Mike Cuesta, director of marketing at CareCloud, a Web-based medical practice management software firm in Miami, offered some tips for medical practices when it comes to creating and maintaining websites.

However, just because a medical biller is performing these steps, it does not mean she/he is fully doing the job of a medical biller. As time goes on, most medical practices realize that there is more involved than just billing patients and collecting money. Some physicians and staff realize there are better ways to perform medical billing, but just don’t know where to start. These “better ways”, or best practices, can make turnaround time for collecting money more efficient, coding more effective and insurance claim approvals increase. But for others, figuring out the “how-to” to improve these items can be confusing and frustrating.

Who should be informing me of the best practices in medical billing?
Physicians are very busy people. Not only are they seeing patients, writing up charts, and keeping up to date on the latest medical innovations, they also have to run a small business if they are in private practice. Good physicians are always trying to stay on top of the latest medical research and technology to better take care of their patients; they must also use this approach to take better care of their business.
One way to solve the best practices issue is to outsource medical billing to a specialized company. But not all companies are equal in providing medical billing services. Sometimes, companies that are providing medical billing are only going through the steps listed above, routinely, day after day without any kind of feedback to the medical office they are serving.

How then, can a physician’s office stay on top of changing billing information while also learning of best practices to improve the medical billing process? The answer is having an outsourced medical billing company consistently review their medical billing practices and then discussing this review with physicians.

The Ninth and Tenth Steps… and why they are important
Most people could agree than in any profession, reviewing processes and procedures in place to determine if any changes could be made for improvement is a good idea. If a new process saves money, improves efficiency, and increases productivity, these are all beneficial to a practice. The same can be said for medical billing as it deals with the primary cash flow in a medical office. By reviewing processes and procedures in medical billing, improvements for coding and billing insurance companies will reduce the number of bills not paid over 120 days. And which medical practice would ever admit that they like it when bills routinely run over 120 days? None that we have found!

Ultimately, consistently reviewing and implementing process improvements in all the tasks listed above is an essential ninth step for medical billers. How would they do this? First, having procedures in place that they consistently perform. Second, creating a plan to review these procedures, how they are implemented, and when. Third, strategies or ways to make the changes needed, then communicating them to the physician and/or practice manager.

Discussing and reviewing these changes with the physicians is an essential tenth step for qualified outsourced medical billing companies. This type of feedback to physicians will explain what has changed in the industry and recommendations for improvement. These improvements, as noted, usually lead to increased cash flow, reduced billing times, and improved claim acceptance to insurance providers. Discussing this information with physicians and practice managers leads them to make better business decisions and helps them plan for the future of their practice. It also has an additional benefit of strengthening relationships between the outsourced company and internal staff, building trust and goodwill.

How do I know if my medical billing partner is performing this task?
Now that you know how important the ninth and tenth steps are, how do you determine if your outsourced medical biller is providing you with this feedback?

Here are some questions to ask:
Is my medical biller looking for ways to increase productivity and profitability?
Are they looking at performance standards of staff, both in the office and the outsourced staff?
How often will my outsourced company provide me with helpful recommendations that will improve my processes?
Will they help train my staff if any problems arise after feedback is given?

A good outsourced medical billing service will provide feedback in all of these areas. They will routinely review procedures of medical billing to improve billing, payment, and records keeping. They will also have extra materials for training, staff on hand to answer any questions for office staff, and will perform a best practices comparison.

But they will also do more than that. Knowing the unique needs of each physician’s specialty is important. Providing unique, specialized feedback based on a physician’s specialty is crucial. Coding issues or insurance changes to specific specialties need to be incorporated into procedures and done in a way that increases productivity, not bogging it down. This is the eleventh step of an outsourced medical billing company: recognizing unique billing requirements of various specialties, and providing solutions for these requirements.
Clinic Service performs all of these tasks, offering free, ongoing consulting to continuously improve, performing a best practices comparison, and providing quarterly reports to physicians and staff. We have a team of full-time pro¬grammers who work constantly to upgrade and audit our system in order to address the ongoing insurance carriers’ changes and to provide solutions for the unique billing requirements of various specialties. We address unique billing challenges, specialty by specialty.

