3. 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.
4. 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
5. 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
10. 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!
11. “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
13. 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…
14. “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?
15. • 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?
16. 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 $$ instead of volume
• Maybe - we can work together to
improve revenues?
17. Financial Score Card
Rad Practice A/R Scorecard W/O Liens Liens Only Dr. Deadbeat
Adjusted Collection Percentage 98% 50% 25%
Days Charges in Accounts Receivable 46 120 175
Total Write-offs as a Percentage of Gross Charges 1.5% 10% 20%
Total Write-offs as a Percentage of Adjusted Charges 24% 50% 75%
Bad Debt Recovery as a Percentage of Collection Agency Write-offs 6% 3% 1.5%
Accounts Receivable Aging Percentage Over 120 Days 22% 50% 65%
Dr. Deadbeat refers 25% of the Liens to Rad Practice
He ONLY refers Liens
18. Let’s talk about -
Orthopedic Quack -“Dr. Slippenfall”
• Sends 50 MRI/month
– PI & WC Liens
– Single source law practice
• 2 years = 2% paid
– $1,200/MR = $1,440,000 in
charges
– $28,800 in collections
– $24/MR
19. “What about his partners?”
Drs. Peepeeo & Sea M S
• Another 50 MRI’s/month
• L-Spine - $445/Medicare
= $1,068,000 over same
2-year period
20. Visit Dr. Slippenfall’s office
• LCD Education
• Are there additional referrals from
non-lien payor sources?
• Is he getting paid on Liens?
• Meet with Attorney to discuss cases:
– Are we writing off too soon?
– Is there a better way to work together?
21. Liens as “Good” Business…
Treat Attorney like a Payor
• Set expectation over annual return
• Bad debt ratio threshold
• Flexibility to negotiate one-offs
• Settlement maze
22. • Lien Fee Schedule: $1200 = $1800
– Attorney’s like high charges
– Settlement nets greater reimbursement
• Communicate minimum $$$ 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
23. 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.
24. 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
25. 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.
26. 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.”
27. " 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 LLC
June 18, 2010
RBMA Practice Management Forum
28.
29. Dr. Older Dan Dirt
keeps ordering
R/O Herniated Disc
Not a valid diagnosis
Billers need signs &
symptoms
31. 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?
32. 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
33. OIG Advisory Opinion 10-04
addresses 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 LLP
May 6 2010 RBMA Practice Management Forum
34. Medicaid, Capitation,
State-funded $40 Mammo programs
and other notoriously low payors
Great Volume - Low Reimbursement
Good for Marketers bonus - scan volume
Bad for billers bonus - collections
