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Med Monthly MAGAZINE

September 2017

The Great Medical Billing Debate:


In-House or Outsourcing? pg. 22


Medical Billing:

Partnering for Success pg. 32


The New l “Medica Billing” issue







MEDICAL BILLING: Partnering for Success

practice tips 6





More than ever, businesses are being audited by government agencies. OSHA DOL ACA INS HHS IRS ARE YOU PREPARED? l Free Business Evaluations l Free Initial Assessment l Complete Readiness Report



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Professional Listing In addition to the benefits in the standard listing our Professional Listing affords you access to services provided by our expert legal and marketing team and a Bizscore Practice Valuation. This valuation compares your practice with other practices in your area, provides projections and determines what your practice is worth.

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919.848.4202 |

Physician Solutions, Inc. Medical & Dental Staffing

Physician Solutions can help match you with dental opportunities that fit your professional and personal goals. We are now hiring dentists and dental hygienists in North Carolina, Florida, Georgia, Kentucky, South Carolina, Tennessee and Virginia. Ongoing and intermittent shifts are available, as well as permanent placement.

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Scan this QR code with your smartphone to learn more.

Med Monthly September 2017 Publisher Creative Director Contributors

Philip Driver Thomas Hibbard Naren Arulrajah Nidhi Vats Behl Kaci Durbin, M.D., FACOG Michelle L. Durner, CHBME Vishal Gandhi, BSEE, MBA Nick Hernandez, MBS, FACHE

contributors Naren Arulrajah is President and CEO of Ekwa Marketing, a complete Internet marketing company which focuses on SEO, social media, marketing education and the online reputations of Dentists and Physicians. If you have questions about marketing your practice online, call Naren direct at 877-249-9666.

Nidhi Vats Behl is an experienced professional with more than 6 years, in Healthcare industry with renowned organizations like: Fortis & Aditya Birla. Currently she is working as a freelance copy writer.

Kaci Durbin, M.D., FACOG is a board certified obstetrician and MBA candidate. Since leaving private practice last year, she has served as obstetrical hospitalist director at St Anthony’s Medical Center in St. Louis. Med Monthly is a national monthly magazine committed to providing insights about the health care profession focusing on practical advice for physicians and practices. We are currently accepting articles to be considered for publication. For more information on writing for Med Monthly, please email us at

P.O. Box 99488 Raleigh, NC 27624 Online 24/7 at

Michelle L. Durner, CHBME is the President of Applied Medical Systems, Inc. – a Durham, NC-based company which provides revenue cycle management, coding, practice management, and consulting services to start-up practices, hospitals, private practices, and hospital based physician groups across the nation. To contact Michelle or to learn more about Applied Medical Systems, visit

Nick Hernandez, MBA, FACHE is the CEO and founder of ABISA, a consultancy specializing in solo and small group practice management. He has consulted with clients in multiple countries and has over 20 years of leadership and operations experience. Visit for more information. MED MONTHLY MAGAZINE |5

practice tips

3 Factors to

Consider When Merging Practices

By Vishal Gandhi, BSEE, MBA Founder and CEO

The reasons medical practices merge with one another have been pretty much the same for the past 20 years. Among them are acquiring more medical expertise, office space and purchasing power, increasing the volume of existing and new business, and having access to a stronger administrative model. Be that as it may, the stakes are high and there’s enormous urgency on recently blended practices to accomplish immediate cooperative objectives to insure healthy mutual financial returns. Three basic



factors must be taken into account before the merger happens in order to make positive returns possible. 1. Physician Leadership. A practice is only as good as its lead doctor or doctors. This is the human capital to take into account when merging practices. At the point of the final merger when individual doctors combine their practices, one unavoidably will assume the role of the practice leader and the others will play secondary parts in the practice’s leadership. To make the

merger fruitful all must be in agreement on practice leadership to survive and flourish as a combined unit. 2. Investment of Partners. If you have an administration assignment in a medical merger, you’re a partner. If you’re a shareholder, then you’re also a partner. Furthermore, if you’re a staff doctor, then you’re a partner. Partners incorporate everyone from practice administrator and support staff to the lead doctor. Any specialist or lawyer who handles mergers and acquisitions will reveal to you that getting the upfront investment of partners is basic to accomplishing a successful merger. While this doesn’t necessarily recommend a law based process where representatives must approve the merger, it does call for an insightful, proficient process that incorporates communication and training for all individuals of the practices involved well ahead of the acquisition’s finalization. 3. Shared Culture. At the point when two medical practices blend, they don’t simply consolidate their financial earnings; they

also acquire offices, hardware, supplies, workforce, plans, and a variety of different components as the practices combine. The merger of healthcare offices is made much more perplexing by the nearness of the doctors, who are the proprietors, each possessing their own values and methods. Doctors bring their own clinical aptitude, medical expertise, and hard working attitude to the merger. They likewise bring their inner selves; personal feelings, numerous self-imposed professional goals, and, every so often, psychological or behavioral baggage. All should be taken into account before the merger happens to avoid future problems. Medical practices considering a merger as a viable business option need to understand their success depends on the leadership of their doctor(s), the upfront investment of all partners and a smooth transition into a combined culture pleasing to both practices. By using these three basic factors, medical practice mergers can start strong and find their combined efforts create a better and more profitable whole for all parties involved. 


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practice tips

Concerns Over Side Effects of Statins Stopping Stroke Survivors Taking Medication


“These findings have highlighted the need for an open, honest dialogue between patients and/or their carers, and healthcare professionals.” - Anna De Simoni



Negative media coverage of the side effects associated with taking statins, and patients’ own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially life-saving drugs, according to research published today. Individuals who have had a stroke are at risk of a second stroke, which carries a greater risk of disability and death than first time strokes. In fact, one third of all strokes occur in individuals who have previously had a stroke. To prevent this recurrence, patients are offered secondary preventative medications; however, adherence is a problem with 30% of stroke patients failing to take their medications as prescribed. To examine the barriers to taking these medications, researchers at the University of Cambridge and Queen Mary University, London (QMUL), analysed posts to TalkStroke, a UKbased online forum hosted by the Stroke Association, across a seven year period (2004-2011). The forum was used by stroke survivors and their carers. The team, led by Dr Anna De Simoni, a lecturer in Primary Care Research at QMUL and visiting researcher at the Department of Public Health and Primary Care, University of Cambridge, has previously used the forum to explore issues such as the impairment that can make it difficult for stroke survivors to maintain a job. The findings of the study, which looked at posts by 84 participants, including 49 stroke survivors and 33 caregivers, are published today in the journal BMJ Open. The Stroke Association gave the researchers permission to analyse the results, and to prevent identification of

individuals, the team did not use verbatim comments. Among the reasons cited by the forum users, side effects were a major factor in decisions to stop taking medication. Several contributors had experienced negative side effects and as a result had stopped taking the medication, sometimes in consultation with their GP and other times unilaterally. Others reported that they, or the person they were caring for, had stopped taking the medication after reading negative stories in the press about side effects. Other users expressed concerns over the medication they were offered. There were conflicting views about the efficacy of the medications – some contributors believed they were very important, while others believed that their risk could be managed by lifestyle changes alone. Contributors also reported mixed views of healthcare professionals – some felt confident in their doctor’s decision, while others questioned their decisions, some even questioning their motivation for prescribing particular drugs. “These findings have highlighted the need for an open, honest dialogue between patients and/ or their carers, and healthcare professionals,” says Dr De Simoni. “Doctors need to listen to these concerns, discuss the benefits and drawbacks of taking the medication, and be willing to support a patient’s informed decision to refuse medications.” However, perceptions did not present the only barriers to adherence: there were often practical considerations. Drugs

were sometimes too large and difficult to swallow, or a drug regime was too burdensome. The complexities of the drug regimens sometimes meant having to develop routines and strategies to ensure patients kept to them. One survivor described having to pay for the medications by credit card as she was unable to work and had no money or benefits coming in. “By analysing people’s views as expressed in online forums, where they are more open and less guarded, we’ve seen some valuable insights into why some stroke survivors have difficulty adhering to their medication,” says PhD candidate and first author James Jamison from the Department of Public Health and Primary Care at Cambridge. “Challenging negative beliefs about medication and adopting practices that make routines for taking medication simpler, particularly for those patients who have suffered disability as a result of stroke, should increase adherence and ultimately improve health outcomes.” The research was supported by the National Institute of Health Research, the Stroke Association and the British Heart Foundation. For more information about statins, visit NHS Choices.  Reference Jamison, J et al. Barriers and facilitators to adherence to secondary stroke prevention medications after stroke: Analysis of survivors’ and caregivers’ views from an online stroke forum. BMJ Open; 19 July 2017; DOI: 10.17863/CAM.10458 Source: http://www.pressreleasepoint. com/concerns-over-side-effects-statinsstopping-stroke-survivors-takingmedication MED MONTHLY MAGAZINE

