April 2019
Spring Newsletter
Dear SMB Clients,  

Happy Spring from everyone at SMB. In this newsletter, we highlight the best ways to ensure up front verification is done prior to patient appointments and how to pick your vendors well. We hope you enjoy the newsletter and the warmer weather heading our way!

SMB Medical Billing
Upfront Verification
By: Cheryl Sands
One of the best ways you can help us is to make sure all the “up front” verification is done prior to seeing your patients. For example, ask these questions every time you see a patient:

  1.  Has your address changed?
  2.  Do you have new insurance or a new insurance card?

Then make sure we get a copy of anything new that has changed.

Also, keep a list of any insurance companies that require a pre-authorization or a referral. Before you see the patient, make sure to take care of that. This is important all the time, but especially before you plan to do a surgical procedure.

Making these calls up front may seem cumbersome, but it pays off in a major way in quick, seamless reimbursements.

Every time you see a new patient we need:

  1. A copy of all insurance cards. Be sure to mark which one is primary and which is secondary, etc.
  2. The patient’s demographic information
  3. The Superbill completely filled out**

**You would be surprised to find out how many times we get Superbills that have no diagnosis or CPT code circled or marked. This takes a lot of extra time to email your office and then wait for a response. Please get in the habit of checking the Superbill prior to sending it to us, which will save us all a lot of time, and once again, ensure prompt payments for you.

Are you getting notifications from your biller that you have a lot of claims on hold for “pending additional information”? This just means there is something missing that we need in order to get your claim paid.

Try and appoint someone in your office who is responsible for getting this missing information and responding quickly to these requests. We only ask if we really need something. Many times, we just need the name of the patient’s Primary Care Physician and the date they last saw them for their diabetic condition, etc. (Are you asking your Medicare patients for this each time?) When in doubt, just ask. If we don’t need it, we can ignore it, but it’s better to have the information than have to hold the claim up and wait for it.

One final thing – Collect all copays and open balances when the patient is standing in front of you. The best way to ask them for a copay (and past due balances) is right before they go in for an appointment. They owe the money so they should be ready and prepared to pay.

Thank you for your help in making this process flow smoothly. For the most part things go extremely well, and communication is great. But for the other 5% of the time, these hints above will really help us all.  
Pick your Vendors Well
By: Chad Bixler
Times are a changing again! Podiatrists need to look to their strategic vendors and determine the risks they represent to their financial well-being.

Cheap, plentiful money, massive investor largesse, along with Affordable Care Act incentives after 2009 has created a lot of risky healthcare vendors/organizations. These operations are risky for they lack a profitable and viable business model.

Phillip Lay in his February 19 th newsletter warned about the trouble ahead for new businesses that are still unprofitable. Read his article here . Health investor Halle Tecco has compiled a list of multiple healthcare businesses what she considers at risk.  Spreadsheet here . There also exists vendors that are public that merge because they do not have a viable business model.  See this article about Athenahealth.

The risks that vendors who lack a viable business model pose to their clients:
  1.  Cash flow – will you be able to make your payroll and pay your bills.
  2.  Loss of control – will you be able to control how and with whom you do business or are you locked into whomever acquires your agreement from your current vendor for an extended period of time.
  3. Wasted time – how much time will it take to select and learn how to use a new vendor.
  4. Wasted investments – how much money did you spend for the product and supporting computer.
  5.  Not being able to contact a vendor’s representative who knows your practice when your need is critical.

What to look for when considering a vendor:
  1. Are they profitable?
  2. How much debt is the vendor saddled with and how does it compare with their current revenue stream?
  3. What are the vendor’s performance standards?
  • Do they submit claims daily?
  • Do they have extensive experience with podiatry medical billing?
  • Are the billers personally assigned to your account?
  •  Do the billers have backup in case they are sick?
  • Does the vendor have a 3% net 90 day and 1% net 120 day accounts receivable track record?
  • Do they seek your permission prior to write-offs?
  • Do they perform as promised – Always get references

Pick your vendors well and may your practice thrive. 
SMB Medical Billing | 1-888-874-5503 | chad@pendoprocessing.com