Ahh, the old days . . . remember them? Madelon Berger, MPH, MA, President of Bill of Health Services, Inc., does. "When I started Bill of Health in 1984 . . . coding wasn't required, and most claims were submitted on paper. Yes, it took longer to get paid, but in most cases you could submit a claim and, after a deductible was met, you would be paid 80 percent of your charges."

The medical world couldn't possibly be more different now. Today's market has become an alphabet soup of plans—HMOs, PPOs, PPMs, IPAs, MSOs, PHOs, etc. Each model puts more risks on the physician, and in every one, the risk sharing is a little bit different. "Healthcare has become so complicated today, it's almost as if you need an MBA to practice medicine, in addition to your MD," Berger said.

Tracking the varying requirements of different plans can be daunting. How can physicians be sure they are submitting claims that will optimize their collections? How can they know if they are availing themselves of every opportunity to generate income for the work they perform? How will they develop the data they need to negotiate the best contract possible with managed care organizations, one that will make money for the practice?

This is exactly why a company like Bill of Health Services, Inc., can make such a tremendous difference to the financial well being of a practice. According to Berger, Bill of Health offers so much more than simply generating bills. Bill of Health acts as a business partner to the medical practice-tracking the administrative details and requirements of managed care plans, analyzing claims and following up on issues to optimize reimbursement for services, and collecting and providing data that physicians need to keep control over the business of their medical practices.

Bill of Health Services, Inc., specializes in medical insurance billing and capitation analysis. The corporation provides efficient services to professionally manage insurance and patient billing and follow-up, minimize office administrative work, and enhance cash flow. A charter member of the International Billing Association, Bill of Health Services, Inc., has grown over the years primarily through the recommendations of its satisfied clients.

So, how can Bill of Health help your practice? First and foremost, with the expertise to optimize your collections through the submission of clean claims. "One of the keys to substantiate what you are doing is proper coding," Berger said.
Correct and specific coding, code agreement between diagnoses and procedures, and appropriate use of modifiers will all help enhance reimbursement. Bill of Health's job is to make sure these and other coding details are correct before claims are submitted. "We are really a second set of eyes for your claims, to make sure they are submitted properly," Berger said.

Bill of Health can also help you make more efficient use of staff time by handling necessary interaction between your practice and managed care companies and insurers and following up on outstanding issues or problems. By establishing liaisons with the major companies, Bill of Health can often get answers to critical questions more quickly and easily than a practice staff member.

"Follow-up on claims is also such an important aspect of billing. There's so much money that can be in your accounts receivable, and many times office staff don't have the training or the time to call. This can lead to a financial crisis situation. We work with the fee schedule from your contract, so we know what needs follow up or what is being underpaid."

Finally, Bill of Health can also help you by managing the data generated in the practice and providing the physician with the information he or she needs for various reasons, such as negotiating successful contracts with managed care companies. "If you are about to negotiate with a carrier for a new contract, you have to know costs and utilization patterns. You don't want to join an HMO or a capitation plan and find out 6 months later that you are losing money on every patient you see."

The benefits to be gained by taking advantage of Bill of Health's expertise are truly significant, according to Berger. "Outsourcing your billing will allow you to focus on practicing medicine again."