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practice tips

Five Ways Physicians Can Better Communicate With Staff

By Nick Hernandez, MBA, FACHE CEO and Founder of ABISA 10


Effective physician leaders are effective communicators. They express themselves well both orally and in writing. Furthermore, they project an image of self-assurance and of understanding. These attributes are continuously communicated by their actions and demeanor. Effective communication is also important because a large portion of a physician’s time is spent communicating with others. A physician’s day is filled with face-to-face communications with patients, patients’ families, employees, and referring physicians. Here are five ways physicians can improve their communication skills when interacting with staff: 1. Be open and approachable. Physician leaders must communicate an aura of approachability. If they do not, their employees will be reluctant to tell them of potentially dangerous situations because of their fear of harsh rebuke or excessive punishment. As a leader, physicians don’t only lead; they must also stay open and listen. Put people at ease and listening intensively when communicating with team members. Ensure to make eye contact, smile, and ask open-ended questions. Once you have eye contact down, make sure to have an open posture when others approach you. An open posture means your shoulders are square and you are still. This can be difficult, because your natural tendency may be to look down or scrunch your shoulders together. 2. Focus on clarity. People cannot be led if they cannot understand what the leader says, means, or expects. There is no place for ambiguity in practice management. Clear direction is a critical dimension of practice climate. When people understand the mission, values, standards, and expectations of the practice, they can do what needs to be done. A lack of such understanding leads to false starts, ineptness, and discontent. Every practice changes priorities as the needs of the business change, but if priorities have no real meaning, and the rules change without conscious planning and intentional explanation, it muddies decision-making and slows down momentum. Employees get worn down and cynical. 3. Explain your reasoning. When communication is effectively used, people do not feel like pawns. Rather, they understand and subscribe to the goals and values of the practice and feel empowered, not dominated. When the reasons for orders are not apparent, the

likelihood of the orders being disregarded increases. Confrontation can paralyze your efforts, so avoid head butting. Additionally, always be thinking about new ways to show your staff you appreciate them and celebrate their successes. Highlight triumphs in staff meetings. 4. Take the quality and sanctity of communication seriously. Despite the proliferation of communication tools, sometimes you just need to meet with your team face to face, in a group. Physicians can share information with staff through regularly scheduled meetings. They can inform team members of upcoming events so people can plan ahead. Even trivial rumors must be squelched, as the transmission of accurate information is vital. Making sure your staff has common goals and are working together (even when working on separate projects) is crucial to the success of your practice. In other words, if employees don’t have a clue what their co-workers are doing, it is likely that projects may overlap or interfere with one another, ultimately causing productivity to decline and perhaps hindering project growth. 5. Pay attention to reactions. One thing great communicators have in common is their heightened sense of situational and contextual awareness; they are great listeners and astute in their observations. When they talk to team members, outstanding physician leaders watch the expressions of those in the audience to be sure they are taking in what is being said. Where there is any doubt, physicians must ensure understanding by making a clearer restatement or requesting that an employee repeat the message in his own words. Important oral communications are sometimes followed up in writing to ensure uptake and understanding. It might seem easy, but communicating effectively actually takes quite a bit of finesse. George Bernard Shaw is quoted as having said, “The single biggest problem in communication is the illusion that it has taken place.” Indeed the office can often be rocky due to poor communication. Effective communication is a necessity for positive and productive workplace interactions. Becoming a more effective communicator will not only make your employees more motivated and productive, but will also have a positive effect on your practice environment. 


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U.S. OPTICAL BOARDS Alaska P.O. Box 110806 Juneau, AK 99811 (907)465-5470 cbpl/ProfessionalLicensing/DispensingOpticians.aspx

Idaho 450 W. State St., 10th Floor Boise , ID 83720 (208)334-5500 aspx?Bureau=OPT

Arizona 1400 W. Washington, Rm. 230 Phoenix, AZ 85007 (602)542-3095

Kentucky P.O. Box 1360 Frankfurt, KY 40602 (502)564-3296

Arkansas P.O. Box 627 Helena, AR 72342 (870)572-2847 California 2005 Evergreen St., Ste. 1200 Sacramento, CA 95815 (916)263-2382 Colorado 1560 Broadway St. #1310 Denver, CO 80202 (303)894-7750 Connecticut 410 Capitol Ave., MS #12APP P.O. Box 340308 Hartford, CT 06134 (860)509-7603 ext. 4 asp?a=3121&q=427586 Florida 4052 Bald Cypress Way, Bin C08 Tallahassee, FL 32399 (850)245-4474 Georgia 237 Coliseum Dr. Macon, GA 31217 (478)207-1671 plb/20 Hawaii P.O. Box 3469 Honolulu, HI 96801 (808)586-2704

Massachusetts 239 Causeway St. Boston, MA 02114 (617)727-5339

Oregon 3218 Pringle Rd. SE Ste. 270 Salem, OR 97302 (503)373-7721 Rhode Island 3 Capitol Hill, Rm 104 Providence, RI 02908 (401)222-7883 php? page=DetailDeptAgency&eid=260 South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4665

Nevada P.O. Box 70503 Reno, NV 89570 (775)853-1421

Tennessee Heritage Place Metro Center 227 French Landing, Ste. 300 Nashville, TN 37243 (615)253-6061

New Hampshire 129 Pleasant St. Concord, NH 03301 (603)271-5590

Texas P.O. Box 149347 Austin, TX 78714 (512)834-6661

New Jersey P.O. Box 45011 Newark, NJ 07101 (973)504-6435 home_page

Vermont National Life Bldg N FL. 2 Montpelier, VT 05620 (802)828-2191 opticians/

New York 89 Washington Ave., 2nd Floor W. Albany, NY 12234 (518)402-5944

Virginia 3600 W. Broad St. Richmond, VA 23230 (804)367-8500 HAS-Opticians/

North Carolina P.O. Box 25336 Raleigh, NC 27611 (919)733-9321 Ohio 77 S. High St. Columbus, OH 43266 (614)466-9707

Washington 300 SE Quince P.O. Box 47870 Olympia, WA 98504 (360)236-4947 aspx


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U.S. DENTAL BOARDS Alabama Alabama Board of Dental Examiners 5346 Stadium Trace Pkwy., Ste. 112 Hoover, AL 35244 (205) 985-7267 Alaska P.O. Box 110806 Juneau, AK 99811-0806 (907)465-2542 cbpl/ProfessionalLicensing/BoardofDentalExaminers.aspx Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 Arkansas 101 E. Capitol Ave., Suite 111 Little Rock, AR 72201 (501)682-2085 California 2005 Evergreen Street, Suite 1550Â Sacramento, CA 95815 877-729-7789

Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 Idaho P.O. Box 83720 Boise, ID 83720 (208)334-2369 Illinois 320 W. Washington St. Springfield, IL 62786 (217)785-0820 Indiana 402 W. Washington St., Room W072 Indianapolis, IN 46204 (317)232-2980

Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7800 Dental_Board

Iowa 400 SW 8th St. Suite D Des Moines, IA 50309 (515)281-5157

Connecticut 410 Capitol Ave. Hartford, CT 06134 (860)509-8000 asp?a=3143&q=388884

Kansas 900 SW Jackson Room 564-S Topeka, KS 66612 (785)296-6400

Delaware Cannon Building, Suite 203 861 Solver Lake Blvd. Dover, DE 19904 (302)744-4500

