Learn To Be The Boss!

AuthorHouse

Contents

My Story: How I Got Started...............................................xiii1. The Business Plan......................................................12. Making Your Business Official..........................................33. Getting Clients........................................................84. Contracts And Agreements...............................................115. Job Responsibilities...................................................156. Technologies...........................................................177. Create A Practice......................................................218. Insurances, Cpt, & Icd-9...............................................239. The Cms 1500 Form......................................................2710. Claims Management.....................................................3211. Recording Payments/Patient Statements/Collections.....................33Glossary of Medical Insurance Terminology.................................37

Chapter One

With your new company being small in nature, it will require a simple organizational structure. Implementation of this organizational form calls for a CEO, System Administrator and a Receptionist. Because of these characteristics, there should be few coordination problems seen at your Medical Billing Agency. Make sure to structure your plan, keeping these key things in mind:

1.0 Executive Summary 1.1 Objectives 1.2 Keys Success 2.0 Company Summary 2.1 Company Ownership 2.2 Start-up 2.3 Company Locations and Facilities 3.0 Services 3.1 Service Description 3.2 Competitive Comparison 3.3 Technology 3.4 Future Market Analysis Summary 4.1 Target Market Segment Strategy 4.2 Target Market Segment Strategy 4.3 Target Market Segment Strategy 5.0 Service Business Analysis 6.0 Strategy and Implementation Summary 7.0 Management Summary/Personnel Plan

Here is an example of a Start-up Summary for a Medical Billing Agency

Expenses Monthly Cost President's Salary $3,500.00 System Administrator's Salary $1,900.00 Clerk's Salary $1,260.00 Rent (partial office space/home office) $ 550.00 Telephone $ 250.00 Marketing Expenses $ 500.00 Insurance $ 200.00 Accounting Services $ 158.00 Vehicle Expenses $ 406.00 Supplies $ 352.00 Utilities $ 569.00 EZ Pass and Gas $ 175.00 USPS Posting/Shipping $ 204.00 Security $ 49.00 Taxes & Licenses $ 986.00 Clearinghouse Services $ 135.00 Cable $ 122.00 Computers & Printers $1,137.00 Internet $ 19.00 Payroll Service $ 70.00

Chapter Two

Business Name - First, you need to come up with a business name and logo for your company that will enable potential clients to easily remember you. Register Your Business - You must by all means register your business. When doing business under your own name, registration is not required, but it is desirable. If trading under any name other than your own, registration is required by the law. Go to the County Clerk's office in the county in which the business is to be located and get the registration forms. Just simply tell the clerk that you would like to register your business. The clerk will then ask you the name of your business and hand you the ledger books to go through with names of all businesses located in your county. You, as the business owner must look through the ledger thoroughly to ensure that no one else has a business registered with the same name already. If the name is taken, then you must choose another name under which to register your business. If the name is still available, the clerk will hand you a document about four pages long that you will need to complete and have notarized. You can also complete this process online. Just "Google" the County Clerk's office for the state that you live in. Once everything is completed and all fees are paid, you will then receive your certificate in one to two weeks later confirming that your business is officially registered. Frame it! You earned it! The same procedure is required for persons forming a partnership. However, they must file a certificate with the County Clerk's office in each county where the business will be physically located.

Your State & Federal Tax Information

* State

Anyone establishing a business must first register it for tax purposes. Call Taxpayer Services of the state Division of Taxation and the Division of Revenue office to receive the appropriate forms to file for a New Business Entity.

Once your forms have been filed, you can contact the Internal Revenue Service to obtain your Employer Identification Number. You must also register with the State Dept. of Labor for an Employer Registration Number if you anticipate an annual payroll of $1.000.00 or more. Call for an application.

* Federal

You must apply for a "Federal Employee Identification Number" (EIN) to comply with Federal Income Tax, Social Security, and Unemployment Insurance regulations. Also, the purpose of this number is to identify you as a business entity, as well as all of your other business transactions, such as payroll, annual reports, etc. This process is done by contacting the local IRS office in your area and obtaining a form. Once they receive your completed form, an EIN Number will instantly be assigned to you over the phone or via email, but you must still fax or mail your completed application to the Internal Revenue Service. Then they will mail your business the official confirmation letter stating that your form was received, along with any additional information regarding when and how to use the EIN number that was issued to you (once again, for payrolls, annual reports, etc).

