The following letter was sent to our New York Delegation in Washington and to our representatives in Albany expressing some of our concerns regarding healthcare reform. Although questions about the final form of any healthcare law are still under discussion, the Chamber Board felt that it was important to express our concerns on behalf of our members and local businesses before a final bill is voted on. We have also included the US Chamber and the Business Council of NY’s positions on healthcare reform in this month’s issue of the newsletter. We are interested in hearing your opinion on this debate and encourage you to send your comments to karen@watertownny. com . If you are interested in signing on in support of the Chamber’s letter, you can also do so by emailing Karen at the Chamber .
On behalf of the Board of Directors and the nearly 1,000 members of the Greater Watertown-North County Chamber of Commerce, I am writing you to express our concerns regarding healthcare reform and its current path. This is a very complicated issue and although health care accessibility and affordability are a top priority for the business community, it is critical that we are not negatively affected by reform.
ANALYSIS TAKES TIME
The United States has the largest healthcare system in the world. The multilayered system we have in this country has evolved over many decades and not only involves doctors, patients, insurance and pharmaceutical companies, it is different in each state. This system cannot be fixed in a few months time. Instead, time must be taken to thoroughly analyze the entire healthcare system layer by layer and program by program, before recommendations for reform are determined. Change should be based not on emotion and political gain, but on a thorough understanding of the systems, the problems, and the impact that any proposed solutions will have on jobs, taxes, and the overall economy.
ALTERNATIVES TO PRIVATE INSURANCE
As the Congress is looking at alternatives to the private health insurance system, it is essential that options other than a government-run plan be considered. A public plan would be an unfair competitor to the private insurance system since it would not reimburse doctors and hospitals at the same rate in order to provide cheaper premiums. And, just like Medicare, this will increase the cost to employers. Versions of member-owned co-op programs or a system that provides a trigger that would kick in if private plans don’t reduce/ control costs within a certain time frame may well have merit, and need to be thoroughly reviewed before a final decision is made.
HOW WILL WE PAY FOR REFORM?
The financing of health reform is of great concern to the business community. Although policy makers predict that changes to the current system will off-set costs, there are also proposals being considered that will add new taxes or eliminate certain tax breaks. Cost estimates run as high as $1.4 trillion. Before any reform laws are passed, a true cost analysis must be performed. The ramifications of ill conceived policy changes and/or tax increases on the businesses and citizens of this country will only hurt the economy further.
NY WILL BE HURT DISPROPORTIONATELY
New York is one of a few states that require local cost-sharing for Medicaid, funded primarily through local property taxes. Shifts in Medicaid spending as a result of any federal changes would have greater consequences in NY’s health care delivery system than they would in most states. New York already has the broadest safety net of subsidized health coverage options of any state in the nation through its Medicaid, Child Health Plus, Family Health Plus and Healthy New York programs – one of the reasons that we have some of the highest taxes in the nation. Will financing national health care reform mean that these taxes will be in addition to, or in place of, substantial mandated health-insurance taxes already borne by New York businesses and its citizens? The Greater Watertown-North Country Chamber of Commerce shares the goals of Congress and the Administration to reduce healthcare costs, improve the quality and expand access to health services. But the devil is in the details. We ask that you consider the impact of the changes you are proposing to our healthcare system on the businesses and citizens.
By Tom Williams
Medical practice outsourcing has come into its own over the last few years. This is especially true for private practices of physicians, podiatrists, chiropractors, and physical therapists to name a few.
Two people who started their own outsourcing business are Dr. William Pena and Shannon Sullivan, CPC. Four years ago, they started a medical practice management company, Atlantic Billing and Coding, LLC, when they saw a real need for providers to have another option for their management needs. “Some health care practices simply have difficulty finding qualified staff, while others want the benefit of a professional company that specializes in the sometimes complex business of coding for services, billing those codes to third party payers (insurance companies), and ensuring that the provider of services gets reimbursed appropriately,” Pena said.
He went on to explain that a side benefit of this arrangement is that the provider and office manager do not have to deal with the day to day staffing issues that go along with employing their own personnel.
Pena said, “We wanted to provide a better way to make sure claims were being paid in a timely manner and, more importantly, we wanted to ensure that payment denials were being worked on diligently.”
Pena knows that treating patients is a full-time job, not to mention the administrative processes of compliance with Federal and State laws, billing, and staffing issues.After they submit claims with regard to the service performed on their patients, physicians, for instance, receive an Explanation of Benefits (EOB) from an insurance company. When an insurance company denies a claim, some busy providers just put the denials aside and never get paid. It is money lost. S
ometimes, the solution is simple. For example, further documentation from the provider needs to be submitted or the insurance company just made a mistake. Atlantic Billing follows up on these denials and frequently gets them paid. When these wrinkles are ironed out, it results in less of a burden for the patient and appropriate payment for the provider.
