Managed Care is Made Manageable

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If you are reading this, then you must have heard that Medical Insurance Billing is one of the hottest businesses of the 90’s. Various magazines, books and news reports have described Medical Insurance Billing as one of the best home-based businesses of the 90’s as well. It is recession-proof, requires a relatively small financial investment and can generate a lucrative income. Most importantly, this field offers security in today’s frightening job market. Is working from home something you really want? Do you want to be your own boss? Work your own hours? Be employed yet still attend your son’s Little League game or your daughter’s ballet recital? Perhaps you are ambitious; wanting to run your own small company. With Medical Insurance Billing, the sky is the limit. You can work as little or as much as you want. So, what does it take to achieve these goals? KNOWLEDGE! A comprehensive understanding of the medical insurance industry. What are the requirements? At the top of the list is, of course, drive and determination. Working for yourself has many rewards, such as flexibility, a true sense of personal accomplishment and unlimited income potential. However, these rewards do not come easily. If so, everyone would do it, right? It takes a certain personality to start your own business. Although sales experience is not required, a salesperson’s personality is essential to success. You must sell your services, which means SELLING YOURSELF. The main ingredient in a successful sales personality is CONFIDENCE. And CONFIDENCE is due to KNOWLEDGE. Remember when you were in school and had stayed up all night studying for an important test? Remember that great feeling of self-confidence you felt walking into class, just knowing that you were going to do well? It is the same with running your own business. If you are going to convince someone, especially someone in the medical professional, to trust you with their livelihood, then you should know what you are talking about! First, let me introduce myself. I have been in the healthcare profession for over 10 years. I have worked as a medical insurance biller, office manager and outside medical office management consultant to various physicians and hospitals in New York, Florida and California. As well as having vast experience inside the medical office, I presently own a Medical Billing Service in Southern California. I decided to embark on this project at the urgings of several friends who were also interested in starting their own billing services, yet had become frustrated at the investment choices available. Each individual had their own reasons for wanting to work at home ranging from pregnancy to career burn-out; yet they all had one thing in common -- lack of financial ability to invest thousands of dollars in a business they knew nothing about to begin with! I knew of course, that it was possible to start a billing service with much less. Therefore, I was persuaded to share my own experience and KNOWLEDGE. Who better to educate others in starting a Medical Billing Service, than someone who has done so? The first thing I did was to research the various “business opportunity” options I found advertised in several magazines and newspapers. I was curious as to what these companies offered for the required “investment." After conducting my inquiries, I was further convinced of the necessity for


an alternative. The information I received contained numerous charts and graphs explaining how Electronic Claims Processing works. Upon further examination, I found that their brochures concentrated mainly on just that subject -- Electronic Claims Processing of Medical Insurance Claims. They suggested that by using their billing software and marketing techniques, one could make thousands of dollars strictly processing claims electronically! I located people that had used some of these companies and asked what they had actually received for their large financial investments: Medical Billing Software -- one of the various software programs available, each with its own bells and whistles depending upon price. They will have you believe that “their” software is unique, that it can do things no other software can do. Rest assure, they all do the same thing, process medical claims! Some of these software packages are capable of handling extremely large billing centers, such as those that process claims for hospitals. When and if you are interested and ABLE to expand your business to that level, then of course, purchase this software. However, when you are just starting out, have no experience or working knowledge of this business and have no clients, it is absolutely ridiculous to own this kind of software! I do billing for 12 doctors and still am not in need of this kind of software. Let me give you an example: You decide to take up skiing as a sport. Would you spend hundreds of dollars on the most expensive, top of the line skis, poles, boots, ski outfit, etc... before you had even taken a lesson? How do you know that you will like it or be any good at it to begin with? Will purchasing the most expensive equipment and clothing enable you to ski any better? Of course not! Only a good teacher and your willingness to learn will do that! Just because it LOOKS better does not necessarily mean that it IS better! Another problem with these software companies is that they place almost total emphasis on the ability to perform Electronic Claims Submission. ALL new medical billing software contains the ability to submit claims electronically, using a Clearing House. As for selling you the idea of doing this as a business, let me enlighten you. Yes, electronic claims submission is faster and far more cost-efficient than paper billing. The goal of the insurance industry is that eventually all medical claims will be processed this way. Unfortunately at present, many insurance companies still do not accept claims in this manner. You cannot electronically bill worker’s compensation or personal injury cases, as well as most small managed care companies. Even with the larger commercial insurance companies, I have been told to submit claims by paper because they were having trouble receiving their claims electronically. Electronic billing is still fairly “new” to many insurance companies, even though it has existed for years. It is becoming more widespread since Medicare mandated that claims received electronically would have priority and be paid first. Like all new technology, there are many “bugs” in electronic billing that everyone still has to work out. The clearing houses, themselves, are still learning! “Putting all of your eggs into one basket” by specializing in only one aspect of a highly diversified field is extremely impractical, unrealistic and downright risky! Personalized Training of the Software -- some companies offered software training by video; others by making you travel (at your own expense) to their headquarters for one to four days. Those companies provided hotel accommodations and ground transportation once you arrived. That’s very nice. Again, the training is geared towards electronic claim