* Incorporation/Corporation ID Number

If you plan to incorporate, you must obtain a charter from the Secretary of State. Call the office to request the appropriate form for incorporating a new business entity. Incorporating is a very wise choice. As opposed to a sole proprietorship, it protects and separates you personally from your business. Meaning, if you file for bankruptcy or have troubles regarding someone suing your business, it affects the business name and not yours. Make sure that when completing this form that it is printed or typed neatly. The form cannot contain any white out and nothing can be crossed out or re-written. It has to be perfect. The process can be done by regular mail, via fax or the internet. If you fax this information, make sure to indicate a phone number, your credit card number and expiration date, as well as your fax number so that they can respond back to you in reference to your form.

Once everything is completed, your state will then stamp "file" on your form and issue your Incorporation number. Be mindful, there are filing fees associated with filing these forms.

* Employer Insurance

If you open a business and hire at least one (1) employee, you must register it with the Division of Unemployment and Disability Insurance. For more information, call the Division of Unemployment and Disability Insurance.

For information regarding Workers' Compensation, call the Division of Workers' Compensation Department.

* Other Licenses and Permits (when renting office space)

New businesses are required to obtain various state and/or municipal licenses, certificates or permits. Contact your local authorities for local business license, permit and inspection requirements.

* Immigration Act

The Immigration and Naturalization Service makes available a "Handbook for Employers", which provides step-by-step instructions on how to complete the "Employer Eligibility Verification" (Form I-9), which is required by law when hiring a new employee. Call to obtain copies of Form I-9, as well as any additional information that might be required.

* Accountants

Having a reliable accountant is also not a bad idea. Your accountant can be very instrumental in helping you with getting your business started. They can help out with the paperwork in the registration and incorporating process, but can also be helpful in assisting you with your business payroll, state, and federal tax returns. You may want to check with your local colleges or universities to see if they have a Small Business Administration office available to request counseling about business planning.

* Business Checking Account

Now you have all of the documents that you need to apply for your business checking account under your new business name. You should keep all of these important documents together at all times because when discussing matters regarding your business, this information will be required.

Chapter Three

Marketing Strategy

Target doctors' offices! Their business is imperative for your success. Our target physicians' offices are very dependent and are looking for reliable, competent, and confident medical billers, with the latest information technology. The doctor's office will need to have an experienced medical billing agency that will be a long-term alliance. You need to show them that your business will be a reliable asset to their office. Unfortunately, many physicians' practices lack the time necessary to adequately train their staff to submit claims to the insurance companies. The medical billing agency is trained to handle those time consuming administrative task for the physician! This will allow the doctor and their staff more time to deal with more pressing issues like providing continuity of care for their patients.

Advertising Strategy

Word of Mouth - The best advertisement tool, of course, is Word of mouth! Many of us have family and friends that work in medical facilities close to physicians. If you don't have access into the medical facilities to distribute professional flyers or business cards, ask your friends and family to do so for you, to introduce your company and spread the word about your billing agency. Local Businesses - You can also become affiliated with the various office supply stores or on-line stores to assist you with getting business cards and professional flyers designed to advertise your business. Networking - You can distribute your business cards and flyers to prospective clients at professional meetings, social networking parties, and any other type of professional group gathering, such as Fraternities', Sororities', Masons, Rotary Club Affiliations, etc. Hey you never know who may know of a physician that's looking for that perfect biller. Remember, you're selling your services at any given opportunity. Computer networking - Internet sites, Web pages, and emails are also other savvy ways of getting your business out there to the medical industry, offering you a wide range of contacts. Local sources - If you have the extra cash, place an advertisement in the Yellow Pages of the newspaper, or in journals, newsletters and on cable television to circulate business within the county.

Potential Clients

Medical billers will find out that there are many physicians in the medical community who will use their services. Listed below are some of the specialty areas you should target.

Allergy and Immunology

Ambulance Services and Ambulatory Surgical Centers Anesthesiologist Audiologist Cardiologist Chiropractors General Family Practice Gastroenterologist Nephrologists Ophthalmology Optometry Physical Medicine and Rehabilitation Podiatrists Psychiatrists and Psychologists Urology Vascular Surgery

Your target potential clients depend on reliable information technology, as does any other business. They care more about reliable service and competence than the rock-bottom lowest price. They rely solely on a medical billing agency with expertise. So you need to convince them to deal with your agency, with a promise of service and support when they need it. Always present yourself as a help, not as a threat to the current office staff. Promise that you will be committed, efficient, and professional while representing their office.

