Medical Billing and SICKO's Impact

As a professional Medical Biller, I feel that it is my responsibility to stay current with our country's health care system and that does include the viewing of Michael Moore's movie SICKO - scheduled for release today, June 29, 2007. Regardless of one's political views, I encourage billers to place their (political) opinions on the back burner while viewing this film. Even if you have not been a fan of Michael Moore and his previous documentaries, the importance of seeing THIS Michael Moore's movie should be of great importance as an active member of the medical billing industry. Many of us can agree that our health care system is (politely) chaotic, regardless of where we fall in the political spectrum. Remaining a TOP medical biller requires staying current with ALL heath care news from ALL sources and sides. I happen to be a fan of Michael Moore and of his previous documentaries. I am sure that, like his last, Moore will offer his usual mix of cynical humor contrasted with piercingly sobering personal narratives, which brings both a chuckle and an "oh my" type of reaction. I understand that Moore traces the START of our health care crisis all the way back to the early 1970's to the presidency of Richard Nixon - pressured to launch the Health Maintenance Organization (HMO) system. That HMO system is the largest, internationally, of for-profit medicine. That HMO system is also the direct cause of phenomena like NO-insurance, UNDER-insurance and toppling health care standards. The direct result has been a continuous downhill tumble, crashing under the health care standards of similarly wealthy countries around the world - most of which have government sponsored and paid universal heath care structures. As many billers, I too hope to remain part of a solution toward improving the processing of healthcare claims and insurance follow up - ultimately getting practices paid. I love what I do. I especially love the glee evident on my client's faces while they witness the immediate, positive impact made to their practice by choosing to work with my medical billing firm and me. I, too, encourage billers to use this film as a conversation point with prospective clients - to point out where the system falls down in places where billers can pick things UP.

Medical Billing - OUTSOURCED; a Not-so SICKO option

I am very excited about the release of Michael Moore's documentary, SICKO, this Friday June 29! I am not only a member of the American general public who subscribes to an HMO Plan, I am also the owner of a Medical Billing Firm. Eligibility, Authorizations, Referrals, Diagnosis Codes, CPT Codes, Electronic Claim Submissions, EOB's, Payment Postings, Aging Tracking, Patient Statements, Claim Payments and Claim Denials, along with the ever-changing Insurance Carrier Rules are ALL part of my day-to-day world. Keeping up with Medicare, Medicaid, and all Other insurance carriers and their regulations is at a MINIMUM, a daunting task! I understand that the point behind Michael Moore's movie SICKO is to spark passions and cause debates nationally about the current state of our healthcare system (or there lack of) and to generate NEW, perhaps radical plans for our nation's future when it comes to healthcare. The primary reason that we, medical billers, are directly, often negatively effected by our weak healthcare system is due to to (a) the incapability of following the goings on and changes per specific insurance carrier nationally and (b) the difficulty in getting compensated for claims processed. Both the advantage to our medical billng clients and the CURSE of our own business strategy is that we DO NOT earn a dime until the practice is paid for services rendored for their patients. And, when (not if) claims are denied, we billers are faced with the frustrating task of follow up to learn the rejection reasons in order to REsubmit the original claim. See, what many don't realize is that on the busy CMS 1500 forms, each box requires DIFFERENT information according to each individual carrier. If ONE single piece is either missing or out of place, the claim is rejected. The EOB's don't offer a total explanation either in a lot of cases. This forces the tying up of phone lines ringing into these carriers from the 4 corners of the country every day of the week. The frustrated doctor and/or medical practice owner has more than likely undertaken this process for him or herself at one point or another. From those agravations of TRYING to get paid, they do one of 2 things; they either hault excepting health insurance entirely OR they seek an outsourced solution - a medical billing firm. Although I don't support or recommend that any practice owner stops taking insurance, especially in this economy, I certainly do appreciate the decision to do so. "Pocket money" even for health care or maintenance is simply NOT as readily available to the general population. People PAY for their insurance coverage and they will more than likely select a healthcare professional based on whether that practitioner accepts their health insurance or not. In fact, many practice owners who once had the luxury of NOT taking health insurance are returning to it being accepted due to their patient's financial circumstances - EVEN their own! This, of course, does WONDERS for my medical billing business. If it makes sense - and MOSTLY it does - practice owners should seek outsourced medical billers to fill the necessary filing process. It is SO much more cost-effective for that practice. Eliminating staff is neither recommended or an absolute necessity. There will always be a need for a front desk person AND a back office manager. Those folks have a lot of responsibilities BEYOND medical billing that should keep their jobs safe. Who would otherwise check patients in, verify elegibility and authorizations for visits, deal with the copier machine repair person, make sure all information is gathered for filing, help GROW the practice? The practice owners? Not likely! Their job remains as it should - to effectively practice good medicine. Medical billers ensure that happens and in fact, HELPS the general public receive the best possible care that they require and deserve by taking over this pain on behalf of practice owners. So, Michael Moore's movie SICKO points out the "issues" of our healthcare system, which is LONG overdue. Where do we go from here? I, for one, am determined to remain a part of the SOLUTION toward IMPROVING the state of our current system by accurately and effectively filing medical claims on my client's behalf. I look forward to learning other medical biller's feedback and reviews of the movie, considering OUR necessary positions in the healthcare industry. Share your comments here OR visit www.MedicalBillingFoundation.com. Many more opinions, suggestions and strategies will be offered there. All of us medical billing business owners should use the release of this film to our advantage by discussing it and pointing out how WE ARE part of the working solution!

SiCKO Shows Reality of Medical Biller's World

With the release this Friday (June 29) of Michael Moore's "SiCKO", audiences will get to see firsthand the vagaries of the U.S. health insurance system. Those of us in the medical billing field, who do our level best to process and advocate for appropriate payment to the doctors we represent, see the games the insurance carriers play every day.

Depending upon the day of the week, it seems, the rules change. What was supposed to be represented in each field of the CMS1500 one day, is unacceptable the next, requiring resubmission after resubmission. The payers know all too well that a significant portion of these rejected claims will fall by the wayside eventually. Hence the point of Moore's documentary.

And of course, the payers will rely on "government regulations" as the reason for modifications, clarifications (obfuscations, in fact). The reality, as SiCKO reflects, is that the massive lobbying community has a chokehold on the leadership of this country. Those new regulations that are fomented in a dizzying fashion out of Washington are, of course, absurdly beneficial to the insurance companies, but lawyered in such a way as to appear either (a) legitimate, or (b) completely hidden from view altogether until a rejected claim comes our way, illustrating the new rule.

The "When did THAT happen?" feeling we often get tends to make one unsure of one's professional abilities from time to time. Not to mention the doctor's frustration that payments for services rendered are increasingly questioned.

For medical billing professionals, this is not a do or die mission, but hopefully with the light shed by SiCKO, perhaps some of the lobbyists will not be quite as bold in the future, and more importantly, health insurance plans will be more accountable to the patient and to the medical practices in this country.

Donald Roche
The Medical Billing Foundation
http://www.MedicalBillingFoundation.com