Kentucky 312 Whittington Parkway, Suite 101 Louisville, KY 40222 (502)429-7280

Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 14

Georgia 237 Coliseum Drive Macon, GA 31217 (478)207-2440


Louisiana 365 Canal St., Suite 2680 New Orleans, LA 70130 (504)568-8574

Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 forms.html Maryland 55 Wade Ave. Catonsville, Maryland 21228 (410)402-8500 Massachusetts 1000 Washington St., Suite 710 Boston, MA 02118 (617)727-1944 dentist/about/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650,4601,7154-72600_72603_27529_27533---,00. html Minnesota 2829 University Ave., SE. Suite 450 Minneapolis, MN 55414 (612)617-2250 Mississippi 600 E. Amite St., Suite 100 Jackson, MS 39201 (601)944-9622 Missouri 3605 Missouri Blvd. P.O. Box 1367 Jefferson City, MO 65102 (573)751-0040 Montana P.O. Box 200113 Helena, MT 59620 (406)444-2511 boards/den_board/board_page.asp

Nebraska 301 Centennial Mall South Lincoln, NE 68509 (402)471-3121

Ohio Riffe Center 77 S. High St.,17th Floor Columbus, OH 43215 (614)466-2580

Nevada 6010 S. Rainbow Blvd. Suite A-1 Las Vegas, NV 89118 (702)486-7044

Oklahoma 201 N.E. 38th Terr., #2 Oklahoma City, OK 73105 (405)524-9037

New Hampshire 2 Industrial Park Dr. Concord, NH 03301 (603)271-4561

Oregon 1600 SW 4th Ave. Suite 770 Portland, OR 97201 (971)673-3200

New Jersey P.O Box 45005 Newark, NJ 07101 (973)504-6405

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)783-7162 Pages/default.aspx#.VbkfjPlPVYU

New Mexico Toney Anaya Building 2550 Cerrillos Rd. Santa Fe, NM 87505 (505)476-4680 New York 89 Washington Ave. Albany, NY 12234 (518)474-3817 North Carolina 507 Airport Blvd., Suite 105 Morrisville, NC 27560 (919)678-8223 North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600

Rhode Island Dept. of Health Three Capitol Hill, Room 104 Providence, RI 02908 (401)222-2828 South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4599 South Dakota P.O. Box 1079 105. S. Euclid Ave. Suite C Pierre, SC 57501 (605)224-1282 Tennessee 227 French Landing, Suite 300 Nashville, TN 37243 (615)532-3202

Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 and_commissions/dental_examiners Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 Wisconsin P.O. Box 8935 Madison, WI 53708 1(877)617-1565 aspx?Page=90c5523f-bab0-4a45-ab943d9f699d4eb5 Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529


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U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 asp?a=3143&q=388902 Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 16


Florida 2585 Merchants Row Blvd. Tallahassee, FL 32399 (850)245-4444 DesktopDefault.aspx?tabid=115

Louisiana LSBME P.O. Box 30250 New Orleans, LA 70190 (504)568-6820

Georgia 2 Peachtree Street NW, 36th Floor Atlanta, GA 30303 (404)656-3913

Maine 161 Capitol Street 137 State House Station Augusta, ME 04333 (207)287-3601

Hawaii DCCA-PVL P.O. Box 3469 Honolulu, HI 96801 (808)587-3295

Maryland 4201 Patterson Ave. Baltimore, MD 21215 (410)764-4777

Idaho Idaho Board of Medicine P.O. Box 83720 Boise, Idaho 83720 (208)327-7000

Massachusetts 200 Harvard Mill Sq., Suite 330 Wakefield, MA 01880 (781)876-8200

Illinois 320 West Washington St. Springfield, IL 62786 (217)785 -0820

Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918,4601,7-15472600_72603_27529_27541-58914--,00. html

Indiana 402 W. Washington St. #W072 Indianapolis, IN 46204 (317)233-0800 Iowa 400 SW 8th St., Suite C Des Moines, IA 50309 (515)281-6641 Kansas 800 SW Jackson, Lower Level, Suite A Topeka, KS 66612 (785)296-7413 Kentucky 310 Whittington Pkwy., Suite 1B Louisville, KY  40222 (502)429-7150

Minnesota University Park Plaza 2829 University Ave. SE, Suite 500  Minneapolis, MN 55414 (612)617-2130 Mississippi 1867 Crane Ridge Drive, Suite 200-B Jackson, MS 39216 (601)987-3079 Missouri Missouri Division of Professional Registration 3605 Missouri Blvd. P.O. Box 1335 Jefferson City, MO  65102 (573)751-0293

Montana 301 S. Park Ave. #430 Helena, MT 59601 (406)841-2300 boards/med_board/board_page.asp Nebraska Nebraska Department of Health and Human Services P.O. Box 95026 Lincoln, NE 68509 (402)471-3121 search.cgi Nevada Board of Medical Examiners P.O. Box 7238 Reno, NV 89510 (775)688-2559 New Hampshire New Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203 New Jersey P. O. Box 360 Trenton, NJ 08625 (609)292-7837 New Mexico 2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 (505)476-7220 New York Office of the Professions State Education Building, 2nd Floor Albany, NY 12234 (518)474-3817 North Carolina P.O. Box 20007 Raleigh, NC 27619 (919)326-1100

North Dakota 418 E. Broadway Ave., Suite 12 Bismarck, ND 58501 (701)328-6500

Texas P.O. Box 2018 Austin, TX 78768 (512)305-7010

Ohio 30 E. Broad St., 3rd Floor Columbus, OH 43215 (614)466-3934

Utah P.O. Box 146741 Salt Lake City, UT 84114 (801)530-6628

Oklahoma P.O. Box 18256 Oklahoma City, OK 73154 (405)962-1400 Oregon 1500 SW 1st Ave., Suite 620 Portland, OR 97201 (971)673-2700 Pennsylvania P.O. Box 2649 Harrisburg, PA 17105  (717)787-8503 Pages/default.aspx#.Vbkgf_lPVYU Rhode Island 3 Capitol Hill Providence, RI 02908 (401)222-5960 South Carolina P.O. Box 11289 Columbia, SC 29211 (803)896-4500 South Dakota 101 N. Main Ave. Suite 301 Sioux Falls, SD 57104 (605)367-7781 Tennessee 425 5th Ave. North Cordell Hull Bldg. 3rd Floor Nashville, TN 37243 (615)741-3111

Vermont P.O. Box 70 Burlington, VT 05402 (802)657-4220 Virginia Virginia Dept. of Health Professions Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4400 Washington Public Health Systems Development Washington State Department of Health 101 Israel Rd. SE, MS 47890 Tumwater, WA 98501 (360)236-4085 West Virginia 101 Dee Dr., Suite 103 Charleston, WV 25311 (304)558-2921 Wisconsin P.O. Box 8935 Madison, WI 53708 (877)617-1565 Board-Pages/Medical-Examining-BoardMain-Page/ Wyoming 320 W. 25th St., Suite 200 Cheyenne, WY 82002 (307)778-7053


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Managing Your Practice Management And Billing Software By Naren Arulrajah Ekwa Marketing

The world of healthcare is going digital, whether we are ready or not. Electronic health records (EHR) are quickly becoming the industry standard, driven by hefty financial incentives and the promise of greater efficiency. Four in five practices have made the leap to digital records, with many implementing adjunct billing and practice management software. Unfortunately, the transition has not been an easy one for many doctors and dentists. The right software, well-implemented, can have benefits including greater efficiency, decreased operating costs, and improved productivity. However, more than 40 percent of practices are experiencing the exact opposite, according to a report by AmericanEHR. Nearly three-quarters of those surveyed said that their systems make workload 18 | SEPTEMBER 2017

reduction difficult or very difficult. You can avoid or resolve most of these common problems by choosing the right software, and implementing it efficiently.

Choosing the Right EHR

The digital transition is not easy on your practice, or your budget. The cost for a large, multiclinician practice easily exceeds $150 thousand, and implementation can take more than a year. Understandably, many doctors and dentists try to reduce the time, expense, and labor involved. One of the most common mistakes is purchasing an inadequate system in an effort to lower costs. Unfortunately, that approach only leads to underperformance, frustration, and greater costs in

sub-par machines. Additionally, a slow computer will reduce staff efficiency. When purchasing or upgrading servers, workstations, and other hardware, invest in quality. • Budgeting for extras – No matter how carefully you plan, there will likely be several thousand dollars of unexpected expenses. Some of the most common include hardware upgrades, subscription services, technical support, and additional labor. Avoid glitches by preparing for these expenses.