When choosing a new medical billing outsourced company, see if they offer steps 9, 10, and 11. If they don’t, keep looking.
Medical Billing Process Explained
The billing process of medical billing is simply stated as the process of communication between the medical provider and the insurance company. This is known as the billing cycle. The medical billing cycle can take in upwards of days to months to complete, and at times take several communications before resolution is reached.

The medical billing process begins with the medical care provider patient visit. The patient’s medical record is then updated summarizing the diagnosis, treatment and any pertinent information. This information is then recorded electronically for future account updates.
From the patient record an evaluation of care is determined and a five-digit procedure code is assigned from the procedural terminology database. The verbal diagnosis is also dictated in the record as an additional numerical code. These codes are used in claims during the medical billing process.

The next step in the medical billing process is to transmit these codes to the proper insurance company(s). In most cases this is done electronically using an ANSI 837 file, and is transmitted directly to the company. This claim is then processed.
Medical claims adjusters or examiners usually process claims, but when higher dollars are involved sometimes a medical director will evaluate the validity of the claim. Once the claim is approved the medical provider is reimbursed based on a pre-negotiated percentage. Any rejected claims are sent back in the form of Explanation of Benefits or Electronic Remittance Advice.
If the provider receives a rejection during the medical billing process they must review the message, reconcile, make corrections and resubmit the claim. This exchange might be repeated several times before full reimbursement is made. Trying as the rejection process may be, the provider has to show patience during this time.

The number of rejections, denials etc. has been known to reach as high as 50%. This is mainly because of the complexity of the medical billing and coding system. Another reason for this is insurance companies denial of services not covered under the policy. Proof comes into play here and one can usually see success in overturning the original decision of denial.

Movie surgeons (most recently, the sports doc played by Bill Hader in this summer’s hit comedy “Trainwreck”) have long endearingly or flamboyantly operated to tunes, a case of art imitating life. Now, doctors at the University of Texas Medical Branch in Galveston report musical accompaniment may result in speedier surgery and neater stitches. The researchers asked 15 residents in plastic surgery to stitch up pigs’ feet, with and without music. (Pig feet are easy to get and pig skin is similar to human skin, the authors said.)

The results, published in the Aesthetic Surgery Journal, found that those who listened to their favorite music finished the task 8% faster. Judges reviewed the work without knowing which operations had been performed to music and ranked their quality on a 1 to 5 scale.

Senior residents were faster, with a 10% drop in surgical time. Authors Shelby Lies and Andrew Zhang said that could mean substantial savings: “A 10% reduction in operative time per hour equals savings of $396 per hour.”

Surgeons who listened to music did slightly better when graded on multiple measures, including suture-knot visibility or unraveling, and uniform appearance.

Residents were randomly assigned to hear music or operate in silence. Researchers than asked residents to do the task again, but flipped the musical assignment. Notably, residents were allowed to pick a preferred type of music on Pandora.

Taste varied, the authors said. “Genres of music preferred by the study participants included rock, hip-hop, pop, Latin and classical, with a diverse distribution.”

The company Research Now conducted a survey that looked at how mobile health applications and the mobile health industry is affecting patient care and physician workflow. Research Now polled a total of 1,000 mHealth app users and 500 medical professionals. The results show that 86 percent of healthcare professionals believe mobile health apps increase their knowledge on a patient’s medical condition.

Additionally, nearly half of surveyed providers – 46 percent – felt that mHealth apps actually strengthen their relationship with their patients. Three out of four polled medical care professionals – 76 percent – have suggested that mobile health tools assist patients with managing chronic medical conditions.

Additionally, three out of five surveyed physicians and medical staff help patients who are at high risk of developing serious health problems. As previously stated, fitness trackers can help patients exercise more regularly and lose weight, which would reduce their risk of heart disease.

Additionally, more than half of those surveyed believe that mHealth applications can help consumers who are healthy remain at an optimal level of health. Also, nearly half – 48 percent – of survey takers think that the technologies within the mobile health industry may be able to help patients who were recently discharged from a hospital make a better transition to home-based care.

Most importantly, nearly all survey takers – 96 percent – believe that mobile health apps “improve their quality of life.” In addition, the survey illustrates that users of mHealth tools already improve their wellness and lifestyle through these technologies. For example, 60 percent use the tools to monitor their workouts while nearly half – 49 percent – use apps to record their calorie intake.

