Interview With Medical Biller

ARTICLE FOLLOWS:

Interview With Paul Hackett Medical Biller - Medical Billing

Before becoming a Medical Biller, what did you do? My background was mainly customer service and then I took that one step further and went into sales. So the last two years before I opened the doors of my business I sold copiers to other businesses.

How did you come to find out about medical billing and what about it intrigued you enough to start a business? It was a fluke actually because I didn't even know that there was a thing called medical billing. If it weren't for my girlfriend looking for a new career path I still wouldn't know about it. She enrolled in a trade school to become a medical assistant and she made friends with a few people that were taking medical billing and terminology courses so she tried it, like it and when there were exams I would help her study.

I began asking questions about what she was learning and was shocked that there was such a huge process that a physician/practice has to go through in order to get paid for rendering medical treatment to patients. It literally blew my mind that all the times I went to a doctor (from a child to that point) I was never aware or even thought about how they were compensated for their services, LOL.

Being the curious person that I am this revelation made me research the field, the marketplace, and the industry and I found there were certain problems that most physicians and their practices were experiencing. I am also the type of person that is always looking to elevate my economic situation and myself. I thought that if I could find a way to help the physicians and get paid handsomely for doing it then I could start my own business instead of working for someone else.

Before starting Stelo Medical Management, Inc. in 2000, had you ever run a business of your own? Well, if you view having a paper route when I was a kid a form of owning your own business then I would say yes, LOL. As I said before the majority of kids aren't taught or encouraged to become entrepreneurs so we don't aspire to become Presidents, CEO's, COO's, CFO's or anything connected with owning and running a business. Instead we are told that there is a structured path that everyone must take in life and if you work really hard and put in enough time with a company that one day we might be offered the opportunity to be executive within a company. So in other words you will still work for someone else but you'll have a better salary.

Why did you choose to incorporate your medical billing business instead of staying a single proprietor? Listen, I don't understand half the stuff that CPA's and lawyers are talking about when it comes down to Corporations, LLC's, Sole Proprietors and taxes (but I'm learning for the sake of my business). I remember a story I read in a financial magazine where a company was sued and the owner of the company (small businessperson) lost almost everything he had, including personal possessions like bank account, house, and other assets. Possessions they had acquired over the years and it was mentioned that if he had set his business entity up correctly from the start he would have only lost what the company had made not his personal possessions.

So when I decided to go into business my main concern was protecting my personal assets and the assets of my partners. After careful planning and with the guidance of a business lawyer and CPA, we agreed that with the direction we trying to take the company, the amount of partners and future investors that would be involved, the type of people we were going to be conducting business with and my vision of expanding into other areas that are not linked directly to medical billing (like my medical billing beginners book series for example) incorporating was as our best option. Oh yes, we also considered the ramifications of how our business would be impacted by taxation. On a side note, if my goal was to be just a one man or two person operation then our business entity would probably have been a lot different.

Does your business hire medical billers as well as work with Practitioners as a Medical Biller? Yes, we do hire medical billing personnel, but they are not treated or looked upon as employees and we all work with the physicians that we have contracted with. One of my goals when I started (and it still is) was to make everyone that worked with us a partner or part owner in the business. That way, everyone will be able to be well compensated for his or her time and efforts as well as have a physical asset that they own unlike being an employee.

This makes our process of choosing partners very lengthy so our team is small but highly specialized in their functions whether its medical billing, compliance, sales, marketing, customer service or dealing with insurance companies.

We all make our money on a quarterly basis not like a regular job (weekly or bi-weekly) and how much is made is determined by how well we as a company do during that time. So, everybody has a vested interest in doing everything we can to keep our physicians highly paid for their services. In turn if we make more money during a quarter and on payday everyone goes home feeling that his or her efforts and time were well rewarded and deserved.

When you first started your medical billing business, what types of problems had you run into? Ha-Ha, what didn't I find to be an obstacle in the beginning? The biggest obstacle was confidence in myself because I knew nothing about the medical billing industry, running a business, setting up a business, what software to get, which companies to do business with, how to speak to doctors, how to market my services in the industry, how to find a CPA, how to register my company, or how to pick a company name. And the list goes on.

You see, without having a mentor or a resource to show you or tell you how it's done then you find yourself learning by trial and error. That's one of the reasons that I wrote my book so that the countless others out there don't have to stumble around in the dark like I did (or the countless others before did) in order to get started.

Do you feel that it is mandatory to take courses in medical terminology and laws in order to take on a career such as this, why or why not? My initial response is no because I know people that have started their businesses without having an understanding of the terminology but they knew the process of submitting the claims and how to follow up on them. Today is a different story. I would say that if you don't know about the industry that you get educated whether by online courses, trade schools, or college classes so that you firmly understand what the field is about, how to handle certain situations, how to professionally process the claims for your clients and get them paid in a timely manner.

