We recently asked Bob a few questions about Documed and about some of the challenges facing practices today when it comes to managing billing. Here’s what he had to say:
What services do you offer through Documed?
Services include collecting patient, insurance, and charge data in order to bill third-party payers efficiently and effectively.
After insurance payment, any remaining patient co-pays or deductibles are billed to patients with toll-free phone support for any billing questions. Regular reports are provided to clients showing billing activity, payments and other useful data needed for practice management. We are always available to consult with clients as they decide how best to adjust to ever changing practice environments.
What sets you apart from your competitors?
Our experience includes eight years at UCLA Medical Center, from patient account management to administrative analyst positions. This institutional experience was followed by management of a free-standing surgical practice and account management for a large medical billing company. Only then, was Documed founded with the necessary expertise to handle all aspects of practice management with a focus on reimbursement. Our support staff is comprised of experienced billers and we outsource some tasks to other established billing services. Our roster of long-standing clients validate that our experience is what sets us apart.
What are the biggest challenges your long-term clients are facing right now?
A national trend has hospital and medical corporations buying up small independent practices and as a result, creating pressure on the solo and small practice. Providers are facing the choice of continuing to evolve their current practice and patient relationships or join a large group where everything from length of patient encounters to billing practices are dictated by the group.
What about some of the biggest challenges you’ve faced as a medical billing services company?
We are fortunate to work with many talented and forward-thinking programmers and medical management experts. The Healthcare Technology Alliance includes practice management leaders from around the country. Ideas and solutions are freely shared to everyone’s benefit in adapting to new government and private insurance requirements. Our practice management program developer, MedTrak Data Systems of Houston, Texas, has been ready for every new change, from new insurance forms, to ICD-10 diagnosis codes, to electronic data interchange. The ongoing challenges are having our system ready for inevitable change, and so far, we have met those challenges.
How has medical billing evolved since you started Documed?
The fundamental task of submitting claims for reimbursement from insurers has not changed. Today’s tools are vastly different and more efficient.
Our first claims were printed on dot matrix printers and processed on XPs and other early computers. Before that, they were individually typed. Claims were stuffed into envelopes and mailed at the post office.
Today, most billing data is received electronically from clients and submitted to payers electronically via clearinghouses. EFT payments are deposited directly into client’s accounts and payment details are downloaded and posted to patient accounts. Claim errors are typically corrected online and re-submitted through the clearinghouse. New regulations are researched online with the ability to study multiple approaches for meeting the changes all practices face.
What has been the impact of the Affordable Care Act on your business?
Medical billing has always been a blend of government and private payers. The ACA has increased the number of insured while forcing some providers to consider the impact of reduced reimbursement.
Medicare is pushing toward quality and outcome-based reimbursement and moving away from fee-for-service. In some cases, in addition to services provided, claims include additional codes describing current and expected outcomes. ACAs, Accountable Care groups, have had mixed impacts and success rates. This is partly due to that fact that many individual provider electronic health records (EHRs) do not currently share patient health data among the patient’s team of providers.
What about the impact of patient pay?
Patients are more aware of their co-pays and deductibles than ever. Eligibility and benefits are routinely checked prior to services being rendered, so there are fewer surprises after claims are processed. Today, both patient and providers have access to the same claims processing data on private insurance and government websites. It is, of course, important to collect the patient portion for care provided as it is part of the “allowed” amounts determined by payers. Some practices simply bill patients a reduced rate to avoid having to deal with insurance at all. Others offer an annual surcharge in exchange for greater access to providers who promise to extend visit times and reduce overall patient load.
What plans are you making to keep your business competitive? How will you evolve Documed to keep up with the evolution of medical billing today?
We have learned the value of having access to electronic health records used in our clients’ offices. We get current insurance and demographic information as well as authorizations and reports used for billing. Many EHRs include a billing module. In some cases the EHR is free to the practice if the EHR company does the billing, keeping a percentage of revenue. The competitive edge we offer is our proven billing expertise and track record with long-standing clients in addition to focused responsiveness to their needs. We stay competitive because we use EHRs as tools rather than threats to our business.
What advice do you find yourself repeating to your clients about improving billing, reimbursement and their revenue management cycle as a whole?
Rather than fixing simple errors in billing data we receive from our clients, we return some encounter forms to them, asking for the missing items. In this way, they eventually learn what is needed for billing. We also encourage collections of co-pays at the time of service, since this information is easily found when verifying coverage online.
What healthcare trends, innovations or headlines are you following closely today?
We review Kaiser Health News online daily. It collects articles from a variety of sources on current medical and reimbursement topics. Government websites, such as CMS, offer detailed regulatory information on existing and future trends. Our program developers, MedTrak Data Systems, updates our system with ever improving tools for efficient billing.
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Last Updated on September 13, 2016