However, the Research Now survey also uncovered that healthcare professionals have not shown strong adoption of mHealth apps with only 16 percent currently using these tools. Nonetheless, nearly half of medical professionals surveyed indicate they are planning on utilizing mobile health applications within the next five years.

The mobile health industry is truly making an impact on improving the lives of everyday citizens. Technologies like health apps, wearable devices, and remote monitoring tools are revolutionizing the healthcare industry on a constant basis.

“New developments in machine intelligence will make us far far smarter as a result, for everyone on the planet,” Eric Schmidt, Executive Chairman of Google, said in a public statement. “It’s because our smart phones are basically supercomputers.”

“Around 400 million people in the last year got a smartphone,” Schmidt continued. “If you think that’s a big deal, imagine the impact on that person in the developing world.”

Satya Nadella, Chief Executive Officer of the Microsoft Corporation, also stated, “I’m most grounded on the role of technology. Ultimately to me it’s about the human capital and the human potential and technology empowers humans to do great things. You have to be optimistic about what technology can do in the hands of humans.”

Kiera Berger has a major in genetics and cell biology, a solid GPA and a score on the Medical College Admission Test that’s about average for science undergraduates.

She applied to 10 medical schools, and every one turned her down.

The University of Minnesota student had discovered a cold reality that’s striking many hopeful seniors this commencement season: The number of medical school applicants is increasing much faster than the number of openings, and being average isn’t good enough anymore.

Last year, more than 43,000 students applied to the nation’s medical schools. Only 42 percent of them got in — the lowest acceptance rate in more than a decade. The number of graduates — 18,200 last year — has risen over the last 10 years, but only modestly.

That bottleneck worries many health care analysts, who foresee a shortage of doctors over the next decade as the population ages and the Affordable Care Act increases the number of Americans with health insurance. By one estimate, the nation will be short 90,000 physicians in the next decade. In Minnesota, the estimate is 2,000.

But many programs, including the University of Minnesota Medical School, are at capacity. The class size on the U’s Twin Cities campus expanded from 165 to 170 after the Association of American Medical Colleges (AAMC) called for an increase in admissions a few years ago. But vice dean for education Dr. Mark Rosenberg said it can’t grow any more without adding residencies, the training programs where students get practical experience.

Josh Bush is a U junior who hopes to apply to medical school.

Josh Bush is a U junior who hopes to apply to medical school.
In order to practice medicine in the United States, students must complete a residency after they finish medical school. Medicare is the largest source of funding for residencies, but a cap on federal funding has created a residency squeeze at hundreds of hospitals.

“Even if we train more, unless we increase the number of residency positions, it’s not going to do us any good,” Rosenberg said.

To avert a doctor shortage, the AAMC in 2006 called on schools to increase admissions 30 percent by 2015. Officials say the schools are on track to reach that goal by 2017, but meanwhile, the applicant pool continues to improve and competition has become fierce.

The deadline for students to accept admission offers is May 15. Afterward, schools can send acceptance letters to wait-listed students if they have spots to fill. Come June 3, the rolling admissions process begins, and rejected students can try again amid an even more competitive pool.

Looking at plan B

From the moment she started college, Amelia Black did everything right.

In her four years at the U, the microbiology senior attained Latin honors, researched in a malaria lab, volunteered at a children’s hospital, studied abroad in Australia and shadowed physicians on a trip to Guatemala. When she applied to 17 med schools, she got into four and was wait-listed for two.

Students like Black are the “professional athletes of science,” according to Tricia Todd, assistant director for the Health Careers Center at the U.

“These students have to be on their game from the day they set foot on this campus if they’re going to be successful getting into med school,” she said.

But four years increasingly isn’t enough time to accomplish everything top applicants need to do, said associate dean of admissions Dimple Patel at the U’s Medical School.

More students are taking a “gap year” after college to broaden their experience; the average applicant age is going up, reaching 24 in 2012.

Now Patel encourages students who don’t get into med school to take a year off for additional preparation and to decide if becoming a doctor is their best choice. She urges them to think of a plan B.

For Phillip Thomas, a gap year paid off. After getting a pile of rejection letters in his first cycle, he took the time to work in a lab, volunteer at a children’s hospital and relentlessly study for the MCAT. He did so well on the test the second time that Kaplan Test Prep hired him to teach classes.