Now I don't want people to say "OH MY GOD I CAN'T DO THAT" or "IT SOUNDS SO COMPLICATED" because when it boils down to it... all you're doing is data entry and customer service which the most of us already know how to do. However the more you know about your business, the processes, the shortcuts, the terminology, the appeals process, the way insurance companies work, and how to deal with patients and insurance companies when things are outstanding or unclear then the better you will be at keeping your clients more than satisfied. Which in turn makes you more money for your home business and you will find that those happy doctors/dentists will bring you more business than you can handle (which means mo' money, mo' money, mo' money, LOL).

As for laws... you should know how the laws apply to your business and how they affect your clients. This field is always changing so you will have to keep up with those changes but if you network yourself with those government agencies that make the laws you will know well in advance of any changes so that you can notify those physicians that are going to be affected by them and change any internal practices that you need to. Most of the time you look like a star to your clients when you notify them because they aren't up on most of the changes until months later.

Believe me when I say once you get started if you do things correctly, have a support network of other billers, continue to educate yourself about the industry, stay abreast of the changes in the market and keep the line of communication open between you and your clients it all becomes second nature and you'll do things without any thought.

Can you give us a few examples of medical terminology that is used and the meanings? I don't really want to confuse or overwhelm anyone that might be interested in this field as a home based business by getting into medical terminology because like I said the majority of people will just be doing data entry, follow up, and submission of claims so medical terminology doesn't have a great impact in what they do. However most medical billers have learned or should learn terminology to some degree while in school or in training courses so that the have an understanding of what the physician did and how to look up the procedure or diagnosis if something is missing from a claim.

You must understand that once you are given a claim as a biller, you can't change anything. All you can do is send the claim back to the physician if something is missing or enter it as it is written (that's why I say it's mostly data entry).

If you were a medical coder on the other hand you would have to know medical terminology and in most states be certified in order to handle and code the charts. As a home based biller you won't have any charts to code because that's not your job so having a deep understanding of terminology is not necessary although it could help you to decipher claims that have mistakes and when you are in the marketing stages by lending to your credibility.

I understand that your girlfriend received her certification from the American Academy of Professional Coders, was this a mandated certification, or did she take it to add prestige and credentials to her resume? First let me say that there are no rules or regulations (city, state, or federal) that state a medical biller needs to be certified to process claims (whether in an office setting or as an at home business) at this time but things may change in the near future. National Certifications are awarded by the AAPC and AHIMA to those that have proven that they are experts in coding (Physicians Based or Hospital Based) and Registered Healthcare Information Administrators or Technicians.

For Paula (my girlfriend) it was not mandatory. She attained her credentials as a personal goal for herself so that if the business didn't work out or she wanted to go back to doing coding that she would be in demand because of her accomplishments. As I said before things change rather quickly in this field and when you are certified you are mandated by the issuing organization to continue your education much like doctors do during the year (which earns you credits) in order for you to keep you certification.

As business people we use all of our credentials as a marketing tool when speaking to potential clients because that makes us truly unique from 90% of our competition. So, having everyone that handles the processing of claims nationally certified became our standard because it speaks volumes about the company, it's people, our dedication and our professionalism.

How has this medical billing certification helped her, in the business world? I remember when Paula was making $6.50 an hour working as a medical biller / data entry specialist in a medical billing company while going through school. As soon as she passed the National Certification Exam she was able to land a job in a very renowned hospital for about $20K and then she went to an even more renowned hospital and doubled that salary.

So having the certification is like having a college degree and you can literally tell people what you want.

As I said, she attained it as a personal goal and she is in the process of studying for yet another national certification exam coming up later this year and when she passes she will be awarded with yet another set of initials behind her name and will be considered an expert in another form of coding.

During your two-year research to prepare and start your own company in this field, had you run into any scams? If so, what were they? I run into scams all the time. The biggest rip offs can be seen in newspapers (especially in local hometown papers like the Thrifty Nickel, Penny Savers and even in large daily newspapers) where there is an ad that states:

You Can Earn $50,000+ Processing Medical Claims From Home (or something to that effect). No experience necessary! Call 1-800-***- **** for information. Then when you call you get a swift taking salesperson who's only job is to make you believe that if you spend $300 and up for their products and services you will make thousands of dollars in your first year.

The second is the on the web but it takes on many forms such as: medical billing opportunity vendors that want you to purchase training, software, marketing materials and lists of doctors as a package deal for $300-$9000.

Then there are those that are resellers of well known/branded medical billing software programs that are the most basic in design and won't be able to support your business as you begin to grow. So you in turn call them back and spend another set of money with them to upgrade the software (so you get taken twice).

The next is the software companies that also claim to be their own clearinghouse companies and claim to give you discounted services because you bought their software in the beginning and will submit your claims exclusively through them. So once again you are paying twice, except this kind of service is an extended and drawn out milking of your wallet.

How would you prepare others, so that they do not run into the same situations? My preparation with regard to others is rather simple, ARM THEM WITH THE TRUTH ABOUT THE INDUSTRY AND THEY WILL BE ABLE TO DECIDE BASED ON FACTS. IF THIS FIELD IS THE TYPE OF BUSINESS THAT THEY WANT TO PURSUE AS AN AT HOME BUSINESS VENTURE!

