Billing vs. Marketing: The War with Two Winners!

Brigette LaBar Deborah MacFarlane

Disclosure:

Brigette LaBar –Nothing to Disclose

Deborah MacFarlane – President of HealthEdge Consulting, Inc

Learning Objectives:

• Explain how feedback from billing can provide marketing with opportunities.

• Collaboration leads to increased revenue and profitability for the radiology practice.

• Explain how to win the battle of the“hard to collect” revenue: Brokers, Liens, Medicaid.

Anatomy of a Medical Biller -“TAB”• Time Urgency/Impatience• Free-Floating Hostility or

Aggressiveness• Competitive - Strong

Achievement Orientation• Physical Attributes

* Facial Tension (Tight Lips, Clenched Jaw, Etc.) * Tongue Clicking or Teeth Grinding * Dark Circles Under Eyes * Facial Sweating (On Forehead or Upper Lip)

Hypertension, Heart Disease, Job Stress, Social Isolation

Anatomy of a Marketer -“TBB”

Hangovers, Gym-related Injuries, Plastic Surgery Scars

• High energy “schmoozer”• Center of attention• Partier - “good time” working• Short attention span• Last minute response - deadlines• Physical Attributes

* “Laid back” - relaxed physique * Rapid talking, aggressive hand gestures * Wide eyed -”deer in the headlights” gaze * Vain - unable to pass mirrors without pausing

Without Marketing….

Ahhh - but without Billing - There’s no Marketing $$$

“Donut Dollies” went out with

Paper Claims

Marketing:

•Identifying new referral sources

•Building Relationships

•Clinical Education

•Problem Solving

•Payor Contracting

Marketing:

• Resolving Patient Complaints

• Calming referring physician offices tired of getting endless phone calls about auth numbers

• Talking to referring physicians about uninsured patients

. . .and now there’s PECOS!

“Not our Fault. Billers need data to do our job!” Signs and symptoms

- ICD-9 codes Retro-active pre-certifications Medicare limited coverage PECOS = no payment

A more realistic picture

Honey or Stings• Marketing defender of the customer• They have MANY choices:

– Referrals follow the path of less resistance

– Front office staff - decision maker• How much work do they need to do to get

the radiologist paid?• Why can’t billers just be nice?

You’re costing us business…

“Maybe it’s business we need to lose?”• Billing’s writing off bad debts from

the same referrers month after month.

• Any chance some other practice fired them and that’s why they’re referring to us now?

• Billing types love numbers – Why not share?  – Marketers focus on scan volume

• Show us who the deadbeats are:– Contracts / Physician Referrers

  Let turn this problem into an opportunity! What can you give us?

How about some Feedback?

How about a financial scorecard?

• Contractors that aren’t paying– brokers, over-reads, group accounts

• Referring Physicians– Payor mix, net-collection ratio, bad-debt– Evaluate by $$ instead of volume

• Maybe - we can work together to improve revenues?

Financial Score CardRad Practice A/R Scorecard W/O Liens Liens Only Dr. Deadbeat

Adjusted Collection Percentage 98% 50% 25%

Days Charges in Accounts Receivable 46 120 175

Total Write-offs as a Percentage of Gross Charges 1.5% 10% 20%

Total Write-offs as a Percentage of Adjusted Charges 24% 50% 75%

Bad Debt Recovery as a Percentage of Collection Agency Write-offs 6% 3% 1.5%

Accounts Receivable Aging Percentage Over 120 Days 22% 50% 65%

Dr. Deadbeat refers 25% of the Liens to Rad PracticeHe ONLY refers Liens

Let’s talk about -Orthopedic Quack -“Dr. Slippenfall”• Sends 50 MRI/month

– PI & WC Liens – Single source law practice

• 2 years = 2% paid – $1,200/MR = $1,440,000 in

charges– $28,800 in collections – $24/MR

“What about his partners?”Drs. Peepeeo & Sea M S

• Another 50 MRI’s/month• L-Spine - $445/Medicare

= $1,068,000 over same 2-year period

Visit Dr. Slippenfall’s office • LCD Education

• Are there additional referrals from non-lien payor sources?

• Is he getting paid on Liens? • Meet with Attorney to discuss cases:

– Are we writing off too soon?– Is there a better way to work together?

Liens as “Good” Business…Treat Attorney like a Payor

• Set expectation over annual return• Bad debt ratio threshold• Flexibility to negotiate one-offs• Settlement maze

• Lien Fee Schedule: $1200 = $1800– Attorney’s like high charges

– Settlement nets greater reimbursement

• Communicate minimum $$$ needs to Attorney • Billing - general guidelines for settling• Why wouldn’t you wait 2 years for 3x the

reimbursement?– Or sell the paper…– Except for I. Wanadiscount, Esquire

Making Liens Make Sense

You sent Dr Jones’ PA to Collections! • No routine write offs

for any patient group• Professional courtesy

should be eradicated from billing system

• Case-by-Case

Paper trail - Imarn called / issued one-time only adjustment for specific financial status.

What about some customer service training for the billing staff?

• Do they know?– Payors & referring physicians are customers.– Physician office staff steer patients to our

services. – Our future relies on continued referrals and

positive patient experiences.• Include Billing in customer satisfaction surveys

Dr. Fay Nancial Hardship

“Help me with my cash patients &

You’ll get my PPO patients.”

30% off 3x Medicare fee schedule = $935

Not affordable.

Cash Rates

If an Imaging Center is advertising under the 100% allowable fee then it is a violation of the MFC- "Most Favored Nations Clause.” 

" In May 2000, …the OIG pointed out that the exclusionary rule is "not a blanket prohibition on

discounts to private pay customers.”…. " Thus, the OIG explains, "a provider need not

even worry about section 1128(b)(6)(A), unless it is discounting close to half of its

non-Medicare/Medicaid business."

Thomas W. Greeson Reed Smith LLCJune 18, 2010

RBMA Practice Management Forum

Dr. Older Dan Dirtkeeps ordering

R/O Herniated Disc

Not a valid diagnosis

Billers need signs & symptoms

•Cpt codes lists•ICD-9 cheat sheet•Ordering Guidelines•Laminated

Physician Education…

Dr. Precerts Office Complaints about Billing

• Calling 12x a day for patient auth #s– Interrupting their Workflow

• It’s too much work to get Blue Cross auths– “Why do I have to pay someone $30,000 just

to get the radiologist paid?”– “That company LonePhone will do the auths

for us…. we’ll just send through them.”

What can we do?

What can we do?• Meet with Dr. Precert’s office manager

– Fax list of patients missing auths daily– “Assist” them with Blue Cross auths– Offer assistance with other payors

• Establish workflow protocols• Set reasonable expectations

– Benefits of direct working relationship

OIG Advisory Opinion 10-04addresses a proposal by several imaging providers

to offer free insurance pre-authorization services to patients and physicians. 

“The OIG concluded that while Proposed Arrangement could potentially… ‘violate’ the

anti-kickback statute, the OIG would not impose sanctions in connection with the arrangement.”

http://www.oig.hhs.gov/fraud/docs/advisoryopinions/2010/AdvOpn10-04.pdf.

“The call center has to say it is calling on behalf of the imaging center, not the referring physician.”

Thomas W. Greeson Reed Smith LLPMay 6 2010 RBMA Practice Management Forum

Medicaid, Capitation,State-funded $40 Mammo programs

and other notoriously low payors

Great Volume - Low Reimbursement

Good for Marketers bonus - scan volumeBad for billers bonus - collections

Questions, Comments, Discussion?

ASRT Code:

VAD0090034

AAPC Code:

18315VEPWB