Thomas is now a third-year medical student at the U who got a spot on the admissions committee so he can review applications and help other students like him. Applicants, he said, need to convince a med school that medicine is the right career for them.

“I wanted to make sure that my application reflects my desire to be here and my goal that I want to be a physician,” he said. “This is what I want to do with the rest of my life.”

Finding a different dream

When Todd recognizes a student who may not have what it takes or be the right fit, she sits down with them to have a “courageous conversation.”

“Medicine isn’t the right place for you,” she said she tells students, “or if you’re going to go into medicine you’re going to have to change your portfolio and it’s going to have to look a lot stronger than it does now.”

She finds that many students are on the right track; for others, she tries to help them find another career in the field — public health at a state agency, for example, or physician assistant.

For Kiera Berger, becoming a doctor used to be her only dream. Everything else, she said, felt like settling for less.

To explore other career options and build research experience, she got an entry-level position at a genetic testing company in Wisconsin. She’ll work there for at least two years before applying to medical school again.

“It’s still probably at the top of my list,” she said, “but it used to be the only thing on my list.”

Rebecca Harrington is a University of Minnesota student reporter on assignment for the Star Tribune.

Micah Solomon
CONTRIBUTOR
I write on customer service, customer experience and corporate culture
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Opinions expressed by Forbes Contributors are their own.
Improving patient satisfaction, customer service and the customer experience, and, of course, HCAHPS scores: Here are seven bullet points I find myself emphasizing frequently (as a consultant and professional keynote speaker) in hospital and other healthcare environments.

1. Strive to deliver service on the schedule of your patient, not just a schedule that happens to be convenient for your institution.

Examples:

• Avoid unnecessarily long waits for lab results to be distributed; this practice is disrespectful and even cruel.

• Consider implementing something along the lines of the Vocera Communications Badge where the patient speaks the name of the nurse and is directly in communication with her instead of waiting on a response to a call light.

As promised, the Centers for Medicare & Medicaid Services (CMS) today formally proposed to shorten the reporting periodfor its meaningful use incentive program for electronic health record (EHR) systems in 2015 from 12 months to 90 days.

The shorter time frame applies to physicians who are new to the program in 2015 as well as those who’ve participated before. In 2016, only first-time participants will be eligible for a 90-day reporting period.

The shorter time frame, sought by organized medicine, will make it easier for physicians to satisfy the requirements of the incentive program and avoid a penalty. Physicians also will be able to schedule their 90-day reporting period for the latter half of 2015, giving them more time to install an EHR system and train on it.

The program is designed to encourage physicians to use EHRs in specific ways — such as prescribing electronically and compiling medication lists — that improve patient care and lower costs. However, medical societies have complained that the requirements are overly burdensome and not always relevant.

Today’s CMS proposal relaxes the meaningful use program in other ways besides shortening the reporting period. The government said in a news release that it would reduce the number of reporting requirements by winnowing out those that “have become duplicative, redundant, and reached wide-spread adoption.”

And some requirements that make the cut will become less onerous. Right now, 5% of patients in a physician’s practice must access their records electronically under a requirement in the program’s Stage 2 phase. Criticized for making compliance dependent on something a physician can’t control, CMS is proposing to lower this threshold to 1%.

More information on today’s announcement is available on the CMS website.

A well-organized workflow will save you time, money and aggravation.

Jill Young, CPC, CEDC, CIMC

Fam Pract Manag. 2010 Nov-Dec;17(6):28-32.

Inefficiencies in a medical practice do not merely waste time and effort; they can also contribute to errors, reduce productivity, hurt the bottom line, and frustrate patients, staff and physicians. It’s no wonder, then, that efficiency was named one of the “aims for improvement” in the Institute of Medicine’s landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century.

Despite the potential for serious consequences, many practices fail to address the bottlenecks, redundancies, delays and waste in their workflows. Perhaps they can’t see past “the way we’ve always done it,” or perhaps the complexities of modern medical practice make inefficiency seem inevitable. Or perhaps they just don’t know where to begin.

This article identifies common inefficiencies in the patient care process – starting with the front office and ending with the physician – and practical ways to address them.