Implementing Electronic Medical Billing

Capterra surveyed hundreds of physicians, nurses, administrators, and others who use EHR systems for their EHR industry report. Participants were asked what features they most wished their systems included. Among physicians, the least requested feature was medical billing and claims processing. While it may not be high on your priority list, automated billing probably has more potential to impact your practice’s revenue than any other feature. The implementation process is cumbersome, but once completed it can save time and reduce the cost of claim submissions by more than 50 percent. Follow these steps to ease the transition and make the most of your medical billing software:

• Technical support.

the long term. When looking for ways to trim your budget, don’t “cut corners” in these important areas: • Features – Analyze your workflow and talk to your staff. Think about how the software will be used, what might simplify the process, and what would save time. Choose a system that has the power to meet your practice’s needs. • Integration – EHR systems range from standalone applications to components in complete practice management suites. Even if you don’t plan to digitize every aspect of your office right away, give yourself the flexibility to do so. Look for an allin-one system, or a billing friendly EHR that is compatible with other essential programs. • Hardware – No matter how good your software is, it will not deliver maximum performance on

When something goes wrong with your billing system, you need it fixed ASAP. Few IT professionals have experience with these complex systems, so it can be challenging to find a highly skilled expert in a hurry. Find a reliable service, or hire an adequately qualified technician to maintain your software.

• Invest in training for all team members who will use the system.

Perhaps the most interesting takeaway from the above mentioned EHR industry report was that most respondents did not know all of the features their systems had. This included features on their “wish lists.” With good software, your team will have valuable, time-saving tools at their fingertips – but without training those tools may go unused.

• Establish consistent in-office procedures. A detailed and well documented billing policy will help prevent errors and inconsistencies. The

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process should include doublechecking and cross-referencing before submitting a claim, deadlines to follow up on rejected claims, and procedures for responding to non-paying patients.

• Provide documentation. Make sure employees have access to policy manuals, software user guides, “cheat sheets” of commonly used insurance codes, and other useful reference materials.

• Hire a service or budget plenty of employee hours for data entry. This is probably the most tedious and time-consuming aspect of implementing your system, but it is essential. Electronic billing allows your team and your patients to access account history easily. However, all of the old data must be entered in the system first.

Next steps

Implementing a new billing system is not a once- and-done activity. Despite your best efforts, there will most likely be some glitches. Monitor the rate of claim rejections, average payment time, billing-related client complaints, and number of overdue payments. If you notice any of these financial metrics declining, review the system to find out why. Also encourage feedback from your team. Once your EHR and electronic billing systems are in place and operating smoothly, it’s time to consider taking your technology



to the next level. Integrated patient portals, online appointment scheduling, electronic forms, and mobile apps are excellent additions for office efficiency and improved patient experience.

Orthopedic Practice serving Eastern NC, minutes from the Atlantic Ocean


Digitizing and automating your office may seem like a daunting undertaking, but you will be richly rewarded in revenue, office efficiency, and patient satisfaction. As an added bonus, your willingness to embrace technology will help cultivate a progressive, modern brand image.  About the Author: Naren Arulrajah is President and CEO of Ekwa Marketing, a complete internet marketing company that focuses on SEO, social media, marketing education, and the online reputations of dentists and physicians. With a team of 140+ full time marketers, helps doctors who know where they want to go, get there by dominating their market and growing their business significantly year after year. If you have questions about marketing your practice online, call 855-598-3320 to speak one-on-one with Naren.

Orthopedic practice for sale on the coast of North Carolina, established with a solid patient base. The demographics for this practice are excellent and the location impressive. This newly listed practice is fully furnished, staffed and ready for a fresh face to see orthopedic patients in this beautiful part of North Carolina. The ingredients for success have been established and the owning doctor is willing to stay with you for a reasonable time to assure a smooth transfer of care. This is the perfect practice to add on to your existing practice as a satellite or to make it your main orthopedic practice. Includes X-Ray, 3 exam rooms and could be easily converted into an urgent care. Average Orthopedic Patients per Day: 10 to 15


List Price: $135,000

Contact Philip or Danielle at 919-848-4202 or email


The Great Medical Billing Debate:

In-House or Outsourcing?

By Kaci Durbin, MD FACOG Second only to treating patients, medical billing is the most important aspect of your practice. Unfortunately, it is also the most complicated. Multiple payers, thousands of codes, claim denials, and changing health care laws pose a challenge to practice owners. Two main options exist for most physician offices: in-house billing or outsourcing with a medical billing company. Both have their merits, and each practice or group needs to decide which option is most cost-effective for them. In an in-house billing scenario, the office staff are responsible for all the billing and revenue 22


cycle management. The office staff is responsible for setting the charges, submitting claims for reimbursement, collecting copays and deductibles, and managing accounts. This is usually done with the assistance of a billing software. The alternative option is to outsource. When an office outsources the billing responsibilities, the physician owner uses a third-party billing service to manage all the billing and revenue cycle management. In-house billing might be best if you are a financially-savvy physician who wants to retain control or if you have simple

billing needs. Some physicians prefer this method in order to maintain complete control over their finances. Billers and coders are in the same building as the providers and easily accessible. A physician does not have to call an outside company to check on the status of a claim or address a patient’s billing issue. In-house billing is also more cost-effective for offices that have uncomplicated billing or coding needs. For instance, a medispa with patients that pay cash does not need a billing service. However, for many practices, in-house billing has significant pitfalls.

First, in-house billing can be expensive. Offices must pay for medical billers and coders and their salaries, benefits, and ongoing education and training. Ongoing education is necessary to keep up with the ever-changing healthcare laws. Startup costs are high with the purchase of computers and medical billing software. The office must also register with a clearinghouse to assist in processing claims. In addition to being expensive, in-house billing is time-consuming. Office staff are responsible for managing denials and appeals, collecting payments, and calculating expected revenues.

Finally, in-house billing can create unwanted liability if office staff do not perform as expected. Just as under-billing can lead to lost revenue, over-billing can lead to legal action. Outsourcing, on the other hand, is the best option for practice owners that prefer a hands-off approach as well as physicians that have more complicated billing and coding. It is usually cheaper, more reliable, and consistent. Outsourcing avoids the costs associated with in-house billing. Billers and their associated salaries and benefits are not needed. The physician pays

for the billing service, but does not need expensive billing software and maintenance. It is consistent as well. While an in-house biller may quit, become ill, or go on vacation, an outsourced billing company is always available. Experts will regularly send claims and are contractually required to follow up on all denials and unpaid claims. Liability is not an issue as the billing company will usually take on full responsibility for errors. Yet, while outsourcing has its benefits, it does have pitfalls. As mentioned, some aspect of control continued on page 24


