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Friday, April 1, 2011

In last month’s budget proposal, the Obama administration offered a solution: a plan to encourage evidence-based medicine by limiting the malpractice liability of doctors who follow clinical practice guidelines — in effect, granting them immunity.

Doctors love this proposal, and patients should too: When doctors follow good guidelines they are less likely to order too many or too few tests or to prescribe the wrong treatment.

Unfortunately, the proposal will not achieve the noble goal of providing quality care at a reasonable cost because the current guidelines, written by nonprofit medical groups and for-profit insurance companies, are not good enough.

For more details visit http://nyti.ms/eUMC71

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posted by Stephen Craig @ 12:34 AM permanent link   | Post a Comment | 0 comments




Thursday, March 17, 2011

Whether you are a physician with a one-doctor practice or a multi-doctor practice, the question of outsourcing your medical billing services must have come to your mind more than once. When a decision has been made to outsource, it is imperative to choose the right partner as billing could make or break a practice. In a previous article, I had specified the questions a doctor must ask while choosing the outsourcing partner. In this article, we will look at the answers to these questions and how that influences the decision.

1. Process
Does the billing company have a well-defined process for delivery? What are the artifacts available? How does escalation work? Do they have clear lines of responsibility? What are the SLAs? Are there safeguards for poor performance and termination plans?

Check on how the medical billing company would perform a specific operation and have them walk you through the various steps. Look for process documentation to ensure consistency. Interview the medical billing company on some real-life scenarios when a critical decision has to be taken and identify their escalation process and who the decision maker is. Analyze the SLAs and keep them within reach when a crisis develops. Make sure that SLAs carry a clear penalty clause for poor performance and contract can be terminated without complications.

2. Service Portfolio
What services does the medical billing company offer? Does it include a broad range across multiple functional areas or do they have deep knowledge in a narrow vertical? Can they offer other related services?

Evaluate the physician billing services offered by different vendors and ensure that they demonstrate the knowledge as well as the confidence to take up additional tasks. Interview the actual team and validate the knowledge of the team members.

3. References
Who are their customers? Can you talk to a current customer in your functional area to gain insight on the current delivery processes of the company? Are customers truly happy or satisfied with the billing company? Does the customer size match with your size?

Get a list of existing customers and interview one or two to get honest feedback on their working relation and performance. Check for signs of frustration, despair, happiness and contentment. Verify if the customers would renew their contract with the medical billing company.

4. People
Do you trust the folks running the company? Do you have enough information on the top management people? What kind of pedigree and experience do the people in the billing company have?

It would be great to strike a chord with at least one person at the top management team of the billing company. Verify the top team’s credentials and experience and develop the confidence that they will deliver to your expectations.

5. Intangibles
Do you feel confident about the execution plan? Can you visualize a positive and growing partnership with the billing company? Are you fearful? Are you a micro-manager and would you require hourly and daily reports or weekly and monthly reports?

Ultimately, a well experienced, process-driven company can fail you and an inexperienced startup medical billing company might delight you as the former might be complacent and latter might be hungry and sincere. Based on the 4 points above, you should feel confident that the billing company will execute on the plan and you should be able to visualize a positive working partnership. It is imperative that you specify your expectations clearly to the billing company and let them know how they would be evaluated. Micro-managing an outsourced operation might not be pragmatic and it would be prudent to demand weekly reports along with specific details on any escalations.

Outsourcing medical billing operations is a practical and almost essential exercise for many small and medium doctor offices. The success of such an exercise will depend on both parties vetting each other and doing a thorough evaluation as mentioned above. A financially rewarding and mentally relieving experience awaits those doctors that find the right partner.

For all your medical billing and coding needs, contact Stephen at a1bs.com (stephen@a1bs.com).

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posted by Stephen Craig @ 2:58 AM permanent link   | Post a Comment | 0 comments





The function of submitting claims to insurance companies and receiving the remittances in the medical office’s bank account constitutes the primary role of billing companies. Medical Billing is the second most important aspect of the physician practice, the first being patient care, and billing can make or break a practice. Doctors take the decision to outsource their medical billing to billing companies with a little bit of trepidation and some reluctance.

It is beneficial to a doctor to outsource the billing function as this activity is typically not the core competence of the doctor and the billing activity has become complicated and requires diligent folks to give their undivided attention. The outsourced billing companies have also gained tremendous expertise in the area and work hard to deliver the best results for the practice. In an ideal case, the two form a win-win relationship and help bring the best results for the all important patient (customer) at a low price point.

Selecting the billing company to partner with becomes a critical decision for the doctor practice. It would be good to keep the following points in mind during the selection -
1. Process
2. Service Portfolio
3. References
4. People
5. Intangibles

1. Process
Does the billing company have a well-defined process for delivery? What are the artifacts available? How does escalation work? Do they have clear lines of responsibility? What are the SLAs? Are there safeguards for poor performance and termination plans?

2. Service Portfolio
What services does the billing company offer? Does it include a broad range across multiple functional areas or do they have deep knowledge in a narrow vertical? Can they offer other related services?

3. References
Who are their customers? Can you talk to a current customer in your functional area to gain insight on the current delivery processes of the company? Are customers truly happy or satisfied with the billing company? Does the customer size match with your size?

4. People
Do you trust the folks running the company? Do you have enough information on the top management people? What kind of pedigree and experience do the people in the billing company have?

5. Intangibles
Do you feel confident about the execution plan? Can you visualize a positive and growing partnership with the billing company? Are you fearful? Are you a micro-manager and would you require hourly and daily reports or weekly and monthly reports?

When you answer all of the above questions honestly, you will be able to form a pretty good idea about the overall partner you are looking for. There are many gray areas and writing your questions, concerns and thoughts would present a good opportunity for further discussion and resolution.

What would be the answers to the above questions and how does that influence my decision. That would be in another post.

If you are looking for end-to-end medical billing solution providers, please contact us at stephen@a1bs.com.

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posted by Stephen Craig @ 2:53 AM permanent link   | Post a Comment | 0 comments




 

A-One Biz Solutions is an ISO 9001:2000 certified medical billing solutions provider for physicians and healthcare companies. We provide complete end-to-end solutions ranging from insurance eligibility verification, pre-authorization and payment posting to complex denial management and medical claims processing functions. We have very good track record of collecting submitted claims. The A-One Biz team will work with you seamlessly to achieve your Accounts Receivables (AR) goals.
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