submission, not actual medical billing. Had they learned anything about billing specifically for the different insurance companies, or the specialized formatting necessary to bill electronically for Medicare, Medicaid and Champus? NO! They were told that they would learn “on the job." Most doctors I know would prefer if you knew what you were doing before you take control of their bread and butter! Technical Support for your Software -- anywhere from 30 days to one year, depending again on how much you have “invested." After the support contract for your very expensive software ends, you are on your own or must purchase another very expensive support contract. Personalized Sales and Marketing Techniques -- Usually another two or three days at their headquarters, staying at their lovely hotel and using your valuable vacation days. Geared again, towards marketing electronic claims submission and not full-service billing. I found this part very interesting. They are suggesting that you approach physicians and sell them on the idea of submitting their medical claims electronically. BIG DEAL! In order to electronically submit a medical claim, the patient data and daily charges are still required. If you are solely “downloading” the information from the physician’s computer, providing that is possible to begin with, the physician still has to pay someone in his office to input that information. Why should the physician hire another person to submit those same claims electronically? Electronic claims take only minutes to create! That same staff member could easily do it themselves. Why, then are there so many physicians still not doing electronic billing? There are three main reasons: Office #1 Office #2 The software they are currently using does not have the ability to transmit claims electronically. Although not difficult, electronic billing does take training and time to learn. Many office billers do not have the time or desire to “learn something new." The medical office may not have found its way into the “computer age” and may still be doing their billing on a word processor or even worse, TYPEWRITER!

Office #3

An experienced, full-service medical biller can come to the rescue for any of these situations. Not only can you offer the physicians all the benefits of electronic billing, but you can also replace an entire employee, which is cost-efficient. Due to Managed Care, HMO’s and PPO’s, physicians are being forced to downsize their office staff in order to cut operating costs. The more services you can offer, the better sales potential you have. Become one of THEIR Billing Centers - WHY??? This is their way of maintaining control over you. You sign a contract, become dependent on them for information and keep extending those expensive support contracts. Some companies even control which “territory” you may solicit business from in your own area! You can only use “their” clearing houses, because they are receiving monetary compensation for every claim submitted electronically through one of “their” billing centers.


Various Graphics, Brochure-Producing and Invoicing Software Programs -- all of which are available at your local computer store priced from $29.00-700.00 depending upon how technical you want to get.

A PERSONAL GUIDE TO MEDICAL BILLING is unlike any other self-help book available today. I will walk you through the entire process of starting your own Medical Billing Service. My approach is both personal and humorous as I “show you the ropes” to building a profitable service. Unlike many other companies offering a “business opportunity” for an investment of thousands of dollars, A PERSONAL GUIDE TO MEDICAL BILLING teaches you what Medical Insurance Billing really consists of. You must understand the terminology and process of medical insurance billing before you can start to do the work. There is much more to this business than owning a computer and some software. Key points covered in the Guide and are:
          An understanding of the actual medical insurance claim process. An understanding of the medical office, personnel, forms used in the office and for medical billing. Terminology used in medical billing. Introduction to the different types of medical insurance and billing techniques for each. The different code books, seminars and literature necessary for maximum reimbursement. The tools required to operate a billing service and how to purchase them. Identify the various areas of medical billing and how they differ. Paper and electronic billing How to successfully market your billing service to the “right” clientele. Explore the various services your business can offer and how to charge accordingly.

Here’s what I have to offer:

A PERSONAL GUIDE TO MEDICAL BILLING - A unique, self-help reference guide and
about the medical insurance industry and starting your own billing service from home. Find out what medical insurance billing really is and understand what it is you are doing. Learn the “tricks of the trade," how to bill for maximum reimbursement and how to deal with denied or pending claims. Learn about patient insurance verification, insurance follow-up calls, coding problems. How to file worker’s compensation and personal injury claims. How to deal with attorneys and liens. Along with teaching you the intricacies of Medical Insurance Billing, this guide also shows you how to market your business successfully. These are proven techniques that I have personally used to increase my clientele. There is one thing essential for any sales and marketing strategy to prove successful, and that is KNOWLEDGE. You will be dealing with professionals who have years of training in their field and expect the same kind of professionalism from you. Physicians are interested in the person who will be handling their finances, not the