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is lost when a physician gives up his or her billing to a third party. One also needs to watch for variable costs and hidden fees. Most billing companies charge a percentage of what the physician brings in (meaning, the busier the office is, the more they charge). These variable costs can be difficult to budget for given the changing amounts. Another potential concern is patient privacy. It is important for a practice to ensure that the billing company is HIPAA compliant and will keep patient information safe. The first step an office practice should do is perform a cost analysis of each option. Typically, for in-house billing, the average office will need 1-2 billers per 1-3 providers. As alluded to earlier, however, those offices will simple needs will likely require less. In addition, the office needs to estimate the cost of purchasing a revenue cycle management software system. Regarding outsourced billing, the fees of the medical billing company should be estimated; most companies charge 5-10% of revenue. Next, each physician owner needs to decide how much time and energy he or she wants to spend on revenue cycle management. Although the billers and coders will be doing most the work on this with in-house billing, the physician is responsible for overseeing these issues. As mentioned, outsourcing requires little to no outside energy. After analyses, the physician owner needs to research his or her options. As variation exists among software and billing 24


companies, physicians need to do their homework to ensure that the product or service can meet the office’s needs. The following are some recommended questions one should ask when evaluating billing software or a medical billing company. Questions When Evaluating Medical Billing Software 1. How much does it cost? a. Are there startup or cancellation fees? b. Maintenance fees? 2. What does the software include? What doesn’t it include? 3. How easy is it to use? Can I see a demonstration? 4. Do you provide ongoing support? a. What happens when we run into a problem? b. Are you available 24/7? 5. Do you offer cloud-based hosting or am I required to pay for and maintain my own local servers? 6. What specialties is this compatible with? 7. Is this compatible with my existing EMR? 8. Does the software include a patient portal? What does it include? a. Can patients fill out paperwork and insurance information online? b. Is the portal easy to use? 9. Can the software create performance reports and analyses? 10. What type of training do you provide? Questions to Ask a Potential Medical Billing Company 1. What is the cost? a. How are you paid? What

percentage of the office revenue do you receive? b. Does this include co-pays that office staff collect at the appointment? c. What additional fees are there? i. Start-up fees? ii. Cancellation fees? 2. What specific services are included? What is not included? a. Do you check claims for errors? b. Do you follow up with the insurance companies to ensure claims were accepted? c. Do you provide analysis and performance reports? Are those included or an extra fee? d. Do you provide coding? Do we need our own coders? e. Do you offer EMR as well? Do we need our own EMR? Is our EMR compatible? 3. Can you guarantee someone will always be available? Who manages my account when my representative is out of the office? 4. Do you have experience with my specialty? How many years? 5. What happens if an error is made? 6. Are you HIPAA compliant? How do you ensure patient information remains private? 7. How and in what capacity do you interact with patients? a. Can you send patients statements directly? b. Do you take patient phone calls? c. Do you offer a patient portal? 

Our large database of MDs, NPs, PAs, and DDSs means that we will be able to find the perfect provider for your practice’s unique needs.

At Physician Solutions, all assignments are important, all clients are valuable, and all candidates are treated with the respect they deserve. We listen carefully to your needs and look beyond the obvious to find innovative solutions. Find out why providers choose Physician Solutions. P.O. Box 98313, Raleigh, NC 27624 Scan this QR code with your smartphone to learn more.

phone: 919.845.0054 fax: 919.845.1947 e-mail:



Using and Improving Your Existing Billing System or Shifting to a New Billing Practice By Nidhi Vats Deputy Administrator Shri Ram Singh Hospital & Heart Institute, India



Using and Improving Your Existing Billing System How effective is your practice’s medical billing? The time has come to put a full stop to any negativity about the billing department! It’s a time for action. Making the most of the given team should be the goal of an administrator. Here is a possible plan of action to consider for increasing the efficiency and profitability of your practice’s medical billing. A successful model is divided into three main parts. 1. Process of a successful billing plan 2. Understands the myths 3. The key areas to address in the billing process Part 1: Process of a successful billing plan 1. Plan & strategize: Have you developed policies in regard to billing and insurance related matters? What is your plan of action for planned cases, surgeries, and unplanned admissions? Do you have pre–approval for planned admission? 2. Data Entry: It’s important to identify your data entry points and to make sure that the trained staff performs the data entry on the appropriate software. If everyone is allowed to perform data entry, then what is your system to crosscheck the correctness of data entry? 3. Expressive Communication: How does your team communicate with your end users? Do you have scheduled times to communicate new billing needs? How effective are your financial counseling sessions? Do you to do regular updates and do you communicate the changes to your patients? Two other parameters to consider are feedback analysis and co-ordination while completing the entire billing cycle. It’s believed that man has the solution to all his problems, provided he looks within himself. The same is true for organizations, too. If practice/ hospitals are to emerge victorious from this billing pit, then they have to strengthen, empower and encourage their team. Despite of all the new software and procurements in medical billing and record keeping, billing is human centric. All administrators will agree with this fact, there are several service delivery points in billing process and at each point it’s a human who makes an continued on page 28 MED MONTHLY MAGAZINE

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entry for the each and every service provided to the patient. Part 2: The common myths practiced in the healthcare billing set-ups We have explained about the process for successful billing. There are few myths in billing which are dangerous and must be addressed if we want to have a successful plan of action for our medical billing. 1. Billing is a discharge process: The fact is billing is an admission and pre-admission process which is only totaled at the time of discharge. The process of billing starts when the patient is at the admission department/receptionist. They should be addressed about insurance at this time and should be guided through the registration information. 2. It’s the patient’s responsibility: The patient is only responsible to pay the amount. It is the medical facility’s role to let the patient know the amount to be paid, as well as to provide information to the patient regarding the insurance approval needs and the amount of co-payment. 3. The patient is smart and well informed: People who have insurance are not always aware of a lot of things in their health policy. So it is the responsibility of the medical staff to ask and inform them about components like co-payments, excluded items cost, and out of pocket payments. It can be a routine job for the medical staff, but not so common to the patient. It is the responsibility of the staff to communicate and assist the patient so that they understand each and every query related to billing and payments. 4. Brochures, websites and written material should suffice: Nothing can beat one-to-one communication between the patient and the staff. Speaking with patients over telephone or face-to-face will achieve the best feedback and allow a better chance for hassle-free payment from the patient. The mantra is “Expressive communication”. 5. I’m just being professional: When you talk to the patient about the financial part of their visit, add that humane touch to it. Don’t just babble all the figures that you have scribbled, but explain in



simple terms what each amount is for. That’s your job! 6. Billing department is responsible for billing: This is a big myth which most medical staff believes. The billing staff only does the summation and segregation of the items under correct heading/sub-heading. Actual billing is done by the nurses or PAs. They are the people who add the components which are prescribed by the treating physician. So rather than blaming the billing staff for all errors, it’s better to understand that it’s the team effort which includes everyone to get an accurate final figure. Part 3: The key areas to address in the billing process 1. Strong communication: Know who to address about the billing information pattern, who is the primary person responsible, what the best method of communication (in person, telephone, or email). 2. Trained administrative staff: Administrative staff should have everything in writing and even the commonest information should be communicated to the patient. 3. Prepare well before communicating: It is equally important to understand the medical facts about the patient before moving into a conversation regarding billing matters. The staff needs to modify the talks and may have to alter the time of discussion, if the patient is not comfortable or not in a condition where such aspects should be discussed. 4. Team work for success: The administrative staff should be in touch with clinical departments, treating doctors, laboratory and radiology. This helps in understanding which patient requires new estimates and new insurance approvals. 5. Double-checking is important: A senior person should be appointed who can check the services given from the patient file to the amount billed, or not billed, for that service in the software for final accuracy. It becomes easier to handle most billing situations, if these steps are followed. Many times billing concerns can be avoided if administration handles the billing part smoothly.

Shifting to a New Billing Practice It’s not an easy decision shifting to a new billing practice. Billing metrics are complicated and transition can disrupt productivity and staff morale. But technology upgrades and output improvement are the necessities of a growing business. So, when you come to the big decision, it’s time to prepare for a smooth transition. By implementing some smart methods you can easily migrate to new improved billing practice without revealing to clients and vendors that you are upgrading to a new system. In your medical billing practice, there may be 100+ non-collectable accounts receivable (A/R) and the decision with what to do with them is the real problem area. You can go ahead and hire a company that can help you completely clean those A/R out of your billing system, but this might delete some information that is important for claims. The second option is to approach the new billing

company to take things a bit further. Some may be willing to do a deeper outsourcing job, but be prepared that some billing companies might not be able to assist you. Higher fees will incur as there will be involvement of several additional resources from their end. The information they need from your practice will also increase to complete the claims successfully. The third option is to courteously approach your most trusted and competent staff and request that they to assist during this new transition period. They know the business well and can prove to be a great asset. If they prove proficient in this new task, relief of their previous duties and promotion to this new position should be recognized, both in title and in salary. When you change your billing practices you will need access to the database containing a record of patients in 100+ account receivables, filling in all insurance forms properly. To execute this work you will need the help of old billing company which continued on page 30


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generally doesn’t happen when you are switching to a new company. In that case, the new billing company might extend some help or you can still rely on old billing company if the trust is still there. This way most of the non-collectables can be collected, making it very cost effective. The trained staff can now handle the customer queries and the rest of practice can operate smoothly without any disruption. Your practice could pay a reward or offer an incentive for collections done each month to the staff involved in improving this process. During the transition period, you can start planning the cash flow as the new system is being implemented by the billing company. You can also research an estimate of how many A/R were collected at your end. The team should be formed to ensure that gaps do not form in the new process and the documents are provided in a timely manner for claim submission. When switching to new billing practice there are some other factors that need to be considered. • Before making the decision you need to properly analyze the new system as to whether it is efficient

• • • •

enough to handle your entire requirements. You should also have satisfactory IT infrastructure to execute the work without any productive time lost. You should identify the difference between old system and a new system in terms of operation, learning and rectifying mistakes when they happen. Another important thing is to choose a date when you usually have a lighter work load so you will not disrupt customer and employees functions. Create SOP and other procedures to operate the new billing system in advance. Staff and management both should learn the new system well and know how to handle any troubleshooting needed. The new system should be tested and precautions should be made to keep the patient information safe.

