We recently asked Kari about the changes she’s observed in revenue cycle management in recent years and how she helps her clients weather these changes. Here’s what she had to say:
Tell us the story behind the Administrative Billing Solutions.
In 2000 I began thinking about starting my own medical billing business, to afford me the opportunity to stay home with our future family. I had several years of various insurance industry experience, including working in the Provider Call Center for Medicare Part B in North Dakota. I put together some flyers, distributed them and within a few months had signed my first client. From there, I have had 15 years of ups and downs, but have always enjoyed the basics of medical billing and revenue cycle management. I love the fulfillment of posting a payment to a claim that insurance had tried to deny.
What differentiates your business from others in your field?
We strive to provide personalized attention to each client, based on their practice. We look for the needs within each office and tailor our services to fill those needs.
Can you talk a little bit about the landscape and complexity of your billing?
The medical billing field is ever-changing. The codes, rules, regulations … something is always being updated or completely uprooted and replaced. It requires constant attention and education to stay on top of the changes, to ensure bills continue to get paid. In today’s environment where healthcare fraud is rampant, it’s important for us to remain compliant and to help our clients to be practicing ethically and in compliance.
How has revenue cycle management evolved since you got in the business?
It now encompasses so many more facets of the business. It used to be, what do I have to do to submit a claim and get it paid? Now, the process includes reviewing and analyzing the numbers needed to make the client’s practice successful. Also, things like HIPAA, compliance, authorizations and liens tend to play major roles in the big picture of revenue-cycle management.
How do you help your clients better understand the life cycle of a claim?
It depends on how interested the client is in participating in that life cycle vs. trusting us to handle it for them. I educate the client wherever I feel it would be helpful for them, to increase their revenue or decrease the lag time on getting a claims paid.
Where do you find are the biggest misunderstandings or misconceptions about the claims cycle?
Well, as nice as it would be for the claim cycle to just need to be initiated and then complete itself, less and less often does it work that way. From tracking down the correct third-party payer for a given insurance company to knowing which code needs to be billed for a given service to a certain insurance company to ensuring that automated processes are executed correctly, there’s much more involved in getting claims to a completed status.
Because of this, we find small practices, that often depend on their front desk person to handle billing as well, are ill-equipped to bring in the revenue they expect to see when they open their practice.
What advice do you find yourself repeating to clients over and over about how they can improve revenue cycle management?
The importance of submitting accurate, complete claims the first time around. The patient’s name must be spelled correctly, they need the correct DOB, complete insurance ID number, as well as, as I said, knowing where the claim actually needs to be billed. When a clean claim is submitted the first time, it increases revenue, decreases delays and costs less (in time and manpower) to get the claim paid.
What’s your plan to stay competitive with major players like Athenahealth, eClinicalWorks and McKesson?
I don’t really feel they are my competitors, as I work with relatively small clients and on a much smaller scale than them.
How has the Affordable Care Act affected your business?
It has not affected my business as much as I feared it may have, but I still hold those same fears. It is, I believe, affecting fee schedules and payments to providers, which will affect my business down the road. I fear the ACA will continue to drive out competition from the insurance market, which will make it easier for the remaining companies to lower their fee schedules, making it nearly impossible for small practices to accept insurance reimbursement for their services.
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