software program they use. It is assumed that you are using a workable billing system! At the end of the month, the concern is with payments that have come in and payments outstanding. Do not be mislead into thinking that physicians do not have any interest in their billing. This is their income! Whichever member of the medical office staff you meet with regarding your services, rest assured they will be experienced in medical billing and will know if you are, as well. As for the software necessary for producing these marketing materials, you may realize that you already own them. If not, you will learn what software programs to purchase. These are very important aspects of the medical billing field and knowledge of them is vital if you are to become successful. The only way to be truly successful in this business and to beat out your competition is to be able to offer more services and better quality of service to your clientele. Why should a physician hire someone to solely process electronic claims, when there is someone who can offer full-service billing? Someone who can take complete control and allow the doctor to concentrate on their patients. The full-service biller who has the most knowledge and ability to maximize the practices’ reimbursements will always prevail. MEDICAL BILLING SOFTWARE - I have researched various medical billing software programs and have found MediSoft Advanced Patient Accounting® software to be both inexpensive and user-friendly. Because of the built-in tutorial and the comprehensive manual, it is one of the most popular billing software programs and is utilized by many medical and dental offices in the United States. For those who require additional help with the software, MediSoft holds weekly training classes in various cities across the nation. If traveling to a class is not possible, there is a Video Training Seminar (three tape video training library) available. Of course there is always the top-notch technical support available. I believe that every individual is different. Some may read the manual, practice on the tutorial for a couple of hours and feel comfortable to begin using their software. Others may require more training and feel a class or the video training library is necessary. Whichever your case may be, the choice is yours, ensuring you need not spend money unnecessarily. My goal is to provide you with an honest, informative approach to the Medical Billing business and to lead you towards success, not debt. MEDISOFT ADVANCED PATIENT ACCOUNTING® SOFTWARE: MediSoft Advanced Patient Accounting® is accounts receivable, insurance billing, and practice management software designed for all types of healthcare practices and billing services. MediSoft Advanced eases a healthcare practice’s patient accounting tasks and provides precise information to aid in more effectively managing any practice. MediSoft Advanced is the product of many years of refinement, relying on practices using the program to recommend changes to make their job easier. MediSoft Advanced delivers state-of-the-art features with unparalleled ease-of-use. It works like a healthcare practice works, following the same simple steps as a manual accounting system.

Accounting is Simpler


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Open item accounting makes it easy to match payments to individual charges. Know exactly what hasn’t been paid. Patient ledgers show complete patient account activity including charges, payments, and account adjustments. Reviewing a patient account is faster with the on-screen ledger window. Patient and insurance aging reports easily pinpoint past-due patient and insurance payments. Patient statements may be produced on attractive, standard business forms or customdesigned in just the right format with the report designer. Reduce patient account inquiries by holding patient statements until all of a patient’s insurance has paid. It’s automatic with the patient remainder billing. With multiple fee schedules, up to twenty-six prices may be stored and recalled for each procedure. Payments automatically match charges using payment application.

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Practice Management is More Effective
Charge, payment and account adjustment information on the practice day sheet makes closing a day fast and accurate. The practice analysis report guides and informs with information on procedures performed, payments received, and accounts adjusted for any period including a day, month or year. When a practice depends on referred patients, the patient referral report pinpoints these important sources of revenue. Scheduling appointments is a snap with Office Hours, the patient scheduling program included with MediSoft Advanced. Scheduling patient recall reminders for one visit or a series of visits needed for tasks like calendering a child’s immunization schedule is easy with the recall system. Patients can be informed of recall appointments with custom-designed post cards, or recall information may be exported for use in letters from your word processor. Billing information is secure in MediSoft Advanced. Powerful security is built into the program to prevent unauthorized access to sensitive information. Office managers can easily review changed or deleted billing data on the audit report. An extra user-defined screen of patient information is available for tracking special information like immunizations, prescription medication or research data. Use it to define your own special data fields. Tracks each patient’s last visit date to make contacting patients for periodic care easy and automatic. Design reports, write personalized form letters, and more with the report designer.

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Insurance Billing is Fast and Accurate
 Stores information for billing virtually every type of health insurance including private commercial insurance, Medicare, Medicaid, CHAMPUS, Blue Cross and Blue Shield, Worker’s Compensation, auto insurance for personal injury cases, and many others. Prints HCFA-1500 insurance claim forms. Custom claim forms are easily created with the report designer. Software updates to meet new insurance carrier requirements are readily available. The billing/payment status report makes it easy to track down claims that have not been sent to insurance carriers. Insurance billing stays timely and accurate. Turn up your cash flow with electronic claim submission. Clearing house electronic claims software is included with MediSoft Advanced to send claims for most carriers. Using a clearing house can prevent errors, reduce rejections and shorten payment times. Depending upon the location of your practice/business, claims for Medicare, Medicaid, Blue Cross/Blue Shield and commercial insurance may be submitted through a clearing house. MediSoft Advanced is compatible with MediSoft Electronic Claims Direct software to send electronic claims directly to selected insurance carriers.