Shifting to a new billing practice requires big decisions and preparations. Find comfort knowing the process will take some time but switching will bring efficiency and error-free billing to your practice, meaning a smoother and faster revenue flow. 

Discounts as big as a house. Or condo. Or apartment.

SHARE YOUR STORY WITH US One thing that is free and everyone has is a “PROBLEM” and what we are searching for is an “ANSWER”. The fact is the solutions are within us. But still, we never find an answer. We will tell you how you can find answers; write the problem and all your feelings of anger, hurt, frustration, incomplete love, corporate stress, weak moments, dark aspects, being bullied, and many more. As you write, you will think, speak to yourself and analyze the problem. Writing is the best way to express yourself. So we want you to write your story and share it with us. Nidhi Vats is working on a website wherein she wants people to come to one platform and share all their issues and problems, which are creating daily stress. Come forward, share your story and feel better. If you do not want to reveal your name, you can submit it anonymously. If you still have any doubts, write to the email below. You can submit your stories to



Lindsay Gianni, Agent 12333 Strickland Road Suite 106 Raleigh, NC 27613 Bus: 919-329-2913

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What’s your practice worth? When most doctors are asked what their practice is worth, the answer is usually, “I don’t know.” Doctors can tell you what their practices made or lost last year, but few actually know what it’s worth. In today’s world, expenses are rising and profits are being squeezed. A BizScore Performance Review will provide details regarding liquidity, profits & profit margins, sales, borrowing and assets. Our three signature sections include:  Performance review  Valuation  Projections

Scan this QR code with your smart phone to learn more.



Medical Billing:

Partnering for Success By Michelle Durner, CHBME Applied Medical Systems, Inc. If you have a private practice chances are high that you’ve at least considered outsourcing your revenue cycle management functions at some point in time. You’ve likely asked yourself questions like; Would it make my practice more profitable? Would it make life easier? Would it free up my time to do the things that I really want to do? Yes. Yes. Yes. In the end, the question becomes do you want to treat patients or deal with insurance companies? Is there really a choice to 32


be made? In the past 10 years the “administrative simplification” of HIPAA has made the medical billing process extremely difficult and more so for the majority of small medical practices. Yet even as cumbersome as medical coding and billing has become, we aren’t at the end of the tunnel yet. The average time and resources to process a claim throughout the full revenue cycle can be surprising.

that 2.0% of Medicare claim lines had an undisclosed claim edit applied which resulted in zero payment for the lines. Essentially physicians are now required to be technologically knowledgeable, meticulous, AND psychic. And this is ONLY Medicare. There are 7 other commercial carriers which make up the NHIRC that have their own payer-specific edits, estimated around 780,000 if you’re keeping count. A qualified third party billing company typically embodies the efficiency, productivity, technical and operating skills through technology and staff to master the “rules” that carriers utilize when adjudicating claims. Certified and expert staff, continuous education, compliance and active involvement in the billing industry will set apart a qualified third party billing company. If these aren’t reasons enough to outsource your billing, there are many others that a practice might consider worthy in deciding to work with a third party billing company to enhance their revenue cycle management:

Why? Increase Collections l Reduce Labor Costs l Reduce Overhead & Technology Costs l Complexity of Coding & Billing l Increased Patient Confusion & Financial Responsibility l Control Billing Costs l Compliance/HIPAA l Optimize Coding l Access Technology l Billing Expertise l Patient Satisfaction l

The 2013 American Health Association (AMA) National Health Insurer Report Card (NHIRC) reported that, for Medicare alone, 46.8% of claim lines were the source of a disclosed claim edit (or processing “rule”) applied due to CPT, NCCI, CMS Publication 100-04, ASA Relative Value Guide or payer-specific edits. Medicare’s payer-specific edits alone numbered 3,009,536. That’s a lot of edits to keep up with. Additionally, the 2013 NHIRC says

While this list might seem exhaustive, I promise you it is not, and each of these bullet points could be expanded. Ultimately, there are many personal and business reasons why a practice might choose to outsource and you have to determine what those reasons are for you.

Ask Questions If you do choose to investigate third party billing companies, there are more questions to consider than just “How much does it cost?” continued on page 34


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continued from page 33 l What

does the price include? ie. A/R Follow Up, Denials, Appeals, Postage, Coding Review, etc. l What certifications does the company/employees hold? l What trade associations are they active with? ie. HBMA, AAPC, EDPMA, etc. l Do they support your medical society or specialty association? ie. AAFP, AAP, ACEP, etc. l Is the company experienced in your specialty/ state? l Do they have a compliance plan? l Will you have a dedicated team? l Will they bill off of your practice management system or theirs? l Do they carry Errors & Omissions (E&O) Insurance? Cyber Insurance? l How do they keep their/your employees up to date on industry changes? l What’s their philosophy on patient balances and helping patients who call? Does that philosophy mesh with yours? l Do they have references? Sure, this article is about billing, but most billing companies also offer consulting, bookkeeping, payroll, coding and auditing, provider enrollment, training, human resource management, ICD10 implementation. How hard is it to find one or two employees that encompass that wealth of knowledge? And how much would it cost you to pay them a salary and benefits vs. using the services only as you needed them? I realize that everyone hates the dreaded sales pitch and I encourage you to speak with a representative, not necessarily the salesman, of the billing company. The manner in which that conversation flows, as well as resulting follow up and follow through, could be a major indicator of what you can expect if they are your chosen billing company.

Pricing In order to price appropriately, expect that a reputable third party billing company is going to have questions for you. There are some companies that charge a flat percentage of collections regardless of EMR, location, form of documentation, specialty, volume, financial



mix, historical charge and collection data, etc. There is no way to know the true cost of processing a claim without having some knowledge of these variables. Depending upon speciality and volume, some companies may require a feasibility study in the form of a chart audit. If a company is offering you a very low, flat fee without asking questions, some things could be at play. One option is that some practices are subsidizing the true claim processing cost of their peers. For example, the average collected amount on a Plastic Surgery claim is going to be much higher than that of a Family Practice claim, yet in a flat-fee scenario they are both paying 4%. Who is paying the brunt of the cost? Is there that much work involved with a Plastic Surgery case that it necessitates that they pay a substantially higher fee? The other option is that perhaps FULL revenue cycle management is not included as part of the price. ie. working denials, appeals, etc. or maybe there are other fees that are added on such as postage or clearinghouse fees. To further illustrate. please review the table below showing example collection amounts. Company 1

Company 2

Billing Fee



Monthly Collections



Billing Fee



Net Cash Flow



At first glance it might seem like the best choice is the lowest percentage. However, consider that you might not be comparing apples to apples. The difference between a full-service and a a bargain-bin billing company can be astonishing. Disparities in technology, employee knowledge, process efficiencies, etc. could lead to huge differences in the total amount collected. Choosing the cheaper option could result in lower collections and a resulting decreased net cash flow. Sometimes paying more for more is better than paying less for less! Regardless of the direction you decide to take, do your due diligence. Make it a point to ask the right questions and to take the time to analyze the answers that you receive. Hard work and patience in the

selection process can pay huge dividends in long run, both in the profit of your practice and the relationship with the billing company that you select.

