Physical Therapy Billing

MIB Assistant — Hiring Them Right

by Nitin Chhoda PT, DPT | Sep 29, 2013 | Electronic Medical Records, Medical Billing, Physical Therapy Billing

A large majority of medical insurance billers (MIB) start their businesses at home and as the company grows, the MIB often discovers they require an assistant.

However, liking someone isn’t enough upon which to base a working relationship and in this insightful article, Nitin Chhoda examines the criteria billers should employ when seeking an MIB assistant.

The key to hiring an MIB assistant is having someone with an eye for detail. The lucky candidate will be functioning as an extension of the biller and in many instances will represent the business to the public.

The MIB assistant will need some basic skills and if they’ve never worked in the field, they’ll need to be trained.

Background Checks

MIBs shouldn’t balk at conducting a background check on potential employees. An MIB doesn’t want to discover that their new MIB assistant has a history of white collar crime, computer theft or embezzlement. It’s better to learn as much as possible about the applicant before making a definitive hiring decision.

Prior Employment

Some type of experience in the medical field is an advantage, but not a necessity. Knowledge of computers, data entry or experience with numbers is also helpful. Even if the person has no experience, if they’re trainable and learn quickly, it’s possible to have a competent MIB assistant in just a few weeks.

Electronic medical record (EMR) technology is essential for secure transmittal of reimbursement claims. Few outside the profession will be versed in their use. Many MIBs choose to leave data entry to their MIB assistant and handle the actual submissions themselves. Either way, MIB assistant must be cognizant of HIPAA security standards and thoroughly understand them.

Skill Sets

Organization, honesty and integrity are critical skills for an MIB assistant. The individual will be required to communicate with clearinghouses, insurers, patients and clients.

A good command of the language, a pleasant demeanor and a courteous manner are essential, as is the ability to be assertive when needed.

An ideal MIB assistant will have initiative, be able to solve problems on his/her own, and know when to bring difficulties to the attention of the MIB.

Accuracy and the ability to communicate through written means are also essential elements. A winning candidate must be detail-oriented, able to take direction and have a personality that complements the MIB. The MIB assistant will be much more than someone who enters data.

The individual will be an extra pair of hands, but they can also become a friend and the primary backup person should the MIB be unavailable.

Acquiring an MIB assistant is a huge step and one that will have a dramatic impact on the medical billing business. The ideal assistant will ease the MIB’s workload or allow the firm to take on more work. They represent the MIB and the company, making it essential that they have the skills to do it well.

Health Insurance Exchange 101 – The Backbone of Obamacare

by Nitin Chhoda PT, DPT | Sep 28, 2013 | Healthcare Practice Management, Medical Billing, Physical Therapy Billing, Physical Therapy Management

Beginning Jan. 1, 2014, everyone in the U.S. will be required to have some type of medical coverage as part of the Affordable Health Care Act, otherwise known as Obamacare. Coverage can be in the form of Medicare, Medicaid or a typical health insurance policy.

Consumers can purchase coverage through the Health Insurance Marketplace beginning Oct. 1, 2013.

The Marketplace is the backbone of Obamacare, designed to provide four levels of coverage at levels the federal government deems as affordable.

As part of the Act, individuals buying insurance through the Marketplace may be eligible for federal subsidies to help them pay for coverage.

Federal dollars are allotted based on income.

Who Should Enroll?

Open enrollment through the Health Insurance Marketplace runs from Oct. 1, 2013 to March 31, 2014. Patients who don’t qualify for Medicaid, Medicare and CHIP, or who don’t have an employer-based insurance plan, qualify for enrollment.

Individuals who haven’t enrolled in a plan by Jan. 1, 2014 or have received an exemption, will be assessed a fee when they file their income tax return.

Employees who have insurance through the workplace can’t use the Marketplace unless the cost of their insurance exceeds 9.5 percent of their income, or if the plan doesn’t offer the minimum services mandated by Obamacare.

Individuals can choose not to buy insurance and pay the Individual Mandate Tax (IMT) instead.

In 2014, the IMT is $95 per adult and $47.50 per child, or 1 percent of income, whichever is greater. The penalty increases to $325 or 2 percent of the family income in 2015. In 2016, the penalty will be $695 per adult and $347.50 per child or 2.5 percent of the total income.

Fines are based on a cost-of-living formula after 2016.