To get the word out I wrote a book entitled Medical Billing Beginners, I answer peoples phone calls and post messages in medical billing forums and on message boards answering peoples questions and warning people about the several ploys that are used by companies to trap them. I also tell them where to go to check on the reputations of these companies before they decide to sign up or spend any money.

Although I have to say that it amazes me the amount of people on a daily basis that will bypass the valuable information that I have taken the time to put together (or that other medical billing business owners have put together) for them for a mere $40 and instead of educating themselves with us first they go and spend $500 freely on a scam and then have the nerve to email me/us afterwards to ask if it was a worthy purchase or what they can do to rectify the mistake.

In your book, you mention getting Errors and Omissions Insurance, what is it and what types of businesses would need it? To put it simply E&O Insurance (also known as Professional Liability Insurance) protects you and your business from the mistakes you're bound to make and from the greedy physician's/patients and others out there that have the need to nit-pick when things aren't the way they assume it should be.

Any company or self employed entrepreneur that provides a professional service, renders a professional opinion, advice, consulting, billing, coding, or transcription is a candidate to acquire this type of insurance.

How much does the average person charge per claim to be filled out and how long does the average claim take? How much a person charges is affected by several factors such as geography, the amount of time spent on each service, the amount of effort you have to exert in providing that service, etc.

As a national average most companies charge between $2.00-$500 per claim, 3.5%-9% of he monthly amount collected or a flat fee of anywhere from $700-$2000 a month depending on the type of service being provided. Hourly fees can be charged for going into a practice to set up the software, train the staff on new software, consulting the practice, audits, or for your time that's spent inside their office doing things outside of what you were contracted to do.

Once you have all the initial information (patient, insurance, codes, fee schedules, practice) entered it take about 2 minutes per claim to enter and when all the claims are filled out then you send them in a batch electronically to a clearinghouse for distribution, error checking and processing.

Would you mind briefly explaining the process a medical biller takes in preparing medical billing sheets? The medical biller picks up or has the super-bills delivered to his location, enters the patient's demographics-practice information- physicians information-diagnosis codes-procedure codes-insurance information into the medical billing software and submits it to the proper insurance company. If the claims need to be submitted by paper the medical biller will fill out the claim with the above information and send by mail to the insurance company.

The medical biller tracks the claim until the claim is paid and collects the receipt (know as EOB's or Remittance Advice) sent from the insurance company to the physicians office that verifies the transaction-tells what was paid-tells what the patient owes and how much if any should be written off. The medical biller places these numbers into the software to balance the practice and patient's accounts and bills the patient if need be.

If a claims is denied the medical biller would investigate the reasons why with the insurance company by phone and will send them anything they need to get the claim paid. If they can't resolve the dispute the medical biller will then appeal the decision by the insurance company in an effort to get the claim paid.

That is the basic concept of a medical biller's duties so now you understand what I meant when I said that the majority of work is data entry (with attention to detail) and customer service (dealing with patient accounts, the practice, the physician, the insurance company, and the physicians staff).

What have you found to be the best, or most beneficial aspect of running a Medical Billing Business? The MF (money and freedom). There is no feeling in the world like building a company from scratch, molding it, nurturing it, watching it grow under your command, seeing it become profitable and then exploding into a entity that you never expected could be so big and most of all the freedom to do whatever you want-whenever you want and having the money to do it on a whim. Anyone want to go to France for some fries or toast, LOL?

If you could leave parents with just one bit of advice, when it comes to starting a home business or even a small brick and mortar, what would you say? Don't Give Up Before the Magic Happens!!! Most people that have tried to start businesses have quit because they didn't think they would become successful or that success was taking too long to achieve so they left the game early without giving a really concerted effort.

You need proof? Go online and see how many MLM, Internet marketing programs or network marketing companies are out there. Everyday there is a brand new, hotter than hot, you better get in now, 2X2 or 3X5 matrix that makes you leave the program that you're currently in with the hopes of striking it rich overnight so you never make a dime but you make the program sponsors rich. If most people would have stuck with one thing (medical billing or a brick and mortar business) or a few fundamentally solid programs, really worked them and the market they could have become rich in time (but like my mom said people always think the grass is greener on the other side). Don't Let This Happen To You Because The Only Place That Success Comes Before Work Is In The Dictionary!

Thank you so much for your time!

Thank You So Much! You're The Best!

Visit him at: pages.ivillage.com/6314/stelopm

About The Author Alyice Edrich is the author of thedabblingmum.com/ebookstore/business/notary.htm Tid-Bits For New Signing Agents. If you're looking for a real work from home job and an estimated $25 or more per hour with no party plans, no inventory, and no commissions, order her book today. Visit thedabblingmumpress.com to order a copy.

* Please note: the code for linking directly to the e-books title is included and will need to be made clickable. ** Don't forget the links in my byline must be clickable and placed on the same page as the article in order to use this article free of charge.