Partnership It cannot be stressed enough that your relationship with a third party billing company should be PARTNERSHIP. A partnership that must be built on trust, transparency, ongoing communication and follow through. It isn’t a matter of simply handing over the reins. The revenue cycle starts inside of the practice, and unless you are outsourcing the front desk and/or coding processes, the practice bears the responsibility of: l Accurate

Demographics l Eligibility Checking l Collecting copays, coinsurance and deductibles at the time of service l Documenting appropriately l Coding according to documentation

To reference the 2013 NHIRC again, consider that 14.0% of Medicare’s allowed amount for a service is patient financially responsible. Aetna comes in at 22.0%. The chances of collecting that money increase exponentially when your front desk is proactive and effective in asking for and collecting patient due amounts. Both the practice and the billing company must be timely and thorough in all communication. As with any collaboration, you work in tandem to reach common goals. A practice cannot take a hands off approach once they decide to utilize a billing service, otherwise, the partnership is doomed to fail. In the end the decision to outsource your billing, or any part of your practice for that matter, can be difficult. You have put a lot of time and energy into your business and it is understandably hard to hand over responsibility to someone else. Ultimately it comes down to what it costs and what you can afford. Specifically, how much does it cost, in both time and money, to handle the administration side of your business? And how much can you afford to spend on the areas of your practice that don’t directly benefit your patients? Essentially, do you want your time to be consumed by words like manage, appeal, and adjudicate, or by words like practice, treat, and restore?  About the Author: Michelle Durner, CHBME is the President of Applied Medical Systems, Inc. – a Durham, NC-based company which provides revenue cycle management, coding, practice management, and consulting services to startup practices, hospitals, private practices, and hospital based physician groups across the nation. Michelle is serving as President of the Healthcare Business Management Association (HBMA) for 2017 and is also fulfilling a 3 year term on the Board of Directors. Michelle served as Chair of the Education Committee from 2014-2016 and has also served on the Finance, Certification and Nomination committees. To contact Michelle or to learn more about Applied Medical Systems, visit


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Practices for Sale Medical Practices Pediatric Practice Near Raleigh, NC

Location: Minutes South of Raleigh, North Carolina List Price: $145,000 Gross Yearly Income: $350,000 Year Established: 1980(s) Average Patients per Day: 16-22 Total Exam Rooms: 5 Building Owned/Leased: Owned. Will sell or lease. Contact: Philip at 919-848-4202

Urology Practice near Lake Norman, NC Location: Minutes from Charlotte, NC List Price: $165,000 Gross Yearly Income: $275,000 Year Established: 1980 Average Patients per Day: 12 to 15 Building Owned/Leased: Leased Contact: Philip at 919-848-4202

Primary Care specializing in Women’s Practice

Family Practice/Primary Care

Location: Hickory, North Carolina List Price: $425,000 Gross Yearly Income: $1,5000,000 Year Established: 2007 Average Patients Per Day: 24-35 Total Exam Rooms: 5 Building Owned/Leased: Lease or Purchase Contact: Philip at 919-848-4202

Location: Morehead City, N.C. List Price: Just reduced to $20,000 or Best Offer Gross Yearly Income: $540,000 average for past 3 years Year Established: 2005 Average Patients per Day: 12 to 22 Building Owned/Leased: MD owned and can be leased or purchased Contact: Philip at 919-848-4202

Med Spa

Family Primary Care Practice

Practice Type: Mental Health, Neuropsychological and Psychological

Location: Minutes East of Raleigh, North Carolina List Price: $15,000 or Best Offer Gross Yearly Income: $235,000 Average Patients per Day: 8 to 12 Total Exam Rooms: 6 Physician retiring, Beautiful practice Building Owned/Leased: Owned (For Sale or Lease) Contact: Philip at 919-848-4202

Location: Coastal North Carolina List Price: $550,000 Gross Yearly Income: $1,600,000.00 Year Established: 2005 Average Patients Per Day: 25 to 30 Total Exam Rooms: 4 Building Owned/Leased: Leased Contact: Philip at 919-848-4202

Location: Wilmington, NC List Price: $110,000 Gross Yearly Income: $144,000 Year Established: 2000 Average Patients Per Day: 8 Building Owned/Leased/Price: Owned Contact: Philip at 919-848-4202

Special Listings Offer We are offering our “For Sale By Owner” package at a special rate. With a 6 month agreement, you receive 3 months free.

Considering your practice options? Call us today. 36


PHYSICIANS NEEDED: Mental health facility in Eastern North Carolina seeks: PA/FT ongoing, start immediately Physician Assistant needed to work with physicians to provide primary care for resident patients. FT ongoing 8a-5p. Limited inpatient call is required. The position is responsible for performing history and physicals of patients on admission, annual physicals, dictate discharge summaries, sick call on unit assigned, suture minor lacerations, prescribe medications and order lab work. Works 8 hour shifts Monday through Friday with some extended work on rotating basis required. It is a 24 hour in-patient facility that serves adolescent, adult and geriatric patients. FT ongoing Medical Director, start immediately The Director of Medical Services is responsible for ensuring all patients receive quality medical care. The director supervises medical physicians and physician extenders. The Director of Medical Services also provides guidance to the following service areas: Dental Clinic, X-Ray Department, Laboratory Services, Infection Control, Speech/Language Services, Employee Health,

Pharmacy Department, Physical Therapy and Telemedicine. The Medical Director reports directly to the Clinical Director. The position will manage and participate in direct patient care as required; maintain and participate in an on-call schedule ensuring that a physician is always available to hospitalized patients; and maintain privileges of medical staff. Permanent Psychiatrist needed FT, start immediately An accredited State Psychiatric Hospital serving the eastern region of North Carolina, is recruiting for permanent full-time Psychiatrist. The 24 hour in-patient facility serves adolescent, adult and geriatric patients. The psychiatrist will serve as a team leader for multi-disciplinary team to ensure quality patient care/treatment. Responsibilities include:

evaluation of patient on admission and development of a comprehensive treatment plan, serve on medical staff committees, complete court papers, documentation of patient progress in medical record, education of patients/families, provision of educational groups for patients.

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624 PH: (919) 845-0054 | email:


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November - Your Practice Staff


December - Modern Medical Lobby MED MONTHLY MAGAZINE

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Modern Med Spa Available

Located in beautiful coastal North Carolina Modern, well-appointed med spa is available in the eastern part of the state. This Spa specializes in BOTOX, facial therapy and treatments, laser hair removal, eye lash extensions and body waxing as well as a menu of anti-aging options. This impressive practice is perfect as-is and can accommodate additional services like primary health or dermatology. The Gross revenue is over $1,500.000 with consistent high revenue numbers for the past several years. The average number of patients seen daily is between 26 and 32 with room for improvement. You will find this Med Spa to be in a highly visible location with upscale amenities. The building is leased and the lease can be assigned or restructured. Highly profitable and organized, this spa is POISED FOR SUCCESS. 919.848.4202

We have several qualified MDs seeking established Urgent Care Practices in North Carolina.

Urgent Care Practices Wanted If you have an urgent care practice and would like to explore your selling options, please contact us. Your call will be handled confidentially and we always put together win-win solutions for the seller and buyer.

Call Medical Practice Listings today and ask for Philip Driver 919-848-4202. 38


Pediatrics Practice Wanted Pediatrics Practice Wanted in NC Considering your options regarding your pediatric practice? We can help. Medical Practice Listings has a well qualified buyer for a pediatric practice anywhere in central North Carolina. Contact us today to discuss your options confidentially.

Medical Practice Listings Call 919-848-4202 or e-mail

Internal Medicine Practice for Sale Located in the heart of the medical community in Cary, North Carolina, this Internal Medicine practice is accepting most private and government insurance payments.


The average patients per day is 20-25+, and the gross yearly income is $555,000.

Established with a solid patient base, this well appointed practice also has a Psychologist in house. The psychiatrist is willing to stay and practice for a month or so assuring a nice patient transition. The city of Jacksonville is underserved by psychiatrist as most patients wait 4 to 5 months to secure an appointment. Treating over a dozen patients per day year round, you can step into this practice with the assurance knowing you will have a solid income and positioning for success. The established doctor is looking to retire but very willing to assure the buyer is comfortable moving forward. Asking $135,000 fully furnished.

