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Spot Light: Pat Byrnes of Business Medical Management Solutions, Inc.

Pat Byrnes is an entrepreneur running her company since 1994 specializing in medical consulting, medical billing and accounting.
We recently reached out to Pat to get her insight on medical billing. Here’s what she had to share:
Tell us your story. How did you get into medical billing? What’s your professional background?
I originally started out as a nurse working in hospitals and medical practices. I saw the need for consulting services and medical billing expertise while working in these medical practices so I changed direction and went into the business side of the medical industry. With my knowledge of the clinical side of the healthcare industry I was able to transition to the business side with my background in business administration, accounting and medical billing.
What do you feel differentiates your service and sets you apart?
My company offers a unique perspective to revenue cycle management. We do a full assessment of a client’s needs, audit their processes and procedures, make recommendations and propose new and efficient revenue cycle management techniques. With our complete RCM techniques devised by myself and my business partner we are able to capture lost revenue and increase the clients revenue per month by at least 30 percent. This lets the physician take care of his patients and leave the business end of his medical practice to us. The physician does not have to worry about his financials every month with our proven track record methodology.
Can you talk a little bit about the landscape and complexity of your billing?
The complexity of billing has increased over the last few years with all changes to the healthcare industry based on CMS changes, HIPPA, ICD 10 and PQRS, Meaningful Use, MACROS and MIPS. These are challenging times for any medical practice and billing company. We all have to become resourceful to make sure the medical practice is compensated for the care they give. We handle many different types of medical practices that require specialized knowledge of billing procedures, coding, and correct modifiers to use. Each Specialty has their own special set of circumstances that all billers need to be aware of. Each biller must be well versed in their field to maximize reimbursement for the provider they are billing for.
Can you tell us about what areas of medical billing/RCM you specialize in? What niche have you claimed as your own?
The areas of RCM my company specializes in is Family Practice, Urgent Care, Sports Medicine, Acupuncture, Chiropractic, Podiatry, Ortho and physical therapy.
We excel at urgent care billing as this is a diverse practice with multitudes of billing options from surgery to a simple cold. All billing for urgent cares can be complex and you have to be up to date on all coding in these days of every changing medicine.
Describe the nuances surrounding your specialty that you find the most challenging.
The most challenging issues I find with billing for practices is the difference in each insurance carrier and what their requirements are for processing of claims to get maximum reimbursement. Each claim has to go out clean without rejections and this is quite a challenge when you are billing for many practices due to their internal dynamics.
What do you like the most about your speciality?
I like the challenge and diversity of billing for urgent care practices since there are so many ailments that are treated in an urgent care setting. It takes a biller who is up on her skills and coding to make a practice successful as well as the satisfaction of a great job done.
In your experience, what should practices be doing to improve the speed at which they’re reimbursed by insurance companies?
Medical practices should make sure that all their documentation is completely accurate and that all providers finish their notes in an expeditious manner so charge entry can be completed and sent out to the clearing house within 48 hours for best turn around time for reimbursement. This also keeps revenue for the medical practice coming in on a steady basis.
What are the most common complaints you’re hearing from clients right now about claims reimbursement?
The most common complaint I am hearing from clients is the decrease in revenue received from the insurance carriers and that more and more patients are responsible for fees owed to the medical practice due to complete changes in how insurance plans are structured for the general public
What are some of the challenges facing practices getting reimbursed as claims get older?
Insurance companies are tightening up their internal regulations and therefore checking claims even more closely than before. It is vital for claims to go out clean the first time so has not to have rejections and denials that have to be worked on the back-end which causes a delay in payments to the medical practice.
What best practices should practices be following in order to improve the rate of reimbursement for older claims?
My recommendation for medical practices is to have procedures in place to work the AR on a daily basis to get possible lost revenue processed and paid to the medical practice. Reports are key to knowing the financial health of a medical practice as well as possible lost revenue.
What’s your plan to stay competitive with major players like Athenahealth, eClinicalWorks and McKesson?
As the saying goes you can’t fight them you join them. Most of my clients are on these platforms so my company uses these platforms as well as others for our clients. Since most PM software is now cloud based it is better to know all the available PM platforms and be able to perform in everyone competently.
How has the Affordable Care Act affected your business? What about patient pay. What has been the impact on your work?
The Affordable Care Act has affected my business as well as all others and most of all medical practices, hospitals and all other medical facilities. With insurance companies having patients be responsible for the amount owed to providers of medical services it is more difficult collecting from patients.
Patients also do not understand their medical benefits and we spend a great deal of time teaching patients what their responsibility to the providers of their medical service is. The impact on our work is tremendous. We spend a great deal of time tracking down patients to get the revenue for the medical providers that is due them as well as working with the insurance e carriers to get the amount due the provider as well.
What headlines or trends in the world of revenue cycle management are you following today? Why do they interest you?
I follow all news regarding RCM and how it affects us as a business and medical practices. I subscribe to multiple newsletters, blogs and continually research CMS and the professional organizations I belong to for information regarding getting the most for our clients. With all the changes that have occurred and are occurring you have to stay one step ahead to make sure revenue stays consistent for all providers of medicine.
What predictions do you have for the future of revenue cycle management? How will the field evolve?
I feel that RCM will come full circle once again. I think that all the changes in medicine and regulations in place presently and to come in the future from CMS and insurance carriers will define our industry for years to come. All in our field will have to adapt to these changes and in turn run their businesses in the most ethical and profitable way within the guidelines set forth by all regulations that will be in place.
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