Marsha Sosebee

I started an incredible journey last year. One that I never thought I would have to take. In May of 2012 I found a lump at the base of my neck which was eventually found to be thyroid cancer. Thank God I am now cancer free, but having gone through the medical system as a patient I came away with some insight into the lives of patients that billers usually don't see or deal with.

Having been in the medical field for more than 20 years, you know I had scores of colleagues, coworkers, friends, and acquaintances who wanted to give me expert advice. I had people tell me their take on the situation or detail their story to me in detail by agonizing detail. Why is it that when something happens to you, everybody in the world seems to know all there is to know about what you should do or shouldn't do and feel compelled to tell you every "worst-case scenario" they have ever heard about?

So this is what I learned about how to deal with patients from being one myself:

1. Be careful what you say and how you say it.

I wanted people to be honest with me, but I also wanted more positivity that I was getting.

I didn’t want to hear things like, "Oh well if you're going to have cancer, thyroid cancer is the kind you want." So, "Um, no, I don't want any cancer, thank you very much," is what I wanted to say back to these hopefully well-meaning folks.

2. Don't make light of what they are going through.

Another common thing I heard was, "Oh, it’s just thyroid cancer." Anytime you say "it's JUST" this or that, you are belittling the seriousness of the issue being discussed. Yes I understand that thyroid cancer is not as life threatening or treatment intensive as some other cancers, but it is still cancer and still an ordeal with which you much come to terms.

You might be able to handle a certain diagnosis better than someone else. That fact does not lessen the impact of what they are experiencing.

3. Don't assume you know what they are feeling.

If I had a nickel for every time someone told me they knew exactly how I felt, I would be a millionaire. Everyone comes into a situation from a different vantage point and with different baggage. Each of us possesses a unique set of emotional triggers and a particular breaking point. Many things go into what feel during a medical crisis… … the external aspects of our lives at that given time, our personality, our previous experiences with similar episodes, our outlook on life, and our faith or lack thereof. Even if you have had the exact same diagnosis as the patient you are dealing with, you did not come from the exact same background nor have you lived the exact same life as that patient, so you do not know exactly how they feel. And feelings are fickle, how you feel today can be completely different than how you feel tomorrow. One thing I experienced during my sickness was that my emotions were wide ranging. Some days I felt strong and blessed while on other days I felt weak and overlooked.

4. Realize that you are not the only biller calling them.

When you have an extended illness or a condition requiring numerous tests, procedures, surgeries, and visits, the bills quickly add up. All billers know that deductibles and out-of-pocket limits have skyrocketed. A few years ago, the average out-of-pocket limit for most insurance plans was $3,000. This year, the average out-of-pocket limit is $9,000. The majority of patients must make monthly payments and that amounts to $750 per month out of their salary. Combine that with lost time from work and there is a very real danger of the patient's savings being depleted or worse.

As billers, we are in a position to offer tremendous help to patients as they try to navigate through the pitfalls of dealing with their insurance company and their medical condition at the same time. Our insensitivity to them can make or break our office's relationship with that patient and eventually other patients as well. 

Articles

Having gone through the medical system as a patient I came away with some insight into the lives of patients that billers usually don't see.

Improving Patient Relations at Your Medical Practice in 2014 

The end of the month is always a bit stressful for billers between trying to make sure all the charges are entered for the month and all the payments are posted before the close of business on the last day of the month. The end of the year is even more stressful because you have the end-of-December stuff and also the end-of-the year loose ends to tie up.

Here are some practical ways to ensure that your billing department finishes out the year strong.

1. Start the first week in December calling on any appeals that have not been cleared up.

2. Check status on claims that were recently filed. Normally I don't check status for three weeks, but in December, I check claim status at one week to ensure that the claim made it through. If claims are not at least in the system after one week, see if the insurance company will let you fax the claim in, especially for high-dollar claims.

3. Pay extra close attention to benefits. Don't assume that this late in the year everyone has met their deductible. I have several patients whose deductibles started in June. Some plans we've recently encountered require that an office visit copay be paid even if the deductible and out-of-pocket limits are met and don't count the deductible toward the out-of-pocket limit. Not paying attention or not asking the right questions can cause unnecessary amounts left in your A/R at the end of the year.

4. Print a list of your patients with balances due. Consider giving those patients with large balances a percentage discount for payment in full by the end of the year. After all, if you end up turning them over to a collection agency, you will pay a percentage to the collection agency.

5. Gear up for New Year insurance changes. Contact your largest employer groups to see if they will be making insurance carrier changes for the coming year. Contact insurance companies with whom you are contracted to make sure you have the most up-to-date fee schedule. Then make sure that it is loaded into your practice management system. Educate your front desk staff about any changes for the coming year. Remind them that the majority of plans will restart deductibles January 1.

Why the end of the year is stressful for medical billers at physician practices, and what they can do to alleviate some of that stress. 

Five Ways Medical Billers Can End the Year Strong

With so much upheaval going on in the medical billing world right now, it can look like a bad time to be a biller. I know many who have either left the job or are actively making preparations to leave the job. Most are not sad to be doing so. But with all that is wrong, there are still positive aspects to the job. Here are a few of my favorite things.

 The two most important jobs in a medical practice belong to the physician and the biller. Without the physician providing the service and the biller collecting the payment for it, the doors would eventually close. We can hold our heads high knowing that we are helping to provide services to those in need.