The front office

The first area to evaluate is the front office. This is a hub of activity: phone lines ringing, faxes coming in and going out, patients checking in, patients scheduling tests or appointments, patients checking out, new patients turning in paperwork, and so on.

The phone system. Your phone system is often your patients’ entry point into your practice. Being inefficient in this area can lead to patient irritation and distress, which in turn can lead to a loss of productivity as staff members try to deal with the repercussions.

Your incoming telephone lines are the first area to scrutinize for inefficiencies. Start with these questions:

• How many incoming phone lines does your office have? (This number should exclude any back-office lines that staff other than your front desk staff are responsible for answering.)
• How many staff members are responsible for answering those phone lines?
• Now do the math: How many phone lines is each person potentially responsible to answer at any given time?

If your answer to the last question is more than two phone lines per person, you have a potential problem. Five or more phone lines per person is a serious problem. At worst, no staff member should have more than one person on hold at any given time. Any more than that, and you will lose callers and, eventually, patients.

Although multiple phone lines are desirable in order to keep patients from getting a busy signal, be sure that they are properly staffed. Think of the last time you called a business and were placed on hold. Did you grow increasingly irritated by the minute? Imagine doing that when you are sick.

Automated phone triage systems can help, but remember how it feels to navigate a confusing voice mail menu. Keep menu choices short and limit the number of choices. Always give callers an option that will put them in touch with a real person, and don’t make it unreasonably difficult for them to access it. Periodically call your office yourself to see what your phone system sounds like to patients. Also, be sure staff members change their voice mail greeting when they are out of the office for an extended absence, and have a system for changing greetings or checking messages when someone is out sick. I once left a voice mail message for a medical staff member after being directed to her mailbox through a practice’s automated triage system. I waited two days for a response and then called back and spoke to the office manager, who told me that the staff member was on vacation for two weeks. Imagine what would have happened if I had been seriously ill while waiting for a call back.

The bottom line is that your phone system can cause inefficiencies, inaccuracies, long wait times and a lack of personal service, so be on the lookout for these problems – and ask your patients for feedback. One tool for doing this is the FPM Phone System Survey.

Messages. One of the most critical activities at the front desk is passing along complete and accurate messages. An incomplete message or one with misinformation is not only aggravating but can be disastrous. If your practice uses paper message slips, try using customized, color-coded slips, with the different colors representing different types of callers. Color coding allows staff members to identify at a glance the types of messages waiting for them (e.g., blue signifies a sick patient who warrants immediate attention and yellow signifies a pharmacy calling about a refill request, which may not be as urgent). By customizing the message slips, you can specify what information needs to be collected from the caller. For example, the information you need from a sick patient seeking care is different than the information you need from a patient seeking a refill. If you involve front-office staff, nurses and physicians in creating these instructions, not only will you have an expert form for your particular situation, but you will have buy-in from your staff because they created it. In addition, in the designing of the form, each will understand the others’ needs and perhaps help avoid the problem of areas being left blank.

Examine how often these messages are delivered to staff. Do you have a Janie Jump Up? This would be the staff member who leaves her desk every time she has a message of any kind to deliver, leaving the phones short-staffed or unattended. Or do you have a Let It Wait Linda? She delivers messages at the end of the day – all of them, all at once. Staff who thought they were done suddenly are staring at work they had not budgeted for, possibly resulting in overtime expenses for the office. Find a happy medium for the timely delivery of messages, taking into account efficiency for both the taker and the receiver of the message.

Computerization can also make message sharing more efficient, but you must carefully think through the process and responsibilities. For example, when one staff member takes a message and sends it electronically to another staff member, who is responsible for follow through? In many cases (e.g., a message about a refill request), the recipient is the person responsible for following through, but in other cases, the person who originated the message may be responsible for closing the loop with the caller. The text of the message should make these responsibilities clear. Also, if an employee is absent, how will you access his or her messages to ensure that patients receive the services and information they need without delay? Does a supervisor need the ability to monitor the messaging system to deter employees from using it to have personal “conversations” while appearing to work? If you don’t address these issues, efficiency can suffer in new ways.