Chapter Four

Develop a contract or agreement in writing when dealing with physicians and facilities. You can go to any office supply store and purchase a "General Agreement Contract." This will clarify job responsibilities and help eliminate misunderstandings. The contract should include a statement of confidentiality. The contract should define all the following services that should be discussed.

1. What your fee will be for processing the claims?

2. When payment will be made to you?

3. Will claims be filed electronically or by paper?

4. Who does the coding?

5. Who is responsible for re-billing?

6. Who will handle follow-up telephone calls or letters?

7. Who will handle collection procedures?

8. Who will pay for photocopying of records, mailing fees, and clearinghouse charges?

9. Under whose name are bills sent to the patients? 10. Will the billing agency's phone number appear on the statement? 11. How often will the billing agency provide pick-ups of their billing? 12. Will internet activity be used in researching claim status? 13. What are the charges for coding consultations or impromptu meetings? 14. Last but not least always put in dates of validity.

If changes occur in the terms of the agreement, write a letter outlining the new terms.

Have your accountant or an attorney proofread your contract for you to make sure everything is in order.

Pricing Your Services and Getting Paid

When pricing your services, a variety of methods are used. If you are asking for a percentage of the reimbursement, you want to stay competitive. Currently, rates range anywhere from 3% to 12%, based on the amount the physician receives once the claims are paid, and not based on the actual amount billed that you will be sending out electronically to the insurance carriers. This is because the majority of providers participate with the carriers you will be billing, and they are paid based on the contracted rate that they agreed to accept for participating with the insurance company.

The doctor can also ask that you bill for your services based on an hourly rate or on a per-claim for fee basis. In my billing agency, we bill on a percentage basis. Deciding on which method you use to bill depends on the client being serviced and the work being done. In my billing agency, we perform all services, from researching the patient's eligibility, to the claim follow-up calls, and then finally filing the claim. At the physician's discretion, we sometimes send a patient to collections, when necessary. Before the end of the month, I then calculate all of the payments I posted in the system for that physician. I'll then print out that Payment Report to send to the physician, along with an invoice for a percentage of the payments.

When you are just starting out with your medical billing agency, on a part-time basis, you will be limited in the services you provide because of time constraints. Listed below is a realistic example of the type of services you might offer:

Filling out claim forms Submitting paper claims

In this case, it is best to charge hourly or on a per claim fee. As your business grows and your services broaden, you can begin to charge on a percentage basis.

Here is the list of my complete Practice Management Services:

Electronic Media/Paper Claims Submission Patient Balanced Billed Statements Accounts Receivable Reports ICD9 & CPT4 Coding

Practice Super Bills/ Encounter Forms

Documentation Reviews

Managed Care Contract Reviews

Practice Reviews

Weekly Day Sheet Reports

Monthly Practice Analysis Report

Monthly Patient Aging Report

Monthly Insurance Aging Report

Quarterly Billing/ Payment Status Report

Quarterly Ledger Reports

Collections

Chapter Five

Your responsibility as the billing agency is to act as a REIMBURSEMENT SPECIALIST with the knowledge necessary to stay abreast of the rules, regulations and requirements of all of the insurance companies that you are billing.

Here is a list of what you will be responsible for to successfully run your Medical Billing Agency.

Submitting, processing, and following up on claims submitted to Third Party Payers. Posting all patient payments received from Third Party Payer's EOB's (explanation of benefits) and handles all insurance company correspondence, replying promptly. Per HIPPA (refer to Chapter 13) guidelines, to keep the confidentiality of the physicians' patient's medical records. Assisting in clearing patients for all types of medical care services by verifying insurance and determining required reimbursement documentation. Preparing the appropriate claim forms per patient and payer.

Collecting the supplemental information and paperwork necessary for submitting a claim. Understanding all National Coding Standards for MD's specific specialties under HIPAA. Understanding of all MD's participating insurances' payer contracts and appropriate methods to submit claims specific to each payer, including calculations and conversion of billing units. Analyzing payment by payers to ensure that the doctor has been paid his contracted fee, promised in the fee schedule for that participating insurance. Submitting claims and following-up on the status of claims submitted, including electronic submission of claims. Follow up on a weekly basis on all identified insurance claims not paid within 21 days of filing. Re-submitting claims, as necessary.

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Excerpted from Learn To Be The Boss!by Hope M. Jones-Packwood Copyright © 2009 by Hope Jones. Excerpted by permission.
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