Preparation And Documentation

To create an account and sign up, consumers will need to provide some basic information including:

Social Security number or document number for legal immigrants;
Employer and income information for each household member;
Policy numbers for any current plan(s) covering household members;
A completed Employer Coverage Tool, available on the site, that lists all job-based plans for which household members are eligible.

Plans And Options

Patients can purchase four types of policies through the Marketplace – Bronze, Silver, Gold and Platinum. The plans pay 60 percent, 70 percent, 80 percent and 90 percent, respectively, of healthcare costs.

Bronze and Silver plan costs are capped at 9.5 percent of income. Gold and Platinum plans are capped at 12 percent of income. High-end plans may be subject to an excise tax of 40 percent of the total cost.

Visitors to the Marketplace can compare policies, deductibles, co-pays and costs. The online calculator allows consumers to find the plan that best fits their needs. They’ll be able to determine if they qualify for a federal subsidy to help them pay for Marketplace insurance and how to apply.

The Marketplace also offers “catastrophic” plans for people age 30 and low-income consumers, but different terms and rules apply and individuals won’t be eligible for subsidies and credits.

Affordable Versus Cheaper

It’s important to remember that affordable doesn’t necessarily mean cheaper. There are no restrictions on how much insurance carriers can charge for coverage and other options may be more cost effective.

Families with incomes less than 15,302 will qualify for Medicaid.

Some may qualify for assistance with out-of-pocket expenses for government programs including Medicaid, Medicare and the Children’s Health Insurance Plan.

Obamacare dictates that each person must have insurance and the Health Insurance Marketplace offers plans to accommodate the law. Patients should evaluate each plan carefully and examine all their available options so they can make an informed decision that’s best for everyone in the family.

Patient and Employer Penalties with Obamacare

by Nitin Chhoda PT, DPT | Sep 27, 2013 | Healthcare Practice Management, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Management

The Affordable Health Care Act, known as Obamacare, requires all Americans to have healthcare insurance. Employers that don’t offer insurance and those that refuse to purchase coverage will get hit where it hurts them the most – their wallet.

Obamacare employs fines as an incentive to persuade patients and employers to comply with the legislation.

People will be required to report their insurance coverage, or lack thereof, through their annual income tax returns.

Penalties will be levied on individuals without health coverage, as well as business owners that don’t provide it.

The Individual Mandate Tax

With the Individual Mandate Tax (IMT), in 2014, the fine amounts to $95 per adult and $47.50 per child, or 1 percent of income, whichever is greater. The penalty increases to $325 or 2 percent of the family income in 2015.

By 2016 penalties reach $695 per adult and $347.50 per child or 2.5 percent of the total income. Fines are based on a cost-of-living formula after 2016.

If the filer doesn’t pay the IMT, it’s carried over to the next year and interest continues to accrue on the total. Some will qualify for an exemption from the IMT. The Congressional Budget Office estimates that 30 million Americans will lack coverage in 2016 and 80 percent of that number will qualify for some type of relief.

Those qualifying for an exemption include inmates, people with religion-based objections, and members of Indian tribes.

Also exempt are individuals who can’t find an affordable plan, anyone that isn’t required to file a tax return, and those who are temporarily unemployed.

People living in states that have chosen not to expand Medicaid coverage and anyone paying more than 8 percent of their income for health insurance will avoid the IMT.

The Employer Mandate

Obamacare refers to the Employer Mandate penalty as a “shared responsibility fee.” The fines for businesses not offering insurance will be $2,000 per person, per year.

Companies that contribute 50 percent toward an employee’s insurance premium are eligible for tax credits of up to 35 percent of their contribution, provided the worker makes $50,000 or less per year and is a full-time employee.

The Employer Mandate affects approximately 5.8 million companies throughout the nation.

Business owners with 50 or more employees, or part-time equivalents, are required to offer their workers insurance.

Those that don’t will be assessed a fine. Full-time is defined as 30 or more hours a week.

Businesses don’t have to pay the fine for the first 30 employees.

The provision, set to take effect in 2014, has been delayed until 2015 to work out details on information reporting requirements for businesses.

The mandate stipulates that employer-provided healthcare must be affordable (no more than 9.5 percent of the employee’s wages.)

Employers offering unaffordable insurance, as defined by Obamacare, will be assessed a $3,000 penalty for each employee who receives the federal subsidy to purchase insurance through the Marketplace.

Policies must provide coverage for the employee’s children age 26 and younger. Plans do not have to offer benefits for spouses. The policy must provide “minimum value,” defined as paying at least 60 percent of the cost of covered services, including deductibles, co-pays and premiums.

