Lynda Hughes, Red House Medical Billing
Red House works with clients in transition at every new signing. These are sensitive moments for cashflow. Working in tandem is essential - that means work from the owners of a practice or ops team at a facility. Attempting to establish new billing processes without two-way set up is a recipe for disaster. Claims may be able to get out the door. But the efforts to work denials, maximize digital workflows and payments, and engage with RPA are hobbled.
If you’re managing your own billing, what do you do when someone is retiring or quitting? Or in analysis, you’ve discovered deficiencies in their work? Who is managing website accesses, CAQH and other compliance updates and is it worth a doctor/owner managing it rather than focusing on patient outcomes? For various reasons, changing your billing can be a serious disruption to your cash flow if not properly handled.
In 2022, industry standards in medical billing are electronic and automated. Major carriers have cut back their customer service staff in favor of websites and voice response systems. Staff nowadays are being forced to register for accounts at carrier websites because customer service agents are literally instructed to refuse service unless an answer could not be obtained from the website first. Carriers encourage or require use of direct deposit for payment and electronic remit (ERA) in lieu of paper EOBs.
The problem with all of this? HIPAA. Not just anyone can perform these enrollments. Security is tight, and providers have no choice but to be involved in the process. If you want your new biller to be efficient, you must be ready to participate in getting these chores done. You must not assume your billers can do the work without you. Insurance companies need the assurance and participation of providers and owners to guarantee they are working with authorized third parties.
Some vendors will call to confirm that the person who registered had your permission. Some will mandate that you first create your own account, and then grant access to an associated user account. Some will ask for seemingly sensitive information, such as owner name, dates of birth, or social security number, especially if direct deposit is part of the process. You will hamper your new biller’s efforts right out of the gate if you do not take the time and make the effort to manage the needed enrollments. And that will likely mean a gap in your payments while they struggle to get everything flowing.
The good news? Once it’s done, it’s done. Once an enrollment is completed, they remain fairly maintenance-free unless there is a major change like a new user or a new bank account. New beginnings can be a bit hectic, but if you work as a team with your new biller, the pain will be very temporary. Stay focused on two-way communication and participation in transition and your cash flow will thank you!
Lynda Hughes is a co-founder of Red House Medical Billing. She has been a dynamic entrepreneur in the RCM space since 2003. She is a certified coder and her work has spanned dozens of specialties, states, and facility sizes. She currently oversees all coding and billing operations for Red House. She has been active in AzPA as a sponsor for 5 years!