March, 2016

Dear SMB Client,

Happy Spring. We are excited to send you our first newsletter for 2016. In this newsletter, we will highlight how insurance companies incorrectly bundle routine foot care, a recent case study done on one of our clients, a new feature on our website and Traci Hain in our Employee Spotlight. We hope 2016 is a great year for you and your practice. Please let us know how SMB can make it even better! 

Cheryl Sands Executive Vice President
Insurance Companies - Incorrectly Bundling Routine Foot Care

We have had an issue with certain insurance companies - (the worst one being Humana) incorrectly bundling routine foot care. There does not seem to be any rhyme or reason behind how they are processing RFC claims. Sometimes they allow the 11055 and deny the 11721, and sometimes they do just the opposite. The denial code is always indicating that you cannot bill both of those codes on the same day. Most of these denials are Medicare Replacement Plans - and they are supposed to follow Medicare guidelines, but they are not.
We have called until we are blue in the face and we cannot get them to realize they are denying these claims in error. We are currently sending in medical notes and appealing every single denial. Sometimes they pay and sometimes they still deny.
When you talk to your insurance representatives who want you to sign your new contracts and such, our advice is to bring up the incorrect denials.  This has been going on for about two years now. We have called the highest ranks we can and we are unable to get them to fix their system error or whatever you want to call it. If you would like examples, we can fax them over to you.
Humana is not the only insurance company doing this. We have also seen Coventry/Advantra and United Healthcare doing this as well. They need to realize that both of these procedures are allowed on the same day and should be paid, just like Medicare allows if billed with the correct diagnosis codes. To bundle them is just ridiculous and erroneous, but somehow they continue to get away with it.
If you have any other pull or ideas within your respective spheres of influence with different podiatry organizations - we suggest you network and talk about this issue to see if you can join together and get something done on this.
We are very diligent in dealing with issues that we know are incorrect, but this one does not seem to be going away.  

Chad Bixler
Business Development
Case Study: Lower Receivables

"SMB really works the Accounts Receivables (Aging). This has dramatically increased my revenue. Thanks, SMB" - Current SMB Client
In this newsletter, I would like to highlight a case study conducted on one of our clients. The situation took place at a podiatry office with the Doctor and Office Manager. At the Practice, the critical issue was the large amounts of money tied up in accounts receivables of over 90 days was deemed unacceptable. The Practice's government and insurance payors as well as patients were not promptly paying the Practice. The reasons for this were many and varied. They included: the Practice had trouble routinely and consistently contacting the payors; the Practice was at a severe disadvantage when trying to aggressively negotiate with the payors on disputed EOBs; errors that creeped into the system were not discovered for 90 days or longer; etc.
Exacerbated, the Doctor and Office Manager concluded they needed a service that tracked the status of all reimbursements within their account receivables and took immediate action if the process for payment to the Practice stalled at any moment.
Fortunately for the Practice, SMB provides all of these capabilities. SMB achieves this low A/R rate by;
  • Expert podiatry medical billers who
    • Monitor your use of codes and modifiers
    • Process your claims
    • Provide you with expert answers to your questions
  • Severely limiting write-offs
  • Aggressively pursuing past due accounts
  • In-depth knowledge of every payors' reimbursement practices
SMB delivered positive results for the Practice. In fact, SMB has reduced the Practice's outstanding 90 day account receivables balance to less than 3% of the Practice's total reimbursements. If you would like to talk more about how SMB reduces your Accounts Receivables please contact me by email or phone at 1-888-874-5503. 

Please Rate Our Website
New feature on our website

Please take a moment to rate our website. Your feedback is important to us and it helps us improve our website. To rate the website, please click here and click on the "Please rate this website" link located at the right side of the website. Thank you in advance.

Traci Hain Billing and Collection Specialist
Employee Spotlight
Traci Hain

Me and my Family:
I graduated from UMKC and have worked as a medical biller for 10 years. I have two beautiful girls that keep me busy with their school activities, basketball, softball, and horseback riding lessons. Michael is a varsity basketball coach, so during the season we spend many hours in high school gyms.
Fun(ny) Facts:
  • I enjoy running and will run 3-4 marathons this year. 
  • I just bought my first kayak and look forward to many hours on the lake this summer.
  • I love dogs and have a 120lb Great Pyrenees.
My Goals to help your Practice:
My goal is to get your claims billed out and processed efficiently and timely to maximize revenue.   I believe it is important to communicate openly and pay attention to detail. I hope to take away your billing worries so you can focus on your patients.  

Thank you for taking time to read our newsletter. We hope you have a wonderful spring.