The IMT is an incentive for individuals to purchase insurance and enforced through fines.

The Employer Mandate utilizes financial penalties as an inducement for businesses to provide insurance or be assessed costly fines that will substantially affect profits. Obamacare places both workers and employers in the same position – get insurance or face the fines.

MIBs: Costs You’ll Incur When Starting Medical Billing Business Part 2

by Nitin Chhoda PT, DPT | Sep 26, 2013 | Electronic Medical Records, Medical Billing, Physical Therapy Billing

Launching a medical insurance billing enterprise has the advantage of low start-up costs. Medical insurance billers (MIBs) are aware of the major financial outlays, but there are many smaller costs that are often overlooked in the excitement of entrepreneurship. In the conclusion of this two-part series, Nitin Chhoda inventories the smaller costs of doing business.

Paperwork

MIBs work with computers, digital communications and electronic claim submission, but there are still occasions when paper documents are required.

CMS 1500 forms are the only official claim document accepted by Medicare carriers for reimbursements. They’re available in boxes of varying quantities, ranging in price from $35 for 500 to $150 for 5,000.

Need For Speed

High-speed Internet is essential for MIBs. Those living in highly populated areas can obtain high speed service for as little as $25, but speeds are on the low end of the high-speed scale. Expenditures for the highest speeds can top $150 per month depending upon the provider. Installation fees may also be charged.

MIBs working in rural areas aren’t as fortunate in regard to pricing options. Entrepreneurs living in a country setting may have to rely on satellite service for their Internet connection. Low end speeds can be purchased for as little as $50 per month, while power plans can range from $100-$150 per month.

Customers should also be aware that many plans have usage limits. Additional costs for MIBs may be assessed for those who exceed the ISP’s limits. Some companies simply throttle the available speeds for consumers who exceed their usage.

Talk Isn’t Cheap

A dedicated phone line is essential. MIBs will spend a significant amount of time on the phone and a speakerphone is a wise investment. It allows billers to continue to work even if they’re on hold. It’s not possible to answer the phone 24/7 and MIBs will want to invest in a phone system with the ability to record voice messages.

Depending on the provider, an additional line can cost as little as $10 for MIBs, while other companies will view it as a completely “new” phone service at a cost of up to $50. A speaker phone with answering and message capabilities will range from $50-$100. Expect to pay $150 for a cordless model.

Most phone companies offer voice messaging services for a fee of up to $10 per month for those who want more than a simple phone answering machine.

Power Plays

Lost data or a fried hard drive will quickly put MIBs out of business. Invest in an uninterrupted power supply for potential outages and a surge protector. A power surge can permanently damage a machine, as can low voltage. Power protection costs range from $20-$200.

An additional cost for the protection of costly equipment and valuable data will be a thumb drive or separate drive to back-up files and information.

A thumb drive will range from $10-$70 depending on its storage space, while a 2 terra byte drive can run up to $500. Electronic medical record (EMR) technology provides regular back-up in the cloud.

The cost of conducting business requires MIBs to plan ahead for every contingency. High-speed Internet, reliable communications and data protection are relatively inexpensive, but the cost is an essential part of the medical billing business and critical for a reliable and reputable firm.

Medical Billing Business — Costs You’ll Incur When Starting Part 1

by Nitin Chhoda PT, DPT | Sep 25, 2013 | Medical Billing, Physical Therapy Billing, Physical Therapy Software

One of the primary attractions of a career in the medical insurance billing (MIB) profession is the low startup costs compared to other businesses. Most MIBs plan for big expenditures, but fail to figure in small but essential costs.

In this insightful, two-part article, Nitin Chhoda examines the cost of doing business and what MIBs can expect to spend when they open their own business.

MIBs typically begin by operating their business from home to save on costs. Renting office space is a major expense that can cost thousands of dollars a month depending on the location.

To equip a medical billing business with the basics will require approximately $5,000 and there are numerous ways entrepreneurs can reduce their costs. Keep in mind that prices fluctuate among retail outlets and geographic areas.

Computer System

It can be tempting to purchase the most expensive medical billing business model available, but a good computer system that includes the hard drive and a minimum of a 19-inch monitor can be obtained for approximately $2,000. A 19-inch monitor will help prevent the eye strain of being in front of the computer for eight hours a day.

The operating system must be the latest version of Windows to be compatible with medical billing software.