Contact Philip or Danielle at 919-848-4202 or email

Listing Price: $430,000

Call 919-848-4202 or e-mail

PRIMARY CARE PRACTICE - Hickory, North Carolina This is an outstanding opportunity to acquire one of the most organized and profitable primary care practices in the area. Grossing a million and a half yearly, the principal physician enjoys ordinary practice income of over $300,000 annually. Hickory is located in the foot-hills of North Carolina and is surrounded by picturesque mountains, lakes, upscale shopping malls and the school systems are excellent. If you are looking for an established practice that runs like a well oiled machine, request more information. The free standing building that houses this practice is available to purchase or rent with an option. There are 4 exam rooms with a well appointed procedure room. The owning physician works 4 to 5 days per week and there is a full time physician assistant staffed as well. For the well qualified purchasing physician, the owner may consider some owner-financing. Call us today. List price: $425,000 | Year Established: 2007 | Gross Yearly Income: $1,500,000 | | 919-848-4202 MED MONTHLY MAGAZINE

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Primary Care Practice For Sale in Wilmington, NC Established primary care on the coast of North Carolina’s beautiful beaches. Fully staffed with MD’s and PA’s to treat both appointment and walk-in patients. Excellent exam room layout, equipment and visibility. Contact Medical Practice Listings for more information.

MD STAFFING AGENCY FOR SALE IN NORTH CAROLINA The perfect opportunity for anyone who wants to purchase an established business.

l One

of the oldest Locums companies client list l Dozens of MDs under contract l Executive office setting l Modern computers and equipment l Revenue over a million per year l Retiring owner l Large

Medical Practice Listings

919.848.4202 |

Please direct all correspondence to Only serious, qualified inquirers.


or family medicine doctor needed in

Urology Practice minutes from Lake Norman, North Carolina

Comfortable seeing children. Needed immediately.

Urology Practice minutes from Lake Norman is now listed for sale. This excellent located practice is convenient to Charlotte, Gastonia, Lincolnton and Hickory. With a solid patient base, procedures currently include; Adult & Pediatric Urology, Kidney Stones, Bladder Problems, Incontinence, Prostate Issues, Urinary Tract Infections, Wetting Problems, Erectile Dysfunction and related issues. Three exam rooms with two electronic tables and one flat exam table.


Established: 1980 l Gross Yearly Income: $275,000 Average Patients per Day: 12 to 15 l List Price: $165,000

Call 919- 845-0054 or email: 40 | SEPTEMBER 2017

Contact Philip or Danielle at 919-848-4202 or email

NC MedSpa For Sale MedSpa Located in North Carolina We have recently listed a MedSpa in NC This established practice has staff MDs, PAs and nurses to assist patients. Some of the procedures performed include: Botox, Dysport, Restylane, Perian, Juvederm, Radiesse, IPL Photoreju Venation, fractional laser resurfacing as well as customized facials. There are too many procedures to mention in this very upscale practice. The qualified buyer will be impressed with the $900,000 gross revenue. This is a new listing, and we are in the valuation process.

Urgent Care serving the South Raleigh and Garner, NC area Established practice averaging 25 to 30 patients per day, year round. Open 7 days a week with two providers and established staff members. 4 exam rooms, 1 procedure room and 1 lab-phlebotomy room. This is a very well laid out and attractive practice in a heavily traveled area with excellent parking. Gross revenues of about one million per year and positioned for continued growth. Priced at $200,000.

Contact Medical Practice Listings today to discuss the practice details.

For more information call Medical Practice Listings at 919-848-4202 or e-mail

Medical Practice Listings Call 919-848-4202 or e-mail

Located on NC’s Beautiful Coast,

Morehead City

Primary Care Specializing in Women’s Health Practice established in 2005, averaging over $540,000 the past 3 years. Free standing practice building for sale or lease. This practice has 5 well equipped exam rooms and is offered for $20,000. 919.848.4202 MED MONTHLY MAGAZINE

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Practice for Sale in Raleigh, NC


Urgent Care

Primary care practice specializing in women’s care Raleigh, North Carolina The owning physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however, that could double with a second provider.  Exceptional cash flow and profit will surprise even the most optimistic practice seeker.  This is a remarkable opportunity to purchase a well-established woman’s practice.  Spacious practice with several well-appointed exam rooms and beautifully decorated throughout.  New computers and medical management software add to this modern front desk environment.    List price: $435,000

Call Medical Practice Listings at (919) 848-4202 for details and to view our other listings visit

Serving Raleigh, Cary, Apex, Holly Springs, Fuquay Varina, Brier Creek and South Point Mall areas. This is certainly one of the most consistently utilized practices serving a large demographic area. 6 exam or procedure rooms, 1 X-Ray in a well appointed and nicely designed practice. Averaging 28 to 30 patients per day, year round and open 365 days per year. The staff includes two providers and full experienced staff to include X-Ray personal. The gross revenues of this practice exceeds one million two hundred thousand yearly. Priced at $260,000.

Call 919-848-4202 or e-mail

Eastern North Carolina Family Practice Available Well-appointed Eastern North Carolina Family Practice established in 2000 is for sale in Williamston, NC. This organized practice boasts a wide array of diagnostic equipment including a GE DEXA scanner with a new tube, GE case 8000 stress testing treadmill and controller and back up treadmill, Autoclave and full set of operating equipment, EKG-Ez EKG and much more. The average number of patients seen daily is between 12 to 22. The building is owned by MD and can be purchased or leased. The owning physician is relocating and will assist as needed during the transition period. The gross receipts for the past three years average $650,000 and the list price was just reduced to $185,000. If you are looking to purchase a well equipped primary care practice, please contact us today. 919-848-4202 42


PRIMARY CARE PRACTICE East of Raleigh, North Carolina


We are offering a well established primary care practice only minutes east of Raleigh North Carolina. The retiring physician maintains a 5 day work week and has a solid base of patients that can easily be expanded. There are 6 fully equipped exam rooms, a large private doctor’s office, spacious business office, and patient friendly check in and out while the patient waiting room is generous overlooking manicured flowered grounds. This family practice is open Monday through Friday and treats 8 to a dozen patients per day. Currently operating on paper charts, there is no EMR in place. The Gross revenue is about $235,000 yearly.


We are offering this practice for $50,000 which includes all the medical equipment and furniture. The building is free standing and can be leased or purchased. Contact Philip at 919-848-4202 to receive details and reasonable offers will be presented to the selling physician. | | 919-848-4202

Pediatric Practice Available Near Raleigh, NC

State of Cha-Ching. Pediatric practice located minutes south of Raleigh, North Carolina is now listed for sale. Located in an excellent area convenient to Raleigh, Cary, and Durham, it is surrounded by a strong health care community. This is a well established practice with a very solid patient base. The building is equipped with a private doctor’s office, five exam rooms, and an in-house lab.

Established: 1980s l Gross Yearly Income: $350,000 Average Patients per Day: 16 to 22 l List Price: $145,000

Call 919-848-4202 or e-mail

Lindsay Gianni, Agent 12333 Strickland Road Suite 106 Raleigh, NC 27613 Bus: 919-329-2913

Get discounts up to 35% * Saving money is important. That’s why you can count on me to get you all the discounts you deserve. GET TO A BETTER STATE . CALL ME TODAY. ™

*Discounts and their availability may vary by state and eligibility requirements. For more information, please see or call a State Farm agent. 1101216.1 State Farm, Home Office, Bloomington, IL


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Physician Solutions, Inc. Medical & Dental Staffing Physician Solutions is now hiring doctors, physician assistants and nurse practitioners in North Carolina, Florida, Georgia, Kentucky, South Carolina, Tennessee and Virginia. We can help match you with medical opportunities that fit your professional and personal goals. Ongoing and intermittent shifts are available, as well as permanent placement.

Physician Solutions, Inc. P.O. Box 98313 Raleigh, NC 27624 phone: 919-845-0054 fax: 919-845-1947

Scan this QR code with your smartphone to learn more.

Med Monthly September 2017  

The "New 'Medical Billing'" issue of Med Monthly magazine.