.

Can you talk a little bit about the landscape and complexity of your billing?

We handle all medical specialties, physical therapy and chiropractic revenue cycle management. Our services can be as simple as review of charges that need to be submitted, posting payments and sending patient statements, all the way to battling insurances on complex denials and appeals, reviewing payer contracts and in-depth practice analysis.

What billing areas do you specialize in? What are some of the specific challenges related to this type of billing?

We specialize in all areas of coding and billing. Our staff are AAPC certified coders, with many years of billing experience. For some clients, we provide claims follow-up and appeals, and for others, we perform all the duties from charge entry review to claims reconciliation. We always incorporate coding audits with feedback sessions, to ensure all charges are being properly coded and documented. This is very helpful, due to the increase in government and commercial payer audits.

Some challenges we come across are for practice staff to stay on top of all the growing payer regulations and demands. We try to simplify the tasks for them, by providing “cheat sheets” and discussing the information during our meetings. We help our clients craft a plan for each new payer guideline.

You write about helping practices streamline their operations and remove inefficiencies. Why do you view this as an important role for billing companies?

For optimal practice performance, it is critical for operations to be streamlined and to decrease inefficiencies as much as possible. When workflow isn’t efficient, the practice loses a lot of money and time. We observe practice dynamics and operations, to see ways it can be improved. Having an outsider perspective, gives us a lot of insight into inefficiencies that may be unnoticed from within.

What are the common inefficiencies you observe in practices today? How can they be corrected?

We notice a lot of overlap or gaps in workflow. Sometimes a practice may have too many staff doing similar duties, and other times a single staff member may be tasked with performing too many responsibilities, such as managing an office and doing all the billing. The quality is usually compromised, for either or both roles.

We also observe lack of or inadequate training for key staff members, such as front desk receptionist, charge entry personnel or billing manager. If these key staff make errors, it can be detrimental to cash flow and revenue, plus it creates a lot of extra work for billers. It is important to evaluate the workflow and have processes in place for everything. There should also be checks and balances, for double checking errors and feedback. Lastly, we strongly advocate on-going staff training. Depending on the role, they may need to be aware of the latest payer guidelines, government regulations, coding, compliance, etc.

What is the value of conducting regular coding audits? What do you typically learn during these audits? How often should practices be doing audits?

Coding audits are extremely important. They ensure the provider is billing for all the services correctly and is staying compliant. We often find codes unbundled, incorrectly billed or poorly documented. Some providers mistakenly believe submitting lower-level charges will keep them under the radar of the payers. However, that is considered fraudulent and can carry severe penalties during an audit.

We recommend for all practices to hire outside, certified coding experts to perform coding audits every four to six months. Even if the practice has internal certified coders, it is beneficial to have an outsider’s perspective. The ultimate responsibility falls back on the providers, so it’s imperative for them to know how to code and document correctly.

In addition, all coding audits should be followed by an educational feedback session. We always go over the results with our clients, explain the guidelines, and demonstrate ways to correct the issues.

What’s your plan to stay competitive with major players like Athenahealth, eClinicalWorks and McKesson?

We don’t view these companies as our competitors. Our greatest competitive advantage is our hands-on, customized approach to taking care of all of our clients. Our fees cover all services necessary for their target goals, including:

  • Coding audits
  • Reports analysis
  • Credentialing
  • Software set-up
  • Staff training
  • Compliance review

Our clients know exactly who is working on their account and develop a deep relationship with that team member. Having in-person meetings and open communication, allows us to be proactive because we understand our client’s needs, initiatives, and any future changes within their practice. We truly become a part of their “office family.”

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

It’s our mission to always be a tremendous asset to our clients; therefore, we make sure to stay on top of the latest healthcare news. We follow all the government regulations, local news from medical societies and all payers’ websites and newsletters. In addition, our staff attend on-going training, and read articles from AAPC. We participate in Medicare conferences and speak to other healthcare consulting companies to share common concerns and issues, as well as solutions. It is vital to stay ahead of all the guidelines and trends, so we can relate and help implement this information with our clients!

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

The field of revenue cycle management is always changing. One thing for sure, there is a massive shift from “fee-for-service” to “value-based medicine.” Insurance companies are moving away from volume billing and are focusing on better outcomes for their patients, decreased hospitalizations, prevention and education.

There is no escaping the electronic world in medicine. Eventually, the EHRs will communicate between each other or there will be several large ones that everyone will need to switch to. Either way, the more proficient providers and staff are in computers, the better.

More and more financial burden is being passed on to the patients. Patients are more confused than ever before about their plan coverage and payments responsibilities. If there will be higher payer competition (with open state boarders), then office staff will need to be even more knowledgeable about multiple plans, so they can assist their patients in understanding their potential financial responsibility ahead of time. This will be instrumental in ensuring proper and prompt collections from their patients.

These are some of our basic predictions. It is hard to know exactly where healthcare will go with the new administration, but we’re eager to take on any new challenge!

We can help you navigate the ever-changing world of revenue cycle management. Compare plans and pricing on PracticeSuite.com.


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