A multi-function machine, often called an all-in-one, is capable of printing, scanning, copying and faxing. All of the capabilities will be required as part of the medical billing process. A basic model can be purchased for as little as $100.

Medical Billing Software/EMR

MIBs have a wealth of medical billing software from which to choose. The software represents a major outlay for a fledgling business. MIBs can expect to spend around $700 for medical insurance billing software, though there are systems that cost thousands.

Another option is EMR software that provides all the capabilities required for medical billing, communicating with clearinghouses and maintaining HIPAA compliance when dealing with patient data.

Fully functional EMR systems are available and only require a modest monthly fee. An EMR that has built in security features, is easily updated when needed, can handle the full range of ICD-10 codes, and can be used to create CPT code databases to reflect client specialties.

Clearinghouse Contracts

Medical billing businesses will be required to contract with a clearinghouse, which allows them to submit client claims for reimbursement. The average cost is $300. MIBs should be prepared for the need to purchase additional software for complete clearinghouse compatibility or to offer clients extra services, an expense that can run around $350.

Printed Material

Manuals and reference materials for medical billing business will account for $200-$300. They encompass coding manuals, insurance directories and disease classifications, along with medical terminology and the intricacies of submitting claims.

Available in book form, many are also offered as CD-ROMS that can offer valuable savings. Part of the reference library should include books on marketing the business.

A career in the medical insurance billing field is one of the few professions that require a minimum of investment by entrepreneurs.

Computers, software, reference material and clearinghouse fees represent the major financial outlays, but there are many smaller costs of which MIBs may not be aware. In the second part of the series, Chhoda will explore the smaller, but no less important costs of launching a medical billing service.

Increased Individual Responsibility with Obamacare

by Nitin Chhoda PT, DPT | Sep 24, 2013 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

Devised by President Obama and endorsed by insurance companies, the Affordable Health Care Act forces individuals to accept more responsibility for the status of their health.

Known as Obamacare, the Act has many controversial elements, but it also contains a little known initiative designed to assist people live healthier lifestyles through recommendations by the National Prevention, Health Promotion and Public Health Council (USPFST).

The Council is tasked with managing the federal government’s national efforts to promote health and wellness.

The organization will study the issue and prepare a comprehensive list of recommendations on how the overall health of Americans can be improved to reduce serious health conditions and control the cost of healthcare.

Screenings And Services To Stay Healthy

Obamacare includes specific provisions to help achieve its goals. Under the Act, individuals have no co-pay when they obtain approved preventative testing that includes mammograms, colonoscopies, immunizations and medication to stop smoking.

Other services include screening for depression, high blood pressure and diabetes, along with cholesterol, HIV, STDs and free birth control. The full list has not yet been finalized.

The goal is to induce more people to undergo preventative testing in an effort to identify and treat diseases and health conditions in early stages.

The strategy is to avoid costly treatments later on and drastically cut medical costs.

The tests deemed the most effective will be available without co-pays and are those that meet the following criteria – non-invasive, easy to perform and highly accurate. Some healthcare plans have “grandfathered’ status and are exempt from the new Obamacare requirements.

Exemptions on these plans went into effect on Jan. 1, 2011 and will continue those exemptions into the future.

Paying For Healthcare

Part of the price for a healthier life is purchasing healthcare insurance. To facilitate the process, Obamacare has expanded Medicaid coverage for the poor, established a Marketplace where individuals can purchase multiple levels of coverage, and set up subsidies to help them pay for it.

Before Obamacare, those who couldn’t afford insurance or chose not to buy it typically went to emergency rooms for treatment. Obamacare requires every citizen to take responsibility by requiring them to purchase healthcare insurance.

The Rewards Of Good Health

Obamacare allows and encourages employers to offer workers financial rewards who demonstrate measurable efforts toward improving their health.

Employers can offer cash incentives and reduced premiums, deductibles and co-pays.

A different standard must be established for those unable to meet the wellness goals established in insurance policies.

Obamacare attempts to address many of the health and wellness issues currently affecting patients by providing free preventative tests and screenings.

Many have pointed out that health can’t be legislated. It requires better decision making on the part of consumers, access to healthier food, and the financial means to purchase it.

While many medical conditions can be prevented through a healthier lifestyle, the effect of genetics can’t be dismissed. Many patients are wondering if they’ll be penalized for a predisposition toward specific diseases and how they’ll find the funds to eat a healthier diet.