Paperwork. Another source of inefficiency at the front desk is processing new patients. Sending out information packets to new patients may seem costly (unless you have the patient’s permission to e-mail the forms), but it is money well spent. If your information packet includes directions to your office, it will cut down on new patients arriving late or not arriving at all because they got lost trying to find your office or didn’t know where to park. Sending new patient registration forms in advance of the visit can reduce delays in the office caused by patients taking too long to complete the forms. Instead, patients can complete the forms in the comfort of their own homes. And whether you have an electronic health record (EHR) system or not, sending out detailed history forms to patients gives your staff a jump on chart documentation. When a staff member calls to confirm the appointment, he or she can remind the patient to bring all forms back into the office.

Appointment confirmation. Calling patients to confirm their appointments is a proven strategy for reducing no-shows and their associated costs, but your system may not be as efficient as it could be. For example, if your front office staff are making reminder calls the day before the appointment, your system is doomed to fail. Patients who work outside the home will probably not receive your message until after work – say 6 p.m., when your office is closed. Their first chance to call you back will be the next morning, the day of their appointment. If for some reason they need to cancel their appointment, you will have very little time to fill that appointment slot and will likely lose revenue.

A simple solution is to call patients two to three days before the scheduled appointment. This gives your patient an entire day to contact you if needed. It also gives your office a day to fill that open time slot.

The back office

Two back-office processes that are commonly rife with inefficiency are preparing the chart and ordering tests and referrals.

Chart preparation. Do you have a standard procedure for preparing the patient’s chart for each encounter? Your clinical staff may not actually do the work of chart prep, but they should at least communicate what is needed. Even in an office with an EHR, a staff member needs to check that appropriate test results and referral reports have come in and are recorded in the chart. If results or reports are not in, the staff member needs to have an efficient method for obtaining the results. For example, a staff member could compile a list of all reports needed per lab so that a single call could elicit multiple reports rather than having to call the lab each time a chart is prepped.

A staff member should also check the chart for refills, screenings or preventive services that might be needed and then flag the chart so the nurse or physician can provide those services during the visit. Additionally, clinical staff can be empowered to collect much of the patient history (PFSH and ROS) in the chart before the physician enters the exam room.

Tests and referrals. Your practice also needs a clear process for handling tests and referrals. When a test is ordered, who is responsible for completing the paperwork? Is it the clinical staff or the physician? If your office orders certain tests regularly, consider pre-printing order sheets. You can include information the testing department needs, such as patient name, date of birth, signs and symptoms, and complicating conditions, as well as items that are helpful to your staff and explanations for patients.

One key piece of information that staff members need is a time line. When does this test or consult need to be completed? If you do not want a test conducted for several weeks, but your staff doesn’t know this and schedules it for the end of the week, the test may have to be repeated, leading to patient dissatisfaction and increased costs. On the other hand, if a consultation is urgent but your staff is unaware, a potentially bad outcome could occur while the patient is waiting for the appointment. Give your staff clear information on the urgency or timing of the test or referral, and then let the staff negotiate with the offices and testing centers.

The physician

In many practices, the physician sets the tone for the practice. Here are two key ways a physician can demonstrate that efficiency is valued.

Start time. In an office setting, one of the most important things that can be done to create an efficient office is for the physician to be on time. In fact, I suggest that the physician arrive at the office at least 15 minutes prior to the first scheduled visit to get a jump on paperwork and patient care. If you see the first patient of the day on time, you are off to a good start. But if you see the first patient of the day after reviewing lab work and test results, signing payroll checks with the office manager and then getting your coffee, you could be as much as 30 minutes behind even if you arrived at work “on time.”

Standardized processes. Another common problem in medical offices occurs when physicians insist on doing things their own way, rather than following a standardized process for the entire group. The best example of this is a physician who refuses to use the practice’s EHR system. Excuses range from “I’m going to retire soon, so why should I learn a new system?” to “I work more efficiently with the old system.” The problem is that, because the EHR requires new work-flows throughout the practice, the old system is no longer viable. Requiring your staff to maintain dual systems is a recipe for disaster.

How is your office doing?

To get a sense of how your practice is doing in terms of efficiency, try these simple tests:

• Call your office around 9 a.m. on a Monday and try to make an appointment.
• Dial into your automated phone system and then try to speak to a human.
• Ask your clinical staff how much time they spend tracking down test results after the patient has been roomed.
• Check your watch when you enter your office each morning and again when you enter your first patient room.

Chances are good that will find opportunities for improvement.