Due to the success of their approach, Pena and Sullivan have added staff with solid expertise. Tammy Carbino, a Certified Professional Coder (CPC), was hired to make sure that all claims are completed properly before they are submitted to insurance companies. Almost immediately, the number of denials went down, which resulted in increased reimbursement. Recently, Karen King, who is also a CPC, was added to the staff.
Insurance companies are responsible for paying providers according to the contractual relationship in effect. Occasionally, providers’ staffs have difficulty maintaining these contracts, as a result of the time demanded by issues of compliance, staffing, billing, etc. Unfortunately, as a result, according to Sullivan “Many dollars can be lost by providers and that’s not good. Health care providers, like other businesses, have significant overhead expenses to be concerned about.”
One example Atlantic Billing has seen is that some practitioners have been using outdated fee schedules, not realizing that reimbursement amounts have increased. As a result, they may be receiving less than they are due. Fee schedule amounts are updated annually, but if practices don’t update their computer software with these new prices, correct payment can be lost.
Atlantic Billing and Coding has proven its worth by showing a positive difference in its customers’ reimbursements. Its clients have seen increased growth in reimbursement, while denials have decreased dramatically.
However, Atlantic brings more to the table than just working on claims and denials. Atlantic Billing and Coding will do in-house or out-sourced services to include: on all denials;
• electronic and paper claims submissions;
• analyze and update Current Practical Terminology (CPT), the diagnostic codes (ICD-9) and the medical inventory codes for braces, canes, walkers, etc. (HCPCS codes);
• analyze and use correct modifiers to increase reimbursement dollar amount;
• accounts/receivables management;
• customized monthly financial reports; and • monthly patient statements and receivable collections and reductions.
Additionally, their consultation services include:
• internal audits;
• on and off site training;
• comprehensive credentialing services;documentation training;
• review and development of compliance manuals; and
• per-diem services, including vacation coverage and maternity leave.
When a provider commissions the services of Atlantic Billing and Coding, a specific person is assigned to the account. As a result, this account ‘point person’ knows and understands the entire office and its procedures. Sullivan said, “It is like having a biller in their own office. It also means the provider needs fewer personnel on staff, which saves both time and money.”
She added, “We are a local company and local people will still be employed.”
Sullivan, who serves as Atlantic’s office manager, started a local certification chapter of the American Academy of Professional Coders in Canton and was its president for the 2008-2009 term. The chapter focuses on education and conducts classes to certify personnel seeking to become professional coders.
According to Sullivan, continuing education is the best thing a practice can do for its employees. She said, “Every day there are changes in the medical field and, if you fall behind, your practice will fall behind. As we move forward, the medical field will continue to face big changes when it comes to third parties processing their claims. We all have to look forward to ICD-10, mandatory EMR and the continuing issue of changing health care plans effecting all Americans.”
She continued, “If your practice doesn’t have a practice management system that can keep up to date with these changes, transitioning can be a real problem. These are big, big changes that will affect small and large practices. The lack of experience and knowledge by personnel doing the claims can result in money being lost. In the end, if a person is not code-certified, it usually affects the doctor’s bottom line in a negative way.”
All Atlantic Billing and Coding personnel are certified and are required to take continuing education classes to maximally maintain their certifications.
Due to the economy, doctors and other health care providers are seeking help in ensuring they are receiving the appropriate reimbursement to which they are entitled. That is where Atlantic Billing and Coding, LLC can really help. Pena said “As things start going downhill, that’s when the yellow light comes on and the physicians start asking, ‘what is going on?’”
Atlantic Billing and Coding identifies with each practice and its unique needs, and, in doing so, helps each practice make sure it’s not just meeting payroll deadlines but making sure the business is staying afloat.
Every doctor and/or office manager can use some ‘outside eyes,’ said Sullivan, “What is the harm in getting some outside advice on how to make your office be more profitable and run smoother. The revenue cycle is everyone’s responsibility in the office, not just the billers. Without change, you will lose money. We can help make sure you don’t.”
The Atlantic Billing and Coding advantages are: it is efficient, all of its personnel are certified coders, and they are local. When a physician or other provider calls Atlantic, he or she can speak to one of the owners and the person that is dealing with their practice. That’s a big plus.
Pena stated the company has helped providers improve their business knowledge and identify lost opportunities lost. They are here to stay and he looks forward to helping more practices.
Atlantic Billing and Coding, LLC bills for all specialties. If you think they may be of help to your practice, please visit their website at www.atlanticabc.com or call them directly at 315-379-9659.
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