Spotlight: Maggie Funk of Medical Billing Solutions, LLC
In part 1 of this post, we learned how Maggie Funk started Medical Billing Solutions and how her company provides the type of service many large billing companies do not. In this post, she shares how she is preparing for the future and offers advice to clinicians looking to improve their billing.

Maggie, what should practices be doing to improve the speed at which they’re reimbursed by insurance companies?

I think providers should stay up to date on coding by taking continuing education classes. I also think they should get their documentation and billing in as soon as possible. If they are not using an EMR, they should be. I think front-office staff needs to be efficient in collecting correct, up-to-date demographic and insurance information. They should verify the information and collect co-pays and deductibles before the patient sees the provider.

What are the most common complaints you hear from clients regarding claims reimbursement?

They complain about CMS rules and regulations. The constant changes to policy mean they have to frequently upgrade their software to meet the rules, which is expensive. Some providers have told me they would like to quit their practice because of their frustration with this.

What predictions do you have for the future of medical billing? How will the field evolve?

I think that change, while scary, can be a good thing. As a professional in medical billing, I have to stay up to date, or my business will not succeed. My clients count on me to keep them updated as well. This keeps my services in demand.
What are some of the challenges specific to billing for behavioral health claims?

Too often, insurers do not want to provide authorizations for patients seeking treatment, or they don’t cover the service, or they make it difficult for providers to become in-network. They also enforce high deductibles and coinsurance on patients, which keeps them from seeking treatment.

Insurers aren’t consistent about policies and procedures in this area of healthcare. How I bill the same code to UHC is different from how I bill Carefirst, Medicare, Aetna, and Tricare. Medicare doesn’t even allow some types of behavioral healthcare providers to become a participating provider. If those providers see a Medicare patient, the patient has to bill Medicare to be reimbursed, and this is often difficult for someone with a behavioral health care issue to maneuver.

What are the most common billing errors that you notice on a daily basis? What can be done to avoid these errors?

Modifiers: when to use them and when not to. Codes that can and can’t be billed
together. To avoid this, providers need to stay up to date on coding changes and billing. Billers need to break out their ICD-10 and CPT books. They need to read the code descriptions.

How has payer management, contracting, and credentialing evolved since you started your business? What are the major changes you’re observing today?

CAQH is a big help on credentialing applications. Today, a provider does not have to fill out that long form every time they want to participate. Overall, I think the credentialing process is tedious, and the payers don’t do much to help with contract negotiations. You need to be really skilled at negotiation; otherwise, the payer will tell you what the fee schedule is, and you accept it because you don’t know there’s a option to negotiate.

What can providers do to make the credentialing process go faster?

I don’t think the speed of this process is in the hands of the providers. More often than not, the payer is backlogged and draws out the process. Some of the Medicaid and Medicaid managed care plans require months for this process; Maryland Physicians Care is one of the longest.

The provider does need to have all his/her paperwork updated and be on CAQH. There are also companies that provide software that can help you with credentialing, and this makes it faster on the provider end, but it costs money you may not have when starting out. Providers should not go it alone; they need someone with experience to help them fill out the contracts.

What headlines or trends in the world of revenue cycle management are you following today?

Quality improvement reporting for physicians. As billers, we need to follow
this closely as it affects our providers’ bottom line.

If you could rant about anything involving Medicare reimbursement, what would you say?

Medicare is constantly making large policy changes that affect providers in a negative way. Also, Medicare should allow all provider types to participate.

If you could offer one piece of helpful advice to doctors or their practice managers, what would it be?

  • Take continuing education classes
  • Never stop learning
  • Keep your contracts up to date
  • Always look at your reporting and EOBs so you know what’s happening in your practice
  • Hire an experienced medical biller
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Last Updated on February 9, 2021