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Easy to Learn and Use
 Search to quickly find patients, procedures, diagnoses, insurance carriers, or other information stored in the program. If you know the name, you can easily find the code. Pop-up code entry windows for setting up or correcting patients, procedures, diagnoses, insurance carriers and more, are available anywhere a code is needed. Pop-up help windows explain every screen in the program. MediSoft Advanced is its own computer expert.

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Managed Care is Made Manageable
 MediSoft Advanced tracks the number of visits allowed and the number of visits used in a treatment series. Visit information displays on the transaction entry screen and may be printed on insurance claims, statements and reports. Handles PPO patients with a fixed amount copayment easily and efficiently.

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Help is On the Line
Any software is only as good as the support it receives and MediSoft’s support is topnotch. The MediSoft technical support staff is available on an extended schedule to answer questions and solve problems for MediSoft Advanced.



MediSoft training seminars are presented every week in major cities across the country. Seminars are hosted by experienced MediSoft experts to make each training day as productive as possible.

Real Windows Software for Real Productivity  Multi-tasking features let you work on several things at once. Enter data, print
reports, and schedule appointments without stopping what you’re doing.

 Print reports, claims and statements on any Windows-compatible printer. Attractive,
engaging shapes, fonts and colors are all available on your reports.

 Share data with other programs because all your information is stored in a standard
database format.

 Standard Windows menus and shortcut buttons give fast access to very function of the

 MediSoft Advanced works like your other Windows programs so it’s easier to learn. MediSoft Bar Code Data Entry
Data entry speed and accuracy are enhanced with the optional MediSoft Bar Code Data Entry system for MediSoft Advanced. With the bar code system, MediSoft Advanced has the ability to print bar coded encounter forms and accept date entry from a bar code reader wand. Each provider is assigned their own superbill, making multi-specialty billing easier. An encounter form accompanies each patient during their visit and is used when checking out the patient at the front desk, or by the billing service upon receipt of the encounter forms from the physician’s office. The included bar code reader wand is used to scan bar coded procedure and diagnosis codes from the encounter form along with the patient chart number, service date and document number to complete the date entry in MediSoft Advanced to bill for the visit.

Procedure and Diagnosis Codes on Disk
With the optional Codes on Disk package, you get procedure and diagnosis codes for over twenty different healthcare specialties automatically installed in MediSoft Advanced. Have the most current code database for your specialty ready to use without typing.

Multi-User/Network Version
This version of MediSoft Advanced supports multiple simultaneous users on popular local area network systems. Networks supported include Windows, Lantastic, Novell and many others.

Windows System Requirements: Pentium 133 or faster processor, 32mb RAM min., Window 95 or later operating system, any supported Windows display and printer, modem for electronic claims submission.


Now that you have seen what MediSoft® features, you can see that there is not much difference between it and the other medical billing software programs, except COST! It is true that certain software programs were designed for specific use in a doctor’s office while others designed specifically for use in a billing service. MediSoft® was originally designed for a doctor’s office, and it’s because of this, that the software works well for a billing service. What you are doing is managing the practices of various doctors and MediSoft® can hold up to 99 different ones. It is user-friendly and very easy to train staff on, which is an essential element as your business expands and you begin to hire employees. As for other software programs necessary for producing marketing brochures and invoices, these can be purchased from your local computer store ranging in price from $29.95 to $700! At least you are in control of the decision, as it should be! There is always room to improve and grow when you operate your own business. Becoming a successful entrepreneur means having business savvy and knowing when and how to spend your money, especially in the beginning. Many small business fail within the first year because their owners were unrealistic and did not pace themselves, allowing their enterprise to gradually pay for itself. There are many other expenses that you will incur when starting out besides software and training, so do yourself a favor and do not “put all of your eggs into one basket!” There are many different packages you can purchase, depending on your financial ability. You can always add on after you have started your business and see what you really need. Please call DK Medical Services at (949) 459-6789 for details and pricing of Medisoft packages. Well, the decision is now yours. If you have decided to get into one of the “hottest homebased business opportunities of the 90’s," then make certain you start out with the right materials. That means having a good medical billing software program that is userfriendly and provides top-notch technical support, which MediSoft® clearly does. I wish you luck and success in your entrepreneurial endeavors! Copyright© DK Medical Services 1995