2. We help patients navigate the frustrating insurance world. 

All billers know some insurance companies use every tactic possible to get out of paying claims. Patients can be at a loss for how to deal with denials of much-needed services. Plus, the insurance jargon can be confusing to patients who don't work in the field. I take pride in the fact that I am able to help patients with insurance problems.

 This goes hand in hand with number 1. Much of the money we work hard to collect is used to pay salaries. Think of the families you are actually helping when you do your job well.

4. We get to see the fruits of our labor.

 The success of our work is easily defined - either the claim was paid or it wasn't. For me, being able to mark claims off my accounts receivable list is a very rewarding thing. I know how much I have accomplished or where I need to next concentrate my efforts.

5. We have the opportunity to bring about positive change.

 In the billing department, we see how many things affect the receipt of payments. If we see errors that are preventing payment, we can work to have those corrected, thus improving the financial side of the practice. We can work with management to ensure that compliance is met with new rules coming out, which seems to be on an almost daily basis these days.

Every time I am on the phone with an insurance company rep who is treading on the last thread of my patience, I remind myself that I am doing a very important job. I think about the cancer patients for whom I have secured prior authorizations for their surgeries. I think about the people whose questions I've been able to answer, bringing a measure of understanding to them that they were not able to receive elsewhere. I think about the elderly patients who are on fixed incomes and can't afford to pay bills just because nobody helped them fight the insurance company to pay what should have been paid. Sometimes in this job, I feel like the lone ranger, that I'm in this all alone. But, there are many others out there fighting the good fight with me every day.

To all the billers out there who are still plugging away every day, I salute you!

With so much upheaval going on, it can look like a bad time to be a medical biller. Why this isn't always the case. 

Five Things I Love About Being a Medical Biller

Dear Diary, even though it’s Monday, today started out with much promise of being a good day. The end of month collection percentage totals for last month looked great. The percentage of money in the over-120-day-and-aging bucket was down to 0.2 percent and the overall amount due on the accounts receivable report was down by $32,000. I had high hopes that the day would end as well as it began.

My first task of the day was to review the schedule to see which of today’s patients had a past due balance. Finding four such patients, I began to review their history and send necessary alerts to the receptionist. The first two patients had balances from surgeries and were making regular monthly payments as promised. So far so good. The third patient had owed a balance for almost two months and had not yet set up a payment plan, even though he had been back for a recheck appointment just last week. That’s where my hopes for the day began to sag a bit.

The fourth patient had been the victim of a car accident and one of our doctors had been called from the emergency room to do surgery. The hospital had not given us any insurance information on this patient, so I looked to see what information the patient had given at his first recheck appointment in our office. Nothing was written in the section for insurance. Great. As I read through the note history, I found a note from the receptionist that said, "At checkout, asked patient to pay on surgery balance. Patient responded that the accident was the other guy’s fault and that’s who would have to pay the bill." Further notes revealed his adamancy that he was not going to pay this surgery balance. We were at an impasse because our doctor was on main ER call that day and we were required to continue seeing him until treatment was complete. At this point, my hopes for the day were swinging mighty low.

I called the car insurance claims adjustor only to be told that the hospital bills had exhausted the MedPay limits on the patient’s automobile policy and the at-fault driver did not have car insurance. The patient’s attorney had already been in contact with them about a settlement but in all reality, it would probably end up going to court. The adjustor said that if a settlement was reached, it would be paid to the patient who would be responsible for using it to pay the remainder of his medical bills.

I added my note to the history and inserted a pop-up note that I needed to speak with the patient when he arrived. Judging by the previous encounter our staff had with him, I was not looking forward to his arrival at 10:30.

The next order of business on the “to do list” was to check status of pre-certs that had been requested last week. I called ABC insurance company first because three of the precertifications were theirs. I don’t know how so much changes in one week at insurance company, but apparently it can. I dialed the same number I had called the week prior to begin the precert process. After going through the maze of prompts, a person answered who informed me that I had reached the wrong department. I assured her I had chosen all prompts carefully. She asked for the number I had dialed originally. I told her 800-000-0000. She said that was the problem; that number was not for precerts at all. She agreed to transfer me to the correct department. The person in that department would have loved to help me, but they don’t handle precerts for that employer group. Again, I was transferred to the correct department. Four transfers later, I finally connected with a representative who said that if I had just dialed 800-000-0000 I would have reached her directly and avoided all of this unnecessary frustration. I’m glad she couldn’t see my expression through the phone.

Confident that I had at last reached the right person, I gave her the patients' information for whom I had requested precertifications. Two were in process she said, but the third request was not on file.

"Why not?" I demanded to know. I had sent all three sets of clinical information and photographs in the same envelope. If two were there, what happened to the third one, I wanted to know. The rep suggested that maybe I had forgotten to include the third one. I knew I had put all three in there. After 20 minutes of back and forth and being put on hold so she could check with other departments, she finally came back to the line to let me know it was found in the mail room. She informed me that I would have to send the photographs again because she was not able to locate them.

At this point, I gave up all hope for the day ending on a good note and I was pretty sure this was a good indication of how my week was going to be. It was also at this point that I wondered if other billers really faced the same frustrations as me. I also contemplated whether or not billers should automatically have a prescription of Prozac. Like some people have a jar of peppermints on their desk, maybe billers need a little jar of happy pills.

Little things can add up, as this glimpse into a day in the life of a medical biller reveals. 